UKCTAS comment on the latest tobacco control plan for England: “Towards a smoke-free generation”

The new tobacco control plan, ‘Towards a smoke free generation’ is a welcome restatement of the government’s commitment to reduce the prevalence, and hence the burden of death and disability caused, by smoking. The recognition that harm reduction strategies can play a key role in achieving these ambitions is applauded, and puts the UK at the forefront of global tobacco policy. However, the ambition to reduce adult smoking in England from 15.5% to 12% by 2022, representing as it does a reduction of 0.5 of a percentage point per year, is modest given that smoking prevalence has fallen by 2.9 percentage points in the last three years.

Recognising reducing smoking in pregnancy as a priority, and aiming to reduce prevalence in pregnancy to 6% or less, is welcome but will not be achieved without adequate resources, improved care pathways and addressing significant gaps in training for midwives and obstetricians. The commitment to make NHS inpatient mental health settings smoke-free by 2018 is long overdue, but it is disappointing that the same strong commitment is not extended to other NHS settings.

The ambition to make stop-smoking services more available is also welcome, but like the commitments to NHS settings and for pregnancy requires funding: when public health budgets are being slashed, how will local authorities afford to increase their smoking service provision?

What matters now is delivery: Action to achieve and exceed these ambitions is the next and crucial step

PDF of the Press Release

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Prof Linda Bauld on E-cigarette use during pregnancy at GFN 2017

Global Forum on Nicotine 2017 – ‘Reducing Harm, Saving Lives’

E-cigarette use during pregnancy – What do we know?

At the June Global Forum on Nicotine event Professor Linda Bauld from the University of Stirling and Deputy Director of the UK Centre for Tobacco and Alcohol Studies, presented an update on e-cigarette use during pregnancy. In the presentation Linda highlights the latest research, a brief overview of smoking in pregnancy and why pregnant women who are still smoking should be encouraged to switch to e-cigarettes.

External link for video: E-cigarette use during pregnancy – Professor Linda Bauld

Other links:

Smokefree action’s info-graphic on e-cigarettes in pregnancy

To see other presentations from the conference click here.

Latest press release from UKCTAS:

Vaping may help explain the record fall in UK smoking rates

 

Vaping may help explain the record fall in UK smoking rates – Press Release with comments from UKCTAS Directors

UK smoking rates showed a record annual fall between 2015 and 2016 of 1.5 percentage points, based on new statistics released today [Link]. The prevalence of smoking among people aged 18 and above in 2016 was 15.8%, the lowest on record. This dramatic reduction is also the second largest annual fall in the last 40 years.

The UK is an international leader in smoking prevention policy, having introduced high tobacco taxes, a comprehensive advertising ban, prohibited smoking in public places, taken tobacco products out of sight in shops, establishing specialist stop-smoking services and a range of other measures. These policies have caused a sustained downward trend in adult smoking prevalence over the past two decades. Over the past five years, however, the rate of decline has increased substantially, falling by 4.4 percentage points, from 20.2%, since 2011.

Today’s new figures indicate UK smoking is falling faster than would be expected from conventional tobacco control approaches. While all the policies put in place will have made a difference, the most likely explanation for the recent rapid decline is the increasing use by smokers of electronic cigarettes as a substitute for tobacco. Data released by ASH last month estimated that there are now 1.5m people in the UK who used to smoke but now instead use electronic cigarettes.

Professor John Britton said:
“Electronic cigarettes were patented in 2004 but we began to see their use in the UK from around 2010. Since then the proportion of smokers using them has risen steadily. They have rapidly become the most popular aid to stopping smoking, and are now used in more than one third of quit attempts. At first we were unsure what their impact on smoking rates would be, but today’s figures suggest that alongside established tobacco control policies, they may have significantly accelerated the downward trend in smoking”

“Overall these findings vindicate UK policy on vaping: and that doing more to encourage more smokers to make the switch could generate huge benefits in public health: especially among those groups in society where smoking remains common.”

Professor Ann McNeill said:
“Since the millennium the UK has implemented a comprehensive tobacco control strategy to encourage and support smokers to stop and to deter young people from taking up smoking. This strategy included encouraging smokers to switch from deadly cigarettes to less harmful forms of nicotine including electronic cigarettes. It is really important that the new government continues this comprehensive approach and publishes its new Tobacco Control Plan as soon as possible, particularly given the need to tackle inequalities in smoking rates across society. In times of austerity, tobacco control is a good investment, as it benefits not just smokers and their families, but services like the NHS which bear the enormous costs of treating smoking-related illnesses”

Professor Linda Bauld added:
“The UK has taken a liberal approach to vaping, supporting the use of these consumer products for smokers who choose to use them. This has been controversial, and other countries have taken a much more restrictive approach. These new prevalence figures for adults, alongside steady declines in youth smoking uptake, suggest that electronic cigarettes may turn out to be a game changer for tobacco control. However, we know that many smokers are still wary of these products and think they are as harmful as tobacco. That needs to change if the positive trend we see from today’s figures is to be maintained.”

• Adult smoking habits in the UK: 2016 – Released 15 June 2017 External Link

• Smoking statistics in England – 15 June 2017 – Latest smoking compendium report signposting to all the up-to-date smoking data. External Link

 

Download the PDF version of this Press Release

 

University of Oxford PhD Studentship ~ Developing and testing peer-led interventions to promote switching from smoking to vaping.

Developing and testing peer-led interventions to promote switching from smoking to vaping.

PhD Studentship ~ Closing date: 26th May 2017

Applications are invited from individuals with a strong academic record who wish to develop a career in behavioural or primary care research. The student will join the thriving Health Behaviours team in the Nuffield Department of Primary Care Health Sciences who are working on range of interventions to support harm reduction and smoking cessation.

The project: The rise in popularity of electronic cigarettes (‘e-cigarettes’) in recent years has been accompanied by a growth in the number of virtual ‘vaper’ communities, with people sharing their advice and experiences of e-cigarettes with peers on internet support groups and discussion forums, many of which address ways of reducing or stopping smoking. The rise of peer to peer support is unique to e-cigarettes; no other means of stopping or reducing smoking attracts such passionate engagement from members of the public. This raises the possibility that we could better harness this peer support to enable more people to reduce or stop smoking using e-cigarettes and this project examines this. Continue reading

How safe is vaping? Media coverage, dilemmas and solutions in work and social spaces

As part of on-going work in relation to tobacco harm reduction, Knowledge-Action-Change is organising a series of dialogues, to examine the often contentious issues that attach to the use of electronic cigarettes, or vaping, in workplaces, places of entertainment and public spaces.

The series entitled ‘How safe is vaping? Media coverage, dilemmas and solutions in work and social spaces’ will take place:
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Why these dialogues now?

There is still a lot of debate between scientists and policy makers about the nature, use and safety of nicotine containing products. The media has produced a lot of stories about e-cigarettes, not all of them either accurate, or supported by scientific evidence. Nonetheless these stories have an impact and can influence peoples’ thinking and reactions on issues. This dialogue is a place where everyone can bring their concerns, air them and hopefully become better informed about the products and their use.

Most vapers are former smokers who have switched to this safer way to use nicotine. Professionals working in public health largely accept that this is a much safer form of behaviour – for users and those around them – but there remain concerns about the impact of their use in some circumstances and in this dialogue we aim to identify some of these and try to address them.

What are the dialogues?

These short events are designed to enable interactive discussion and debate – involving public health professionals, academics and scientists, policy makers, consumers, owners and managers of premises and members of the public – on a range of issues surrounding the increasing use of safer nicotine products (including e-cigarettes) as an alternative to smoking.

During each dialogue a panel of speakers, representing different interests, each make short presentations, addressing different issues relating to e-cigarette use. Q&A and discussion involving the audience follow the presentations.

The dialogues are filmed with the proceedings posted on the web, with the aim of providing information to those who might be interested in the subject and to assist those charged with making policy in having a cross-section of views to draw upon.

Previous dialogues: Knowledge-Action-Change has produced a number of dialogues to date and some of these can be viewed here.

UKCTAS experts reaction to e-cigarettes and cardiovascular risk

Researchers publishing in JAMA cardiology compared heart rate variability and markers of oxidative stress between e-cigarette users and non-users.

Prof. Paul Aveyard, Professor of Behavioural Medicine at the University of Oxford, said:

“In this study, the authors compared 16 e-cigarette users with 18 non-users and compared the two groups for heart rate variability and markers of oxidative stress.  Heart rate variability is normal and healthy, but activation of the adrenaline system in our bodies can decrease this and this may be linked with heart disease.  On two of the four measures of heart rate variability, there were no differences between the e-cigarette users and the non-users and on two measures, the groups differed.

“Oxidative stress is probably one of the main ways that cigarettes cause heart disease.  It is an important part of why cigarettes block our arteries.  In four of five measures of oxidative stress, there was no evidence of difference between e-cigarette users and non-users, while e-cigarette users had higher oxidative stress on one measure.  However, the heavier the user, the greater level of oxidative stress seen.

“The question is why these differences are occurring.  One explanation is that this is a small study.  Whenever you test several measures, as they did in this study, the greater the chance you find differences that are not real, they are simply down to chance.  It’s possible to correct for this kind of problem, but the authors did not do this.  Another possible explanation is down to psychological factors.  Most people who were using e-cigarettes had smoked in the past, while the large majority of the non-users of e-cigarettes had never smoked.  People with some psychological disorders or who are stressed show reduced heart rate variability.  On average, people who smoke or who have smoked have a higher rate of stress or psychological disorders than people who have not, so this could explain the findings on heart rate variability but not the single finding in oxidative stress.  Overall, then, this is a small study with several possible explanations for the findings, only one of which could be that using e-cigarettes is a possible risk for heart disease.

“It is important to put these results in context.  In this study, most people who were using e-cigarettes had smoked in the past.  Nearly everyone using e-cigarettes in Britain either smokes currently or has smoked, and people who are continuing to use e-cigarettes say that they do so to prevent them going back to smoking.  We know without any doubt that smoking is a major cause of heart disease and we still don’t know whether e-cigarettes pose a small risk or no risk, but we do know they are much less risky than smoking.  If a person cannot stop smoking in other ways, public health advice is to switch to e-cigarettes either partially or wholly.  This small study does not change that advice.  Compared with smoking, e-cigarettes are a better option.”

Prof. Linda Bauld, Professor of Health Policy at the University of Stirling, said:

“It is important to assess the cardiovascular effects of e-cigarette use as we know that tobacco smoking is the main preventable cause of heart disease, and e-cigarettes provide an alternative to tobacco. This study looks at the short term effects of vaping on markers of increased risk of cardiovascular disease (CVD) amongst people not currently smoking. It concludes that vaping might be associated with increased risk. However, these findings cannot conclude that heart disease will develop as a result of vaping without smoking. In order to develop our understanding of whether vaping causes any potential pathophysiological effects, further mechanistic research is required.

“A number of questions arise from looking at the study. First, the measures used are mainly applied to people who have already had a cardiac event rather than healthy young volunteers, which may pose challenges for interpretation. Secondly, sensitivity or specificity for nicotine effects is not adequately discussed in the paper. Nicotine is known to stimulate the sympathetic system, but nicotine replacement therapy is considered safe and is approved even for long term use by smokers (including those with cardio-vascular disease) and this is not made clear.  Finally, there is no direct comparison in the study between the risks of tobacco smoking to cardiovascular health and to vaping. This is particularly relevant because, for example, the response of vapers to controlled breathing was found to be normal in this study, unlike the response observed in smokers in other studies. These comparisons are important when communicating any risks or benefits of e-cigarette use.

“However, the questions posed in this study do merit research with longer term follow up particularly for CVD researchers who specialise in arrhythmias – irregular heartbeat. In the meantime, this study should not be used to suggest that vaping is as dangerous as smoking, for CVD or any other conditions. This study does not provide this evidence, and does not prove that vaping causes heart disease.”

* ‘Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users’ by Roya Moheimani et al published in JAMA Cardiology on Wednesday 1 February.

Declared interests

Prof. Linda Bauld: None to declare

Prof. Paul Aveyard: “Paul Aveyard has no personal financial connections to e-cigarette or pharmaceutical companies but in one study on smoking cessation, Glaxo Smith Kline is supporting the study by donating nicotine patches to the NHS.”

 

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