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

 

The Cochrane Tobacco Addiction Group’s 20th anniversary priority setting project report.

Cochrane TAG anniversary Twitter banner
The Cochrane Tobacco Addiction Group (TAG) conducts and facilitates systematic reviews and meta-analyses of the research evidence for tobacco cessation and prevention interventions. The group was founded in 1996 and in 2016 they conducted a stakeholder engagement project to celebrate the 20th anniversary of TAG and to identify future research priorities for the group and the wider tobacco control community.
 
 

The objective of the project was to:

  • Raise awareness of Cochrane TAG and what has been achieved so far.
  • Identify areas where further research is needed in the areas of tobacco control and smoking cessation.
  • Identify specific goals for Cochrane TAG
  • To explore novel ways to disseminate the findings of tobacco research, and Cochrane TAG’s findings.

The survey and workshop resulted in 183 unanswered research questions in the areas of tobacco, quitting smoking and eight priority research areas, including:

  • ‘addressing inequalities’
  • ‘treatment delivery’
  • electronic cigarettes’
  • ‘initiating quit attempts’
  • ‘young people’
  • ‘mental health and substance abuse’
  • ‘population-level interventions’
  • ‘pregnancy’

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Stakeholders who attended the workshop also discussed ways that the public health community and Cochrane TAG could act to move the field of tobacco control forward.

Through this report, Cochrane TAG want to share the identified unanswered questions with the wider tobacco research community to help them to decide the most important research to focus on in the future, and to decide the most important things to work on for Cochrane TAG.

This will involve updating existing reviews, beginning reviews on new topics, and looking in more detail at Cochrane TAG’s research methods.

Contrary to popular belief there are still many important unanswered questions in the field of tobacco control. In addition, it has been noted that many of the results of tobacco control questions are not always reaching their intended targets. Tobacco control stakeholders provide a rich source of information on how these uncertainties should be prioritised; by using this resource the likelihood that the findings of research are useful and will be implemented is much greater. The project was carried out with the hope that researchers and research funders will be able to use the priorities identified to inform their future practice, in the same way that Cochrane TAG are using them to inform new review topics, updates of reviews and methods development.

Cochrane TAG’s findings and implementation suggestions should be considered alongside the existing evidence base and clinical expertise.

 
Here is the full report of the CTAG taps project!
 
You can open the report and the appendices by clicking on the covers below:
ctag_taps_final_reportctag_taps_final_report_appendices
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Discussing the future of tobacco addiction research with the Cochrane Tobacco Addiction Group:

The CTAG taps project ran from January-December 2016. Activities carried out from April 2016-December 2016 were funded by the NIHR School for Primary Care Research (SPCR)

New evidence finds standardised cigarette packaging may reduce the number of people who smoke as UK legislation bans the use of branding on all cigarette packets from May 2017.

A Cochrane Review published today finds standardised tobacco packaging may lead to a reduction in smoking prevalence and reduces the appeal of tobacco.

According to the World Health Organisation, tobacco use kills more people worldwide than any other preventable cause of death. Global health experts believe the best way to reduce tobacco use is by stopping people starting to use tobacco and encouraging and helping existing users to stop.

plain-packs-620-x-348-heroThe introduction of standardised (or ‘plain’) packaging was recommended by the World Health Organisation, Framework Convention on Tobacco Control (WHO FCTC) guidelines. This recommendation was based on evidence around tobacco promotion in general and studies which examined the impact of changes in packaging on knowledge, attitudes, beliefs and behaviour. Standardised tobacco packaging places restrictions on the appearance of tobacco packs so that there is a uniform colour (and in some cases shape) with no logos or branding apart from health warnings and other government-mandated information, and the brand name appears in a prescribed uniform font, colour and size.

From next month, UK legislation on standardised packaging for all tobacco packs comes into full effect.

Australia was the first country in the world to implement standardised packaging of tobacco products.  The laws, which took full effect there in December 2012, also required enlarged pictorial health warnings.

A team of Cochrane researchers from the UK and Canada have summarised results from studies that examine the impact of standardised packaging on tobacco attitudes and behaviour. They have today published their findings in the Cochrane Library.

Continue reading

A randomised controlled trial of a complex intervention to reduce children’s exposure to secondhand smoke in the home.

Exposing children to secondhand tobacco smoke (SHS) causes significant harm and occurs predominantly through smoking by caregivers in the family home. Researchers from UKCTAS at the University of Nottingham trialed a complex intervention designed to reduce secondhand smoke exposure of children whose primary caregiver feels unable or unwilling to quit smoking.

This was an open-label, parallel, randomised controlled trial carried out in deprived communities around Nottingham City and County.

The trial worked with caregivers who live in Nottingham City and County in England who were at least 18 years old, the main caregiver of a child aged under 5 years living in their household, and reported that they were smoking tobacco inside their home.

The research compared a complex intervention that combined personalised feedback on home air quality, behavioural support and nicotine replacement therapy for temporary abstinence with usual care.

The primary outcome was change in air quality in the home, measured as average 16–24 hours levels of particulate matter of <2.5 µm diameter (PM2.5), between baseline and 12 weeks. Secondary outcomes included changes in maximum PM2.5, proportion of time PM2.5 exceeded WHO recommended levels of maximum exposure of 25 µg/mg3, child salivary cotinine, caregivers’ cigarette consumption, nicotine dependence, determination to stop smoking, quit attempts and quitting altogether during the intervention.

Geometric mean PM2.5 decreased significantly more (by 35.2%; 95% CI 12.7% to 51.9%) in intervention than in usual care households, as did the proportion of time PM2.5 exceeded 25 µg/mg3, child salivary cotinine concentrations, caregivers’ cigarette consumption in the home, nicotine dependence, determination to quit and likelihood of having made a quit attempt.

The team concluded that by reducing exposure to SHS in the homes of children who live with smokers unable or unwilling to quit, this intervention offers huge potential to reduce children’s’ tobacco-related harm.

Read the full research report in the BMJ here.

This trial was funded by the UK National Institute for Health Research.

To find more information about this trial and the Smoke Free Homes project click here.

Clearing the air around e-cigarettes

Fears that “vaping” is a gateway to tobacco smoking are unfounded, shows a comprehensive review of available evidence on the harms and benefits of electronic or e-cigarettes and vapour devices, released today by University of Victoria’s Centre for Addictions Research of BC (CARBC) in a report called “Clearing the Air.”

Researchers surveyed the rapidly increasing academic literature on e-cigarettes and found evidence that vaping is replacing—rather than encouraging—the smoking of tobacco cigarettes among young people. The CARBC researchers identified 1,622 articles on the topic, of which 170 were relevant to their review. Evidence shows that tobacco use by youth has been declining while use of vapour devices has been increasing.

“Fears of a gateway effect are unjustified and overblown,” says principal investigator Marjorie MacDonald. “From a public health perspective, it’s positive to see youth moving towards a less harmful substitute to tobacco smoking.”

Among their other observations, CARBC researchers found strong evidence that the vapour from e-cigarettes is less toxic than tobacco cigarette smoke. Vapour devices do not release tar, and vapour emissions contain only eighteen of the 79 toxins found in cigarette smoke, including considerably lower levels of certain cancer causing agents and volatile organic compounds (VOCs). Almost all substances tested were substantially lower, or not detected, in vapour devices compared to cigarettes.

In addition, vapour from electronic devices is airborne for less than 30 seconds compared to 18 to 20 minutes for tobacco smoke, substantially reducing the time of second-hand exposure.

Researchers caution, however, that some vapour devices may contain potentially concerning levels of metals and particulate matter, noting that there has been insufficient research regarding some significant carcinogens that may still be present.

Finally, they found encouraging evidence that vapour devices could be at least as effective as other nicotine replacements as aids to help tobacco smokers quit.

“The public has been misled about the risks of e-cigarettes,” concludes Tim Stockwell, CARBC director and co-principal investigator. “Many people think they are as dangerous as smoking tobacco but the evidence shows this is completely false.”

A media kit containing author photos, full report (for media only, not for publication), and an infographic is available on Dropbox. An executive summary is available here.

Click here to read the original story on University of Victoria’s website.

Media contacts:
Tim Stockwell (Director, UVic’s Centre for Addictions Research) at 250-472-5445 or timstock@uvic.ca
Marjorie MacDonald (Scientist, UVic’s Centre for Addictions Research/Nursing) at 250-472-4399 or marjorie@uvic.ca
Suzanne Ahearne (University Communications + Marketing) at 250-721-6139 or sahearne@uvic.ca

MAJOR NEW REPORT  – UK HOSPITALS FAIL TO MEET NATIONAL STANDARDS IN EITHER HELPING PATIENTS QUIT SMOKING OR PROVIDING ‘SMOKE-FREE ENVIRONMENTS’

 

According to a major new report launched today (7/12/16) by the British Thoracic Society (BTS), NHS hospitals across UK are falling ‘woefully short’ of national standards on helping patients to quit smoking and enforcing smoke-free premises.

Experts f1-mediumpresenting the findings at the British Thoracic Society (BTS) Winter Meeting, will state that many NHS hospitals are missing out on a ‘golden opportunity’ to provide what is often the most effective front-line treatment for smoking patients who are sick  –  support and medication to help them quit tobacco.

The BTS Report ‘Smoking cessation: policy and practice in NHS hospitals’ is
unique in its scope and size; reviewing the smoking cessation & smoke-free policies and practices of 146 hospitals across UK between April and May 2016 – including the analysis of 14,750 patient records.

The main findings of the report are as follows:

  • Over 7 in 10 (72%) hospital patients who smoked were not asked if they’d like to stop
  • Only 1 in 13 (7.7%) hospital patients who smoked were referred for hospital-based or community treatment for their tobacco addiction
  • Over 1 in 4 (27%) hospital patients were not even asked if they smoke
  • Only 1 in 10 hospitals completely enforce their fully smoke-free premises. Rates of enforcement were even lower for hospitals which provided areas where smoking was allowed. The report highlights the importance of a smoke-free NHS – to trigger and support quit smoking attempts for patients and reduce second hand smoke exposure for children, staff and the public
  • Provision of nicotine replacement therapies and other smoking cessation treatments were ‘poor’ in hospital pharmacy formularies
  • Only 26% of hospitals had an identified consultant ‘lead’ overseeing their smoke-free and smoking cessation plans
  • 50% of frontline healthcare staff in hospitals were not offered training in smoking cessation

In the study, 25% of hospital patients were recorded as being ‘current smokers’ – which is higher than rates in the general adult population (19%)   Other studies have shown that approximately 1.1 million smokers are admitted to NHS hospitals a year.

The Society is using the report findings to call for all hospitals to deliver NICE Guidelines in this area (PH48) and that national regulators such as the Care Quality Commission (CQC) hold Hospital Boards accountable for the delivery of smoke-free and smoking cessation hospital policies.

The report also highlights a number of key activities that all NHS hospitals should deliver to help more of their patients quit smoking:

  1. Offer a prescription for Nicotine Replacement Therapy to all patients who smoke to help them cope with their tobacco dependence whilst in hospital
  1. Refer all patients who smoke in hospital to specialised stop smoking support services to explore the option of quitting smoking. Patients can opt out if they like – but the NHS should try to offer the most effective treatment and support whatever the illness – and with many smoking-related conditions such as chronic obstructive pulmonary disease (COPD), support and medication to help people quit smoking are the best front line treatments
  1. Employ an appropriately skilled senior clinician within the hospital to oversee, drive forward, and be accountable for the hospital’s smoking cessation service
  1. Employ smoking cessation practitioners in every hospital – this was recommended by NICE in 2013 but the report shows patchy delivery across the country
  1. Hospital Board involvement in delivering plans is key. Delivering smoke-free hospital grounds – as part of a wider smoking cessation policy – requires Hospital Boards to work together including the chief executive, director of human resources, director of facilities and the medical and nursing directors – in partnership with the ‘smoking cessation lead’ at the hospital

The Society is also encouraging more health professionals to become BTS ‘Stop Smoking Champions’ in their hospital. There are over 160 at present and they deliver a range of vital activities to champion stop smoking service provision.

For further information, contact stopsmokingchampions@brit-thoracic.org.uk or to see a video about the initiative go to: https://www.brit-thoracic.org.uk/standards-of-care/quality-improvement/smoking-cessation/bts-stop-smoking-champions/

Dr Sanjay Agrawal, Consultant Lung Specialist & Chair of the British Thoracic Society’s Tobacco Group, who led the audit said:

“Our report shows that many NHS hospitals are woefully failing to meet national guidance on delivering smoking cessation services and smoke-free premises. This is a dangerous situation that is costing the country dear in both health and economic terms. We must do better. Critically, hospitals are missing out on a golden opportunity to help supply often THE most effective treatment for illnesses that smokers are admitted with – support and treatment for their tobacco dependence.  If patients in other disease areas were not offered, by default, the most effective way to treat their condition – there would probably be an uproar. Nevertheless, this happens all too frequently with people with smoking-related illnesses. Many hospital boards need to sort out their leadership, plans and resources on this issue – so they can deliver some simple but life-changing steps: identify patients who smoke, ask them if they’d like to quit – and give effective treatment and support to help them stop.”

Dr Lisa Davies, Consultant Respiratory Physician at Aintree University Hospital and Chair of the British Thoracic Society Board, said:

“Being admitted to hospital should be a real window of opportunity for smokers to quit – given that smoking should be prohibited on the premises, tobacco use may be linked to their health condition, and expert stop smoking advice and therapies are potentially ‘on tap.’ This report shows, however, that we need to fund, plan and deliver smoking cessation work in hospitals far better – so we can fully deliver on this opportunity for our patients.

At a wider level, there is a real fight going on for the future of stop smoking support services in this country.  Many local authorities, facing overall budget reductions, have cut funding for community-based stop smoking services – meaning that people who need support may have nowhere to go.

The NHS must urgently work together, alongside local authorities, to plan and fund these vital services – to ensure no-one who needs treatment and support to stop smoking falls through the net.”

British Thoracic Society – UK hospitals fail to meet national standards in helping patients to quit smoking

British Thoracic Society, Smoking Cessation Audit Report:

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External news sources:

AOL – Hospitals ‘woefully failing’ to crack down on smoking

The Guardian – A third of children hospitalised with asthma ‘exposed to cigarette smoke’

Birmingham Mail – Number of patients forced to wait for hospital bed ‘rockets in five years’

NHE – All STPs urged to help patients quit smoking

The BMJ – NHS hospitals must help patients quit smoking, says British Thoracic Society