Experts say WHO needs better understanding of the evidence on e-cigs to inform its international tobacco control treaty.

A new WHO report fails to properly evaluate the evidence on e-cigarettes and could even undermine international efforts to reduce smoking, says a group of UK based academics.

UK academics are calling for better understanding of the potential benefits of e-cigarettes to reducing the smoking pandemic ahead of an international gathering of countries that have signed the World Health Organisation’s Framework Convention for Tobacco Control.

The 7th session of the Conference of the Parties (COP) of the Framework Convention on Tobacco Control (FCTC), a global public health treaty, will be held in Delhi, India from 7th-12th November 2016. At this meeting, Parties to the treaty (countries and other jurisdictions) will discuss whether similar policy measures recommended to reduce tobacco use should be applied to e-cigarettes.

In advance of the COP the World Health Organisation published a report about Electronic Nicotine Delivery Systems (ENDS) and Electronic Non-Nicotine Delivery Systems (ENDDS), also known as e-cigarettes. This aimed to summarise the evidence about these devices.

Academics from the UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research Centre of Excellence, have today published a robust critique of the WHO report setting out a series of concerns about the content of the document which, in their view, screen-shot-2016-10-26-at-12-37-14does not fairly represent existing evidence on e-cigarettes. Their critique examines each element of the WHO report and identifies flaws in the way the evidence is presented and problems with how the report could be interpreted, potentially encouraging countries to adopt excessive restrictions on e-cigarettes which could undermine efforts to reduce smoking.

The UKCTAS critique points to evidence set out in the recent Royal College of Physician’s’ report ‘Nicotine without Smoke’ and subsequent research which recognise that e-cigarettes are far less harmful than smoking and that smokers who find it difficult to stop should be encouraged to use them.

The WHO report fails to accurately present what is already known about e-cigarettes. In particular, it: positions e-cigarettes as a threat rather than an opportunity to reduce smoking; fails to accurately quantify any risks of e-cigarettes compared with smoking; misrepresents existing evidence about any harms to bystanders; discounts the fact that e-cigarettes are helping smokers to quit; does not recognise the place of some promotion of e-cigarettes to encourage smokers to switch to these less harmful products; fails to understand that the flavours in e-cigarettes are useful for people trying to stop smoking; mischaracterises the current e-cigarette market screen-shot-2016-10-26-at-12-39-18and appears to support very restrictive policies on e-cigarettes without including any good policy analysis. In addition, the WHO report does not acknowledge that significant restrictions on e-cigarettes could lead to unintended consequences, including increases in smoking.

Finally, the researchers point out that the WHO briefing is based on four unpublished papers which are still undergoing peer review, which does not allow for open, transparent scrutiny of the evidence. This does not, therefore, provide a good basis for policy making and risks undermining rather than promoting the aims of the FCTC, which is a treaty that was designed to help countries reduce smoking rates and save lives.

To read the full report click here.

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Alcohol, Problems, Policy and Practice Course returns to King’s College London in February 2017

After a successful launch of the module in February 2016 we are delighted to announce the Alcohol, Problems, Policy and Practice module will return in 2017 to King’s College London. In 2017 we have confirmed a large number of top class speakers to discuss important areas of this public health issue. With topics ranging from alcohol and pregnancy, alcohol marketing and brief interventions, we can guarantee this course is invaluable to anyone working in this area.

 

MAIN AIMS OF THE MODULE:flyer2017amm

• Enhance students’ understanding of research methods by focusing on current research in alcohol policy and interventions.
• Enable critical appraisal of evidence in alcohol policy interventions.
• Explore the role and perspectives of key stakeholders including the alcohol industry and the role of media and marketing in alcohol use.

WHO IS ORGANISING THE COURSE?

This module is coordinated by the Addictions Department at King’s College London jointly with the UK Centre for Tobacco and Alcohol Studies (UKCTAS) and has been facilitated by Prof. Ann Mcneill, Dr. Niamh Fitzgerald and Dr. Sadie Boniface.

WHO IS PRESENTING?

Leading academics from King’s College London and across the 13 universities in the UKCTAS will present and discuss the latest evidence. Speakers will also include Dr. Matt Egan (LSHTM), Dr. Zarnie Khadjesari (KCL), Prof. Gerard Hastings (Stirling), Prof. Ann McNeill (KCL), Dr. Niamh Fitzgerald (Stirling), Dr. Ben Hawkins (LSHTM) and many others. Many of the inputs have broader public health relevance beyond alcohol, to other health issues such as tobacco, obesity and inequalities. An updated programme will be available later in 2016.

HOW WILL THE COURSE BE STRUCTURED?

The module will be delivered via blended learning with online materials available from January 2017, followed by a week of classroom sessions the week commencing 6th February 2017.

WHO CAN ATTEND?

In 2017 we will be opening the course to UKCTAS affiliated organisations and those working in public health, community safety or a related field. If you are unsure about its suitability for your needs or for information about fees, please contact Dr. Sadie Boniface (sadie.boniface@kcl.ac.uk)

PLACES ARE LIMITED!

Places will be allocated on a first come, first served basis.
Student numbers are capped at 40 to ensure an effective learning experience and teacher-student ratio.
Early bird discounts apply until 17th November 2016.
Applications will not be taken after 6th January 2017.

More information is available on our website!

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Minimum unit pricing and strength-based taxation have larger impacts on health inequalities than increasing current alcohol taxes.

Introducing minimum unit pricing or alcohol-content-taxation would reduce inequalities in health more than increasing alcohol duty under the current tax system or increasing VAT on alcohol, a new report has shown.

Research from the University of Sheffield’s Alcohol Research Group (SARG) compared four policy strategies for regulating alcohol prices to estimate how changes in alcohol price would affect individual levels of alcohol consumption and the subsequent impact on illness and deaths associated with 43 alcohol-attributable conditions in England.

The study, which is the first of its kind, showed that strategies which strongly link alcohol content with the price of drinks were more suited to tackling health inequalities compared to the current duty system where wine and cider are taxed by total beverage volume regardless of strength, and duty rates per unit of alcohol vary widely between different types of drink.

There are substantial mup-graphhealth inequalities in England, with people in the lowest socioeconomic group dying on average six years earlier than those in the highest. Reducing inequalities in health is a key priority across the globe and tackling alcohol-related harm plays a major role in reducing the gap.          

The research, published today (23 February 2016) in the leading medical journal Plos Medicine, revealed a tax based on alcohol strength and minimum unit pricing would both have large impacts on harmful drinking across all socioeconomic groups, whilst having minimal effects on those drinking in moderation.

The four pricing strategies were chosen at a level estimated to prevent exactly the same number of alcohol-related deaths in the population so that the researchers could compare effects in different groups of the population.

The strategies were:

1) A 13.4 per cent increase in duty for all products under the current UK system.

2) A four per cent tax based on product price.

3) A strength-based tax of 22p per UK alcohol unit.

4) Minimum price of 50p per unit, below which alcohol cannot be sold.

“Alcohol is now 54 per cent more affordable in the UK than it was in 1980 and harmful alcohol consumption is a major public health issue accounting for an estimated 2.7 million deaths globally.

Our findings suggest that minimum unit pricing and taxing alcohol by strength are a well-targeted interventions which would lead to greater reductions in health inequalities compared to the current UK duty system or taxes levied on sales price – a tax system prevalent in many developing countries.

Our results also suggest that a substantial 13.4 per cent increase in current duty would be required to achieve the same overall harm reductions as a 50p minimum unit price.

EU countries have limited options however, as EU law prohibits taxation by strength for wine and cider. The implementation of minimum unit pricing in Scotland is still held up in a court case brought against the Scottish Government by the alcohol industry, where the Government needs to demonstrate that minimum unit pricing would have important public health benefits that cannot be achieved as effectively through existing taxation powers.

Similar plans in Wales, Northern Ireland and the Republic of Ireland are resting on the outcome of this court case. Although set in England, our study makes a major contribution to the evidence in this respect.”

Professor Petra Meier

Director of SARG at the School of Health and Related Research (ScHARR)  

“Alcohol taxes are the most common intervention internationally, although minimum unit pricing has recently started to attract much international interest. Until now there was little evidence to support policy makers wishing to compare the health impacts of different taxation. 

Minimum unit pricing and strength-based taxation are better-targeted than the current UK tax system for reducing alcohol-related harm as they have larger effects on heavy drinkers and smaller effects on moderate drinkers.”

Dr John Holmes, Senior Research Fellow at SARG

“As Many as 18% of Current E-Cigarette Users May Have Quit Smoking Completely Using E-Cigarettes”

The key finding of the Harvard study was that in 2014, 20.7% of current electronic cigarette users were former smokers. The important question, of course, is whether these represent ex-smokers who re-initiated nicotine use with e-cigarettes or whether these represent smokers who quit smoking using e-cigarettes and thus are now identified as former smokers who use e-cigarettes.

Deborah Arnott, Chief Executive of ASH

Deborah Arnott, Chief Executive of ASH

These data are consistent with a recent report from the UK which notes that during the past year alone, half a million smokers in the UK switched to e-cigarettes, and that most of these are ex-smokers, suggesting that these are smokers who quit smoking via the use of e-cigarettes.

Officers calls for drink-driving limit to be reduced in line with Scotland!

“We’ve seen a steep decline in men drink-driving over the years, with targeted advertising campaigns, which is great, but women don’t seem to be getting the same message…

We would like to see a lower drink-drive limit, as most other European countries have, as well as Scotland, which saw a marked reduction in failed breathalyser tests as soon as the law was changed last year.”

Victoria Martin, a chief inspector working at the federation.

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Click here to read more from The Guardian.

‘Is nicotine all bad?’ By Kate Kelland

Psychologists and tobacco-addiction specialists, including some in world-leading laboratories in Britain, think it’s now time to distinguish clearly between nicotine and smoking. The evidence shows smoking is the killer, not nicotine, they say.

“We need to de-demonize nicotine,” said Ann McNeill, a professor of tobacco addiction and the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, who has spent her career researching ways to help people quit smoking.

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Smoking kills half of all those who do it – plus 600,000 people a year who don’t, via second-hand smoke – making it the world’s biggest preventable killer, with a predicted death toll of a billion by the end of the century, according to the World Health Organization.

Few doubt that nicotine is addictive. How quickly it hooks people is closely linked to the speed at which it is delivered to the brain, says McNeill. The patch is very slow; gum is slightly quicker. But there is no evidence as yet that significant numbers of people are addicted to either. Daniel, who works long hours in London’s financial district, says he chews less on weekends when he’s relaxing, doing sport and hanging out with his kids.

One reason smoking is so addictive is that it’s a highly efficient nicotine delivery system, McNeill says. “Smoking a tobacco cigarette is one of the best ways of getting nicotine to the brain – it’s faster even than intravenous injection.” Also, tobacco companies used various chemicals to make the nicotine in cigarettes even more potent.

Pure nicotine can be lethal in sufficient quantities. There is some evidence it may lead to changes in adolescent brain development, especially to the part responsible for intelligence, language and memory.

Stanton Glantz, a professor of tobacco at the University of California, San Francisco, says the younger kids are when they start using nicotine, the more heavily addicted they get. “This is likely because their brains are still developing,” he said.

Countering that, others say studies have focused on animals and that in any case, nicotine should not be available to under-18s. Michael Siegel, a tobacco control expert and professor at Boston University, says that in the few studies so far, such effects have been seen only in smokers, not smoke-free nicotine users.

Elsewhere, studies have looked at nicotine’s potential to prevent Alzheimer’s disease, and to delay the onset of Parkinson’s.

A study in the journal Brain and Cognition in 2000 found that “nicotinic stimulation may have promise for improving both cognitive and motor aspects of Parkinson’s disease.” Another, in Behavioral Brain Research, suggested “there is considerable potential for therapeutic applications in the near future.” Other work has looked at the stimulant’s potential for easing symptoms of attention deficit hyperactivity disorder (ADHD).

See the whole article here.

Expert reaction to two new papers – investigating frequency of e-cigarette use and smoking reduction or cessation, and investigating frequency and type of e-cigarette use and quitting smoking.

“These two new studies make valuable contributions to the growing literature on e-cigarettes. Most previous studies have been cross-sectional surveys using broad definitions of use, whereas these new studies are longitudinal in nature so are more able to follow up individuals. Commonly previous studies have asked whether e-cigarettes have ever or recently been used, and have made broad assumptions about their impact on quit attempts and success in stopping smoking on that basis. Most previous studies have also not differentiated between types of e-cigarettes, whereas the second of these studies does investigate that aspect.

“What this new research tells us is what e-cigarette users already know. The type of device, how often it is used, and how much nicotine it contains, all matter. Some devices will be effective to help smokers to quit and others less so. Future studies need to maintain this focus and not treat all e-cigarettes, or all users, the same.”

Prof. Linda Bauld, Deputy Director, Professor of Health Policy, University of Stirling.

View more opinions on the studies here:

http://www.sciencemediacentre.org/expert-reaction-to-two-new-papers-investigating-frequency-of-e-cigarette-use-and-smoking-reduction-or-cessation-and-investigating-frequency-and-type-of-e-cigarette-use-and-quitting-smoking/