This post is from Rhydian Mann, NNA Associate and ViP Welsh Campaign Manager. Rhydian has been involved in a number of campaigns, and this guest post provides some excellent general (and some specific) advice for arranging, and participating in meetings with Stop Smoking Services and related spheres of influence.
After an extended period of emailing my local (Swansea) Stop Smoking Service and numerous tweets to Stop Smoking Wales, I got an email out of the blue from Christian Heathcote-Elliott. He is one of the main co-ordinators at Stop Smoking Wales. This email was in reply to what some vapers noticed something about a campaign with celebrities, I just happened to contact Stop Smoking Wales directly. I DIGRESS.
29 November 2017
NNA has submitted this consultation response to the Mayor of London Health Inequalties Strategy Consultation:
Submission to the Mayor of London’s Health Inequalities Strategy Consultation from the New Nicotine Alliance UK (NNA). NNA is a consumer led national charity which aims to improve public health and reduce the toll of disease from smoking by improving understanding of reduced risk products such as e-cigarettes.
We are pleased to note the ambition of the Mayor of London’s Health Inequalities Strategy. The intention to help Londoner’s make healthier choices including those from the most disadvantaged groups is one we particularly applaud. This is an area where we believe the Mayor can and should play an important leadership role in terms of reducing ill health and premature death by endorsing evidence based approaches to support smoking cessation. Increasingly, around the world, it is cities which are developing new and effective approaches to improving health and we believe that London should be at the forefront of this movement.
The scale of harm associated with smoking is highlighted within the draft Health Inequalities Strategy, with 8,000 premature deaths of Londoners per year and smoking being the leading cause of preventable death. This toll of mortality and related illness illustrates the benefits of reducing smoking rates in a pragmatic and effective manner. While the striking variation in smoking rates between different social economic groups is acknowledged within the consultation document, this general statement doesn’t reveal the full scale of this health inequity. It is well evidenced and acknowledged by Public Health England and the Cochrane Addiction Group that existing tobacco control policies and cessation support have had the least impact on the lowest social-economic groups (1). New approaches are sorely needed.
Within certain groups the rates of smoking, and consequentially the levels of associated harm are at very high levels. For example, amongst the homeless smoking rates of 85% are recorded. In many areas those working with rough sleepers’ report that 100% of their clients’ smoke. This group are not well served by existing services. Nor will their smoking behaviours be positively improved by higher taxes on cigarettes or crack-downs on illicit tobacco supply, after all they frequently are smoking butts left by others.
Those suffering from mental health problems are also likely to experience very much higher rates of smoking. In December 2016 ASH estimated that nearly a third of smokers in the UK had a mental health condition. Smoking rates within this group remain around 40% where as within the general population smoking rates have reduced from 27% to 19% over the last 20 years. The more severe the condition the higher the rate of smoking. People with mental health conditions are dying 10-20 years prematurely and tobacco related disease is one of the chief causes.
The above paints a dismal picture. Using the well-worn approaches of increasing price and restriction is not going to prove effective. There is, however, action which can be taken and has already been highlighted by Public Health England. There are alternatives to smoking tobacco which have been proven to meet the needs of those who are either unable or unwilling to give up nicotine. E cigarettes and other products provide a significantly safer alternative to smoking cigarettes. This has been acknowledged by Public Health England, who are now helping place the United Kingdom at the forefront of efforts to save lives from smoking. It is worth reminding ourselves of a simple truth, observed by Professor Michael Russell 40 years ago, that “People smoke for nicotine but they die from the tar”.
However, there remain many barriers to vaping and the use of safer alternatives to tobacco. These include ignorance, with the actions of many public bodies and individuals leading to many Londoners believing that vaping is not safer than smoking. This disinformation is likely to especially impact those with limited ability to do their own investigation into these products. There are also regulatory barriers where vaping and smoking are treated identically. This is contrary to PHE advice and essentially means that those who have progressed to safer alternatives are confined into environments where smoking is the norm.
There is also the issue of cost. The most addicted smokers usually come from the most economically disadvantaged populations (2) . Standard 12-week therapy using traditional nicotine replacement therapies on their own are often not effective for these smokers. A starter kit for vaping costs a minimum of £10, with no guarantee that the first machine or liquid is going to work for the individual. E-cigarettes are also easily broken or lost. For many this represents a significant financial outlay compared to the cost of illicit tobacco and the guarantee of getting the product desired. There are also issues about recharging the kit. This barrier has been overcome with some of the most disadvantaged groups in Leicester where local arrangements have supported street homeless smokers to successfully transition to vaping.
We hope that this submission highlights the role the Mayor of London and the Greater London Authority should play in helping reduce the harm smoking causes to Londoners. The potential gains in reducing health inequality, individual health and closing the mortality gap are enormous. There is a clear leadership role, for example in supporting the position of Public Health England and seeking to ensure smokers do understand there are safer alternatives. The Mayor is in a position to help remove unintended and ill-conceived barriers that hinder people in making healthier choices for example by drawing a clear and positive distinction between smokers and vapers. It is also about supporting innovative work with those who are homeless, living in poverty or who are experiencing mental health problems to access a significantly safer mechanism for using nicotine.
These are all areas where the Mayor has a major role to play. In significantly reducing the harm caused by smoking to our most vulnerable citizens the Mayor would help ensure we don’t continue to leave behind those whose health suffers most. Action to reduce smoking addresses the whole breadth of the ambitions set out in this strategy and will help Londoners make this the healthiest City in the world.
(1) Leaving No Smoker Behind, Dr Sharon Cox, Dr Allison Ford, Dr Deborah Robson, Professor Linda Bauld & Dr Lynne Dawkins LSBU, KCL, UKCTAS, University of Stirling 2017
(2) Cambridge Handbook of Psychology, Health and Medicine, edited by Susan Ayers, Andrew Baum, Chris McManus, Stanton Newman, Kenneth Wallston, John Weinman, Robert West, Cambridge University Press 2007, page 9
NNA submitted a response to New Zealand Ministry of Health consultation for "Policy Options for the Regulation of Electronic Cigarettes". You can view our consultation response here.
Following the roundtable meeting on e-cigarettes with the Dept of Health in March NNA are keen to continue the dialogue, and in particular raise our concerns with regards to the 'unintended consequences' of policy and regulation. To that end we collaborated with our associate Clive Bates of the Counterfactual Consultancy and sent the following submission to DoH on Friday 29th of April.
The New Nicotine Alliance (NNA) is a registered charity, formed in 2014, which seeks to foster a mature public and organisational understanding of the potential of safer nicotine products for reducing cigarette smoking, including their safety and efficacy, and hence contribute to the reduction in cigarette smoking. To achieve this we work to:
NNA seeks an effective regulatory environment for nicotine delivery devices, which protects the public, but also ensures availability of effective devices.
NNA is non-political and no activities are to the benefit of or in support to any political party. We are completely independent of commercial interests in relevant industries (e-cigarettes, tobacco, pharmaceutical companies, etc) operating on a not-for-profit basis, free from commercial bias. Our policies and public statements are evidence-based, with a clear focus on the health of consumers and the wider public.
A board comprised of volunteers manages NNA. In addition we involve individuals and organisations — consumers, tobacco researchers, policy analysts, public health professionals and scientists, as well as members of the public - who will support and further our aims and objectives.
NNA seeks to influence policy and the regulatory framework, as well as informing the public, concerning new nicotine products through:
NNA provides regular updates to supporters about our work and posts news items, blogs and other information on the website www.nnalliance.org
Download this statement as a PDF or come visit us at Vape Jam 2 2016, Stand P65!
Following an invitation from Nicola Hill, Stop Smoking Services Manager for the North East London NHS Foundation Trust, I attended their team meeting on the 19th of January to talk about e-cigarettes. In a refreshing change from my usual trog halfway across the country this one is local to me - it's good to see my local services finally taking an interest.
The meeting room was small, but packed with enthusiastic advisors from the two centres which provide services for NELFT. Discussions took place in a 'round table' setting, with me opening by telling the story of my journey from smoking to vaping, then explaining the different types of devices available and their use. There was then an opportunity for advisors to get 'hands on' with the demonstration devices I had brought with me before a lively Q & A ensued. I think we overran our allotted time by some considerable margin!
Some good questions were asked about a variety of topics, including the potential for harm to bystanders, youth uptake and long term use. On the whole the meeting was very positive, and I hope it was as enjoyable and useful for them as it was for me.
Everyone who attended the last Glasgow School of Vape agreed that it was a terrific event. There was something for everyone, from new vapers to experienced enthusiasts. Many of us have been badgering the organiser of the events to give us a repeat performance. Well that is about to happen and here are the details..........
After the E-Cigarette Summit and the Maudsley update of 2014 it was evident from the research presented that e-cigs were not only the chosen product that smokers were engaging with to help them become smokefree but we now had enough evidence to say that they were effective.
Following on from the successful launch of The Glasgow School of Vape earlier this year, Colin Robertson has come up trumps with a new venue at the Drury Bar and Kitchen just across the road from Glasgow Central Station, starting at 2pm on Sunday 30th August and running on to 10pm .......
The UK Nicotine & Smoking Cessation Conference is the world's largest event for the smoking cessation field, and the conference in 2015 again brought world-class speakers to present and discuss the very latest in clinical, research and policy developments. Held at the Manchester Hilton, NNA associates Andy McEwen and Andrew Preston were part of the organisation team for the event and ensured we had a presence.
The Global Forum on Nicotine returned to Warsaw for two days on the 5th and 6th of June. Would it be possible to match the success of last year? Most of our trustees attended, here Sarah Jakes gives her personal thoughts on the event.
On the 19th of March CRUK (Cancer Research UK), together with the BHF (British Heart Foundation), ESRC (Economic and Social Research Council) and MRC (Medical Research Council) held the first of two workshops on the subject of gaps in e-cigarette research. NNA trustees Sarah Jakes and Gerry Stimson attended. Read on for Sarah's account of the day.
Artwork for vaping welcome signs and stickers. Please download and print (they are free to adapt and share for non commercial purposes). Scroll down to see the various designs in green, blue and black. Help to get positive vaping images into image search results by posting them on your website. Thank you very much to Daniel Pidcock for designing these for NNA.
Show your support to NNA UK by placing a logo and a link to NNA UK on your website!
Version 1. "Proud Supporter" (200px x 200px, white background):
Or embed the following code to insert the image above and a link to NNA into your site:
Version 2. NNA Logo (400px x 200px, transparent background PNG):
From time to time, the New Nicotine Alliance (NNA https://nnalliance.org/) is asked by researchers to help them with their research. This help may include, for example: providing advice on research design and measurements; steering group membership; promoting recruitment to studies; facilitating access to products; advising on non-technical research summaries; and collaborating on publications. This kind of activity is broadly labelled as Patient and Public Involvement (PPI) in research.
According to INVOLVE (www.invo.org.uk), patient and public involvement (PPI) in research means research being carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them. It should happen at the earliest stage, and during as many stages as possible, of a research project.
INVOLVE was established in 1996 and is part of, and funded by, the National Institute for Health Research, to support active public involvement in NHS, public health and social care research. It is one of the few government funded programmes of its kind in the world. As a national advisory group, INVOLVE’s role is to bring together expertise, insight and experience in the field of public involvement in research, with the aim of advancing it as an essential part of the process by which research is identified, prioritised, designed, conducted and disseminated.
NNA has adopted a ‘nothing about us without us’ approach to supporting research activities that are concerned with improving public health through greater understanding of ‘new’ (lower risk) nicotine products and their uses.
For NNA, it is important to be visible and approachable to research groups to: (a) support funders’ and ethics committees’ requirements that researchers engage people affected by their research; and (b) to reduce the risk of ‘bad science’, by actively engaging with researchers to ensure that they have considered the expertise, experience and viewpoints of users of lower risk nicotine products.
NNA is keen to be involved in proper participatory research and will collaborate with researchers by offering advice and consultancy. NNA does, however, protect its Trustees and Associates from becoming over-stretched or exploited. Much of NNA’s advocacy work requires the commitment of personal time and resources and there is a need to prevent inadvertent excessive burden on members through additional responsibility for PPI activities.
As such, NNA has prepared a statement, in line with current principles of good practice on PPI outlined by INVOLVE (https://www.invo.org.uk/resource-centre/payment-and-recognition-for-public-involvement/), which covers both financial and non-financial expectations of research collaboration agreements, to: (a) support researchers, research managers, institutions and organisations proposing working with NNA in the preparation of their research proposals, protocols and research materials where PPI is concerned; and (b) protect individuals associated with NNA when they embark on PPI activities on behalf of NNA.
NNA statement, based on INVOLVE’s principles of good practice
PPI is often identified as core (and as such fundable) component of an application for research funding and compliance with recognised standards, such as those by INVOLVE, is usually expected through a project or programme of research. We urge researchers to follow the guidance on participation in research issued by INVOLVE. It is already endorsed or embraced by many relevant research funders, such as National Institute for Health Research (NIHR) (which established and funds INVOLVE) https://www.invo.org.uk/, Medical Research Council (MRC) Clinical Trials Unit https://www.ctu.mrc.ac.uk/our_research/patient_and_public_involvement/, Cancer Research UK (CRUK) https://www.cancerresearchuk.org/support-us/volunteer/patient-involvement-at-cancer-research-uk, and includes provision of the following for anyone engaged in PPI activities by a research group:
Ideally, arrangements should be made for advance payment. If this is not possible, research teams should be able to demonstrate that they have mechanisms and systems in place to guarantee timely reimbursement.
SUMMARY: On the basis of this statement, NNA is very willing to offer assistance and advice on research projects. Please contact us for further details or to discuss a project requirement.
NNA will review this statement periodically and in line with INVOLVE guidance.
Download a PDF of the statement of engagement with research groups here
Using e-cigarettes is much less risky than smoking cigarettes. They have helped and are helping many thousands of people stop smoking. Smokers need to know that e-cigarettes are a healthier alternative to cigarettes. However, many people may be confused by media reports on e-cigarettes. Here, NNA summarises the evidence and sets out its position on key issues.