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Created: 18 February 2020

For immediate release

• • The Indian government has passed a law banning e-cigarettes, but it excludes personal consumption
  • The Indian Civil Aviation Ministry has misunderstood the law and is seizing and destroying the property of unsuspecting UK visitors
  • Thousands of UK citizens potentially affected; the NNA has asked the Foreign and Commonwealth Office to update travel advice

LONDON, February 18th, 2020: UK visitors to India who use e-cigarettes to improve their health on the advice of British health organisations are having their devices confiscated at airports.

The New Nicotine Alliance (NNA) has become aware of five travellers who have suffered hard-line and unsanctioned action, but those affected could stretch to tens of thousands more UK citizens who have chosen vaping as a way of stopping smoking.

Regular UK traveller to Goa, Fiona Hodge, reported that UK vapers are having their property confiscated both on the way in and out of India. “I had to leave £60 worth of my property behind despite possession of e-cigarettes not being an offence under the law. UK tourists are being harassed at airports, which will surely be a threat to India’s tourism industry. I certainly won’t be going back if the attitude towards vapers carries the hallmark of being designed specifically to maintain, and even increase, the number of smokers in India.”.

The NNA opposes policies which prohibit the use of safer nicotine products, but if countries pursue such misguided legislation, they should enforce it appropriately and properly inform UK citizens before they travel.

“E-cigarettes are a proven safer alternative to smoking and the UK boasts 1.9 million former smokers who have converted from smoking to exclusively vaping instead. Confiscating products which have a successful track record of diverting smokers away from combustible tobacco is crazy. Their only other option in India is combustible cigarettes, and the Indian Government owns 28% of one of the country’s biggest tobacco companies.”, said NNA Chair Martin Cullip.

“Health groups in the UK, including the NHS, rightly support tobacco harm reduction. Public Heath England also backs vaping and the Royal College of Physicians urges wide promotion of e-cigarettes to reassure and encourage smokers to use them, as does the government’s own Tobacco Control Plan. The Government’s Science and Technology Committee recommended wider acceptance of vaping as an option to switch from smoking in August 2018.

“India welcomes 850,000 visitors from the UK each year and current statistics dictate that around 6 per cent of those will be vapers. That is around 50,000 who could be affected simply for following advice to switch to e-cigarettes on the advice of public health authorities in this country".

“It is not up to the UK to dictate how India chooses to treat e-cigarettes”, said Cullip, “However, it is important that UK travellers are aware of the reception they might receive if they fly to India. We have written to the Foreign and Commonwealth Office saying that it is imperative UK citizens are aware of situations such as this in order that they can make informed decisions about whether to travel to India. Our letter asks the FCO to clarify the law with the Government of India and to update their advice to travellers accordingly.”.

We would suggest that UK citizens affected can give strength to this letter by contacting either the FCO if they are back in the UK, or one of our High Commission offices if in India. https://www.gov.uk/world/organisations/british-high-commission-new-delhi

Issued on behalf of the New Nicotine Alliance

Note to Editors: The NNA is a registered UK charity staffed by consumer volunteers, formed to increase understanding about the benefits of “new” risk-reduced nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation.

Sources

Law banning e-cigarettes but excluding personal use
https://in.reuters.com/article/india-ecigarettes-use/e-cigarettes-use-not-included-in-india-ban-will-defend-any-court-challenge-official-idINKBN1W31S5

Action on Smoking and Health survey, September 2019
https://ash.org.uk/media-and-news/press-releases-media-and-news/in-2019-around-half-as-many-britons-now-vape-as-smoke-and-the-majority-are-ex-smokers/

Govt has banned vapes, but owns 28% of ITC – India’s biggest cigarette maker
https://theprint.in/india/governance/govt-has-banned-vapes-but-owns-28-of-itc-indias-biggest-cigarette-maker/293547/

Public Health England: “E-cigarettes aren’t completely risk free but carry a fraction of the risk of smoking and are helping thousands of smokers to quit and stay smokefree”
https://publichealthmatters.blog.gov.uk/2018/02/20/clearing-up-some-myths-around-e-cigarettes/

Royal College of Physicians: “Promote e-cigarettes widely as substitute for smoking”
https://www.rcplondon.ac.uk/news/promote-e-cigarettes-widely-substitute-smoking-says-new-rcp-report

UK Tobacco Control Plan: “Backing evidence-based innovations to support quitting” (page 5) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/630217/Towards_a_Smoke_free_Generation_-_A_Tobacco_Control_Plan_for_England_2017-2022__2_.pdf

UK Government Science and Technology Committee report, August 2018 https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/505/50502.htm

Foreign and Commonwealth Office most recent British Behaviour report https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/363684/141013_British_Behaviour_Abroad_report_2014.pdf

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Created: 23 December 2019

In our November newsletter, we said that “2020 could present some major challenges for which we will have to be ready so please keep watching our website and social media for news very soon, we will be asking for your help”. This was no idle or generic warning.

Preparations are already underway for a review of the EU’s Tobacco Products Directive (TPD) and, this week, an upcoming meeting between the Commission and ENVI – the EU’s health department -– was announced for the 20th and 21st of January. Rumours abound that this committee will wish to talk about the vaping scare in the US and try to employ it to force a harsher regulatory landscape in Europe.

We believe there is a prevailing sentiment amongst the EU Commission that they were beaten by consumers during the debates on the last TPD between 2012 and 2014 and have not forgiven us for it. No matter that the TPD is currently delivering effective outcomes by regulating e-cigarettes relatively wisely, the EU has a collective ambition to roll the clock back to 2011 and run all the same arguments again. Consider comments from former EU Commissioner for Health and Food Safety Vytenis Andriukaitis who said in March 2019:

“If one uses electronic cigarettes as a method to stop smoking, it has to be managed by medical doctors and specialists, to be sold in pharmacies and not in supermarkets.”

This was the starting point for those trying to extinguish the potential of vaping 8 years ago, and it doesn’t seem that they are happy that medical regulations were not placed on e-cigarettes back then. He also dismissed the concept of harm reduction entirely:

“Harm is harm. No matter if it’s less or more.”

His second in command, Arūnas Vinčiūnas, went further, saying:

“E-cigarettes may be less harmful, according to some reports, but they’re still “poison,”

Andriukaitis and his cabinet only stepped down last month, but don’t expect anything to change. Finland is currently occupying the Presidency of the EU Council, and are being lobbied hard to fundamentally change the EU’s approach to e-cigarettes:

“Mounting evidence suggests that regulating flavours in e-cigarettes to protect youth is wise although not easy. Many countries are currently considering further regulations on e-cigarettes and so should the EU.”

Much like the CDC in the US, the EU will be keen to keep the ambiguity between e-liquid regulated under the TPD and illegal liquids causing all the harms seen in the US going for as long as possible. They are smarting that they were overrun by consumers last time around and see e-cigarettes as an itch they need to scratch into oblivion this time. The US vaping scare is exactly the tool they have been dreaming of to try to get their revenge over vapers for our impudence in resisting them when they previously tried to crush vaping.

The war on harm reduction in the EU is starting again. Much sooner than you realise, minds will be closed and positions taken. By the time any of us are asked for comment on this, policy proposals will already have been made. We are expecting the first significant discussions to start in the European Parliament as soon as the end of January 2020.

 Don’t think, either, that the UK leaving the EU will mean we are excluded from anything that arises out of the TPD. We don’t yet know what the trade agreement with the EU will look like, but it is quite possible that many directives will be part of “level playing field” arrangements in which the UK stays aligned with the EU, and it is highly likely that the TPD will be one of them. Politicians do not see smokers and vapers as a hill to die on, so TPD is probably not an area where divergence from the EU should be expected.

In the new year, we will be urging all UK and European consumers to be as active as possible and to replicate the intense efforts of past years and fight the same battles as before, but more intensely.

This is no time for complacency, there are real threats coming and we are going to need you to put yourselves out to protect your right to choose safer nicotine products. So, please enjoy your Christmas and New Year celebrations, but return refreshed and ready for a mighty battle in 2020 and beyond. This is, we assure you, not a drill.

 ALSO SEE:   BREXIT AND VAPING ,THE COUNTERFACTUAL, CLIVE BATES, 

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Created: 06 November 2019

 Dear Mayor Khan,

We note in your response to a London Mayoral question from Assembly Member Onkar Sahota on 22nd October that vaping adverts are currently not permitted on the London Underground, and that Transport for London “is currently reviewing its overall approach to Vaping advertising”.

https://www.theyworkforyou.com/london/?id=2019-10-22.20007.h

While it is disappointing that a ban on advertising vaping products is in place on the tube, we are encouraged that the policy is wisely being reviewed.

In a comprehensive report, the highly respected Royal College of Physicians advised that organisations should “promote e-cigarettes widely as substitute for smoking” and that “smokers should be reassured that these products can help them quit”.

https://www.rcplondon.ac.uk/news/promote-e-cigarettes-widely-substitute-smoking-says-new-rcp-report

Prohibition of advertising has the opposite, damaging, effect to the RCP’s advice, so we hope you can fast-track the review to allow positive messages on the London Underground as to the benefits that vaping products could deliver to your smoking passengers.

E-cigarettes have been included as an option in the Stoptober campaign for three years now and the Advertising Standards Authority has been considering whether to amend its advice to allow health claims to be made for vaping products, as highlighted by Public Health England which has concluded they are at least 95% less harmful than smoking.

Public perception on the safer nature of reduced risk products like e-cigarettes has been on the wane recently due to alarmist tabloid media, so an intervention from TfL to permit vaping adverts across the entire London transport network would not only fit with current government health advice but could also make a significant positive contribution to the health of Londoners.

Vaping advertising is already prevalent on London buses, so it would seem consistent to also allow the same messages to be presented to travellers on tube trains too. The government’s Tobacco Control Plan aspires to “maximise the availability of safer alternatives to smoking” and recognises the potential of products which reduce harm to smokers who choose to quit. This can only be achieved by promoting the existence of those products, and you have it in your power to enable publicity of them to the millions of daily travellers on the Underground, many of whom will be smokers.

https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england

As a consumer-led charity which advocates for a wider recognition of tobacco harm reduction products and has engaged with government and public health NGOs for many years, we would welcome meeting you or your delegated colleagues to discuss the policy area in more detail. We would also ask that you add us as a stakeholder so that we may be updated on plans for vaping advertising on London Transport in the future.

Yours sincerely,

NNA

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Created: 23 October 2019

For immediate release

LONDON 23 October: The Federal Drug Administration in the US has this week issued a judgement that eight snus smokeless tobacco products can be marketed with claims that they are less harmful than smoking. The New Nicotine Alliance (NNA) welcomes this development and urges the European Union to abandon its archaic and indefensible ban on the products for European smokers.

Snus is a pasteurised tobacco product with decades of epidemiological evidence proving that it presents negligible risk compared to smoking. Owing to unjustified panic in the 1980s, it is currently banned in the EU despite overwhelming evidence that it is up to 99% less harmful than smoking. Sweden – which has an exemption to the ban – enjoys by far the lowest smoking rates and tobacco-related harm in the EU.

“It is inexplicable why the EU continues to perpetuate the ban on European smokers choosing to switch to snus,” says Mark Oates of the NNA, “not only is the sale of snus permitted in the USA but they have now allowed one company to make the undisputed claim that “using snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis”, the difference in approach could not be more stark, and it is the EU which is being reckless with its public’s health, not America.”

“The FDA has recognised that there is a continuum of risk surrounding nicotine use and that snus is at the very low end of that,” Oates continued, “this decision is a welcome game-changer as it acknowledges, quite rightly, that safer nicotine products can offer great potential for smokers who wish to switch from smoking to a safer alternative. Public perception is key, and the US has decided that messaging conveying the relative risk of nicotine products is vital information that can offer great benefits to advancement of public health. By contrast, the EU is wedded to an out-of-date, unscientific and therefore indefensible ban on products which are 99% safer than smoking, while allowing cigarettes to be sold everywhere.”

“It is well past time that the EU stepped out of the 80s and followed the lead of the FDA,” Oates concluded, “there is simply no valid reason for snus to be prohibited in the EU, it is a shameful dereliction of duty which should be overturned at the first opportunity.”

Issued on behalf of the New Nicotine Alliance

Note to Editors: The NNA is a registered UK charity staffed by consumer volunteers, formed to increase understanding about the benefits of risk-reduced nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation. We wish to see 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. This requires engaging with and informing a wide range of individuals and audiences – from health through to regulatory bodies.

Contact: This email address is being protected from spambots. You need JavaScript enabled to view it.

Phone: 0300 30 20029

Sources
FDA grants first-ever modified risk orders to eight smokeless tobacco products
https://www.fda.gov/news-events/press-announcements/fda-grants-first-ever-modified-risk-orders-eight-smokeless-tobacco-products

Reuters: EU court stands by ban on Swedish tobacco product 'snus'
https://www.reuters.com/article/us-europe-court-swedish-match-idUSKCN1NR1AF 

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Created: 29 September 2019

This week saw the publication of the latest survey by Action on Smoking and Health (ASH) into e-cigarette use in the UK which reveals that the number of people using e-cigarettes has swelled once more, despite the best efforts of massed ranks of anti-vaping doomsayers and irresponsible media worldwide.

ASH’s report – the latest annual survey since its inception in 2012 – assesses there to be 3.6 million vapers in the UK now, up from 3.2 million last year. It also reveals that of those there are 1.9 million who have successfully switched from smoking to exclusive e-cigarette use, once again eclipsing the number of people using vaping devices alongside lit tobacco. It is a stunning figure for the fact that there are now over half as many vapers in the country as there are smokers.

Those ideologically opposed to tobacco harm reduction have been throwing the proverbial kitchen sink at vaping in the past year, but fortunately this report shows that it isn’t deterring uptake for many people.

The main points in the new survey make interesting reading:

• E-cigarette use continues to grow, and an estimated 7.1% of the adult population amounting to 3.6 million people in Great Britain currently use e-cigarettes (vape).
• Over half (54.1%) of current vapers are ex-smokers, and the proportion has grown year on year, while the proportion of vapers who also smoke (known as dual users) has declined to 39.8% in 2019.
• The proportion of adult smokers who have never tried e-cigarettes declined rapidly from 2010 until 2014, and continued declining, but gradually, from 2015 onwards. In 2019 it was 34.1%.
• Only 0.8% of never smokers are current vapers (amounting to 6.1% of vapers).

We are encouraged by these statistics as they illustrate that the UK’s approach to regulation of e-cigarettes is proving to be the right one; once again it demonstrates that a regulatory environment which allows safer alternatives to flourish – along with a government signed up to embracing innovation and new technological solutions – can deliver results.

But, sadly, there are also signs that opposition to harm reduction is having a negative effect. Once again, perception of the harmful nature of e-cigarettes is getting in the way. The ASH report states that “In 2018, for the first time since 2015 at least half the population agreed that e-cigarettes were less or a lot less harmful than smoking (50% in 2018 compared to 43% in 2017). However, this improvement has not been sustained, and in 2019 only 45% agreed this was the case.”. This is regrettable and those who are responsible for the fake concern and many column inches of negative coverage should be ashamed of themselves.

However, there is much positive to take from ASH’s data.

The NNA is not a prohibitionist organisation, we advocate for free choice of smokers to choose safer products – or not - on their own terms, and for availability of reduced risk products to be protected, but all smokers and vapers must be properly informed. The plethora of garish scare stories in the media have obstructed that but it is heartening to see that there is still a significant rise in consumers seeing through the noise and choosing to vape instead. It suggests that there is a culture in the UK of smokers and vapers engaging with each other to share experiences and information independent of the campaign against safer nicotine consumption.

The report also contains a salient lesson to policymakers of what could encourage more to make the switch to vaping if they are serious about reducing smoking rates. Over 50% of vapers now cite “I get a great deal of pleasure from vaping” and “E-cigarettes have improved my quality of life” as their reason for sticking to it rather than relapsing. Only 12% stated the opposite for both questions.

While health organisations frame the choice to use e-cigarettes instead of lit tobacco solely in terms of health, we have consistently advocated that enjoyment of the products is the biggest driver towards permanent use and avoidance of relapse to smoking. Recognising that recreational use of e-cigarettes is a good thing would open the door for far better uptake of reduced risk products and we hope that one day the UK government will concede that this is the case.

It is also a compelling reason why the ill-conceived recent focus on restricting flavours in e-cigarettes should be resisted at all costs in the UK. Governments worldwide should be asking vapers why – as this report shows – a majority of fully-switched e-cigarette users favour vaping over their previous smoking habit, because the answer will resoundingly revolve around the choice afforded by flavours.

If you are one of the estimated 400,000 new dedicated vapers since 2018 detailed in these latest statistics, we are very pleased that you have swelled our ranks in the UK. We have many battles left to fight but the more of us there are, the better. Welcome to all of you.

Source
ASH Factsheet:  Use of e-cigarettes (vaporisers) among adults in Great Britain
https://ash.org.uk/wp-content/uploads/2019/09/Use-of-e-cigarettes-among-adults-2019.pdf

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Created: 27 September 2019

NNA is delighted to announce that we have joined with other European tobacco harm reduction groups to partner with European Tobacco Harm Reduction Advocates (ETHRA).

The challenges faced by tobacco harm reduction are not confined to individual countries but are regional and global and ETHRA meets the long standing need for a regional network in Europe.

ETHRA will give European advocates a platform for sharing information and experiences, will enable us to co-ordinate actions and will amplify the message that tobacco harm reduction is a vital strategy for many smokers.

Martin Cullip, NNA’s chair, said:

“We are pleased to be part of this new European initiative to advocate for tobacco harm reduction on behalf of nicotine consumers. We look forward to engaging with policy makers to promote the benefits of sensible regulation in delivering better outcomes for smokers and users of reduced risk products in the future.”

Read more about ETHRA here:

Europe-wide consumer organisation launches to promote safer nicotine use 
ethra.co 

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Created: 15 September 2019

You may have read some pretty scary articles in recent weeks about how ‘vaping’ is causing health problems – including deaths – in the USA. We use inverted commas around the word vaping because it is by far the real story.

We have received concerned messages from supporters about this and have had reports of vapers being contacted by friends and family members saying they should immediately quit using e-cigarettes. Many of you reading this will have experienced the same first-hand or on social media.

We will not be going into detail about why these articles are irresponsible, ill-informed and wrong because others have already done so. We provide links to numerous comprehensive rebuttals below for you to send to those who have been sucked in by the negative coverage recently.

Suffice to say that vaping nicotine is not to blame for any of these episodes, but instead illegal oil-based THC liquids bought from unregulated vendors in America, not the UK. In short, drug dealers.

The advice from Public Health England – and from the NNA – remains the same.

Click image above to see PHE’s full thread

We do however condemn the many bad actors who are fanning the flames of this false panic. Whether it is journalists chasing click-bait or ideologically driven harm reduction sceptics in the UK health community, they are actively deterring many thousands of smokers from either opting to switch to a far safer form of nicotine consumption or guiding those who may be using e-cigarettes to move back to smoking, based on no proper evidence whatsoever.

This is not a game. Their crass conflation of vaping with illicit, unregulated and deadly illegal drug-containing liquids will cost lives and they should be thoroughly ashamed of themselves.

The e-cigarette market in the UK is tightly regulated under the Tobacco and Related Products Regulations Act 2016 so you, your friends and family should have nothing to worry about. Keep calm, educate them, and carry on vaping.

To stay safe, the simple approach is to only buy from reputable vendors who sell products regulated by the Medicines and Healthcare products Regulatory Agency in the UK. Don’t buy from boot sales, men in vans or people in the pub.

It is regrettable that there is so much unjustified negativity being promoted about devices which have driven down smoking rates considerably since 2012 and are making dramatic improvements to the lives of millions. Sadly, it seems that malign influences are at work.

The bottom line, though – and a line endorsed by government institutions - is that there is nothing to see here if you buy from legitimate sources. Ignore the panic-mongers and spread the word.

Futher reading

Science Media Centre, expert reaction to Trump’s decision to ban flavourings in e-cigarettes

https://www.sciencemediacentre.org/expert-reaction-to-trumps-decision-to-ban-flavourings-in-e-cigarettes/

Dispersing the clouds of the vape panic myth

https://spectator.us/dispersing-clouds-vape-panic-myth/

Is Vaping Really Killing People? Here are the Facts, Lee Johnson

https://ecigarettereviewed.com/is-vaping-really-killing-people/

The world responds

https://www.planetofthevapes.co.uk/news/vaping-news/2019-09-12_the-world-responds.html

British vapers are safe, claim health experts after deaths in US

https://www.theguardian.com/society/2019/sep/07/health-experts-reassure-vapers-products-in--uk-are-safe?

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Created: 30 July 2019

LONDON 30^th July: The World Health Organization’s recent report on the global tobacco epidemic will do little but perpetuate smoking by making non-combustible alternatives to smoking like electronic cigarettes less accessible, more expensive and less consumer friendly, the New Nicotine Alliance (NNA) said in a statement Tuesday.

The latest iteration of the WHO’s report on the global tobacco epidemic, called “Offering help to quit tobacco use”, advocates for stricter legislation of e-cigs, asserting there is no proof they help smokers quit their habit, and could even be a gateway to tobacco addiction for young people.

Whilst the NNA, a leading educational charity concerned with improving public health through a greater understanding of risk-reduced nicotine products, supports an effective regulatory environment for nicotine delivery devices, it is our strong view that this new report from the WHO completely ignores credible third-party scientific evidence, including Cancer Research UK and Action on Smoking and Health (ASH), of the harm reduction potential afforded by such products.

Public Health England research has shown that vaping is at least 95 percent safer than cigarette smoking and 2-3 times as effective as traditional nicotine replacement therapies in helping smokers to quit, confirming the UK Royal College of Physicians’ view that vaping has "huge potential to prevent death and disability from tobacco use". A recent study, funded by the leading cancer charity, Cancer Research UK, found that people using e-cigarettes to quit smoking are about 95 per cent more likely to report success than those trying to quit without help from any stop-smoking aids.

The WHO report reiterates the discredited argument that e-cigarettes are a gateway for young people to start smoking. Yet only last month, research published by anti-smoking charity, ASH, found that vaping remains uncommon among young people and is almost exclusively confined to current or past smokers.

Most teen vaping is experimental and short-lived, with Deborah Arnott, chief executive of ASH, saying at the time: “We need to be vigilant and continue to monitor e-cigarette use among young people. However, smoking prevalence among children and young adults in Britain has fallen substantially since 2010, which doesn’t indicate that vaping has been a gateway into smoking.”

On the WHO report on the global tobacco epidemic 2019, NNA Chair Martin Cullip said:

“The UK boasts some 1.7 million former smokers who have converted from smoking to exclusively vaping instead. It is extremely likely that this behavioural shift has been driven by the availability of e-cigarettes and their promotion by public health in the UK. If the WHO truly wants to drive down smoking rates, it must consider the growing body of evidence that vaping is an effective way to help people to quit. The WHO and the tobacco control lobby seem to have abandoned health altogether in favour of just attacking industry.”

Issued on behalf of the New Nicotine Alliance

Note to Editors: The NNA is a registered UK charity staffed by consumer volunteers, formed to increase understanding about the benefits of “new” risk-reduced nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation. We wish to see 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. This requires engaging with and informing a wide range of individuals and audiences – from health through to regulatory bodies.

Contact: This email address is being protected from spambots. You need JavaScript enabled to view it.

Phone: 0300 30 20029

Sources

• WHO report on the global tobacco epidemic 2019: https://www.who.int/tobacco/global_report/en/
• Public Health England: https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review
• CRUK: https://uk.reuters.com/article/uk-health-ecigarettes/e-cigs-can-double-success-rates-of-quitting-smoking-uk-study-finds-idUKKCN1SS31W
• ASH: http://ash.org.uk/media-and-news/press-releases-media-and-news/in-britain-young-people-vape-just-to-give-it-a-try-not-because-they-think-its-cool/

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Created: 12 July 2019

The NNA was a founder member of the International Network of Nicotine Consumer Organisations (INNCO) since its inception in 2015. We regret to announce that yesterday we ceased membership of INNCO due to differences concerning future strategy, including funding arrangements.

We wish INNCO – and all its global consumer association members – the very best for the future and hope they are successful in all endeavours they embark upon in pursuit of prudent regulatory recognition for reduced risk products in jurisdictions throughout the world.

The NNA Board of Trustees

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Created: 19 June 2019

Issued at the Global Forum on Nicotine on 14 June 2019

Removing e-liquid flavours from sale threatens the proven success of e-cigarettes to help adult smokers switch, warns the New Nicotine Alliance

• The array of e-cigarette flavours has been instrumental in their success as a smoking cessation method
  
  
• Demonising flavours in some jurisdictions is a threat to global public health
  
  
• Experts agree that flavours are key to tempting smokers to try safer products

WARSAW, June 14th, 2019: Banning flavours in e-cigarettes could be detrimental to public health, warns leading consumer charity, the New Nicotine Alliance (NNA).

The role of flavours for e-cigarettes and whether they are a positive or negative for public health has been the focus of much discussion in public health, scientific and media circles around the world. The NNA argues that removing all flavours except tobacco would be a disastrous move.

The NNA and other leading experts at the Global Forum on Nicotine (GFN) in Warsaw – an event featuring over 500 delegates from academic, research, industry and consumer organisations - said today that removing flavours from sale would be a deterrent to the increasing number of smokers who are quitting by choosing to use less harmful products.

“E-cigarettes are a proven safer alternative to smoking. The UK boasts 1.7 million former smokers who have converted from smoking to exclusively vaping instead. Flavours have been a big driver of that success, by distancing smokers from tobacco and providing an incentive to switch, with a wide selection of different options to suit their preferences”, says NNA Chair Martin Cullip, who to+day hosted a briefing at the GFN on the subject.

Sharon Cox, Research Fellow at London South Bank University, said:
“Policy needs to reflect real user behaviour, be context specific, make best use of evidence, and involve consumers to serve the public to make informed choices. The evidence suggests flavours are one of a few key components, important to both the new vaper and the experienced vaper, which help people abstain from smoking.”

James Dunworth, blogger on e-cigarettes and owner of Welsh retailer E-Cigarette Direct, said:
“Vaping works because it's fun. Take the pleasure out of vaping and it will stop working. Key to that pleasure is flavour. Because of demand, there are a huge number of flavours, meaning there's something for everyone - and when someone finds their perfect flavour, they’re highly unlikely to go back to smoking.”

Dr Christopher Russell, of the Centre for Substance Use Research, said:
“There is growing evidence that suggests adult smokers increasingly prefer to use vapour products that are not flavoured like tobacco. Evidence from our own research suggests that a significantly higher proportion of smokers who prefer to vape non-tobacco flavours go on to completely quit smoking cigarettes within three months. Restricting adult smokers’ access to flavoured vaping products would therefore very likely result in fewer smokers trying vaping as an alternative to continuing to smoke, in substantially fewer smokers attempting to switch to vaping, and ultimately, in substantially fewer smokers succeeding in their attempt to switch to vaping.”

Nancy Sutthoff, a consumer advocate, agreed:
"The availability of choice is what makes using safer nicotine products so effective - especially when it comes to flavours. Most people who switch go through a learning curve, and a range of flavours that the individual enjoys make the process simpler and more enjoyable. Personally, I know that being able to vape a flavour that I enjoyed helped me immensely in leaving behind my tobacco habit.”

***ENDS***

Issued on behalf of the New Nicotine Alliance (NNA)

Note to Editors: The NNA is a registered UK charity staffed by consumer volunteers, formed to increase understanding about the benefits of “new” risk-reduced nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation.

Sources:
Research forthcoming from CSUR (CSUR press pack available in GFN media bags).

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Created: 28 February 2019

This week, Public Health England released the first of three reports it had commissioned as part of the government’s Tobacco Control Plan for England. This particular report focussed on how e-cigarettes are being used by the public and revealed some mixed results.

Its main findings were that:

• Regular vaping in under-18s remains low at 1.7%
• Regular e-cigarette use among adults has plateaued and a third of adult smokers have never tried one
• Only 4% of quit attempts made through Stop Smoking Services use an e-cigarette, despite this being an effective approach

Despite PHE emphasising that e-cigarette use is simply not a major problem in this country – as you can see from their graphic above – it was disappointing to see that much of the media preferred to sensationalise the rise in youth vaping rather than the far more significant figure of 0.2% of never smokers aged 11 to 18 being regular users. This tells us that the vast majority of youths are either just experimenting with e-cigarettes or, if they are regular users, have smoked before so could be doing so to quit conventional cigarettes. Even the paltry 0.2% of never smokers is not worrisome if you factor in that many of those may well have been smoking instead in the absence of safer alternatives.

It is disappointing to note that regular e-cigarette use among adults has plateaued, but hardly surprising after the onslaught of irresponsible and misleading click-bait journalism we have seen in the past couple of years each time even minor and obscure negative study results are published. There is still a stubborn rump of ideological opponents of harm reduction in public health circles despite their number steadily tailing off into insignificance, but PHE’s report shows that their regular insincere outbursts are arguably deterring smokers from switching and are harming the public’s health.

The report also goes to great lengths in recommending more smoking cessation efforts to encourage vaping. PHE recommends that Stop Smoking Services should do more to encourage smokers that want to quit with the help of an e-cigarette and calls for stop smoking practitioners and health professionals supporting smokers to receive education and training in the use of e-cigarettes in quit attempts.

While this is to be welcomed, it is important for public health institutions and clinicians to realise that, for many, it is precisely because e-cigarettes are not a medical device that they have been so initially successful. We are pleased that PHE is encouraging Stop Smoking Services to recognise the potential of vaping, but they should also be aware that many smokers would not choose a clinical setting for seeking advice on e-cigarettes and that reputable vape shops have much to offer and should be firmly part of the mix.

All in all, this is a welcome report from PHE although we worry that the focus on youth use of vaping products is distracting from more important aspects of the role e-cigarettes can play to the benefit of public health. We hope this is not in response to the wild irrational panic currently taking place in the USA where attitudes towards less healthy choices are completely different to the UK and where the system of politics lends itself to overblown reactions. The UK is getting the balance mostly right with harm reduction and we look forward to PHE’s other two reports for, hopefully, more encouraging news and recommendations which can carry the success of e-cigarettes for public health further onwards.

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Created: 28 February 2019

Estonian Parliament embraces Tobacco Harm Reduction but gets played by the Health Minister

At a session in the Parliament of Estonia (Riigikogu) on the 13th February, members gave overwhelming support to major reforms of current Estonian tobacco legislation. Proposed amendments included limiting e-cigarette restrictions (July 2019 flavour ban, e-liquid excise tax and domestic online sales ban). The Parliament also overwhelmingly supported to correct the long term failure of Estonian Government to regulate novel smokeless products to enter the Estonian market. The amendments were supported by almost all political parties – ‘Conservatives’, ‘Centrists’ and ‘Liberals’ - only the Social Democrats voted against policies which supported tobacco harm reduction.

NNA Estonia was delighted to see that the benefits of tobacco harm reduction has finally been recognised by so many MPs - it’s been hard work and a long time coming!  Apart from continuous public awareness raising one of our recent initiatives included staging a Tobacco Harm Reduction conference in Parliament house in which leading International THR scientists and specialists: Prof.Martin Jarvis, Prof.Peter Hajek, Louise Ross, Dr. Karl Snæbjörnsson and Judy Gibson presented facts and discussed the benefits of e-cigarettes to an invited audience.

Whilst disappointed that the Social Democrats felt unable to support the amendments (a fact which vapers in Estonia may wish to consider when voting in the Parliamentary elections on 3rd of March ), we are very encouraged by our overall progress. Lives depend upon it!

The ‘break in the ice’ was reflected in MP’s comments:-

MP Tarmo Kruusimäe (Conservative)
The law on tobacco is undergoing a Parliamentary review. Whilst detailed methods of tracking [combustible] tobacco ‘like Sherlock Holmes’ is important, it is even more important to reduce the risks from cigarettes and passive smoke - but the the relaxation of the regulations of e-cigarettes and allowing heat-not-burn products to enter the Estonian market provide an alternative opportunity to achieve it.

MP Madis Milling (Liberal) stated that, over the last four years, the debates in Parliament on tobacco law have made alternative products more expensive and also more difficult to obtain than conventional cigarettes, and that, together, it has also made it more difficult to quit smoking. Milling said that the explanations provided by the Ministry of Social Affairs officials, according to which it is claimed that no studies have been carried out on alternative products and that, at the same time, they appear to be as harmful as conventional cigarettes, remain difficult to understand. Milling pointed out that, where innovation is usually supported, in tobacco policy this is not the case and that hundreds of research studies carried out abroad are neglected.

MP Aadu Must (Center Party) had an idea to make Estonian university town Tartu the first smoke free town in Estonia. He envisioned Estonia ten years from now when people would not believe anymore that anybody in such a recent past actually smoked burning cigarettes when less harmful alternatives were already available.

The debate in Parliament was overshadowed by a threat from the Social Democrat Minister of Health, by which she promised to suspend the debate on the bill if Parliament approved the proposals to reasonably regulate less harmful alternatives to smoking that were unsuitable for her.

This wasn’t quite the end…

It is customary in Estonia for the initiator of a bill to control its passage insofar that if substantial changes are made the initiator has the right to withdraw it. The core legislation contained within the Tobacco Bill was required to pass in order to comply with the EU Tobacco Directive.

To cut a very long story short:-

1. The Minister of Health didn’t like the proposed amendments - not one little bit.
2. She reacted by threatening to take back the bill in a letter of intent to the speaker. including all those really important bits needed to comply with EU TPD directive. (Hint: she was later found to have overstepped the mark ;-)
3. Those bits if not implemented within a time period may incur financial sanctions (Ooops)
4. Parliament took not a blind bit of notice of her threat - THR was winning (Yesss!)
5. A legal furore ensued resulting in Parliament being suspended for several hours (which is something of a first in Estonia).
6. Meanwhile The Social Democrats (Booo!) persuaded the Prime Minister to give his approval to their proposal to suspend the passage of the Bill - despite the overwhelming approval of the new amendments (Don’t ask).
7. The imminence of elections has resulted in the bill being postponed - so the whole thing will have to debated all over again under a new Parliament, the EU may decide to impose sanctions and if you ever thought Brexit was bad - welcome to Estonia!!

Let me explain..

MPs were disturbed by such a threat, because Estonia is a parliamentary democracy, where laws are created by Parliament and not by the government. By her letter, the Minister set a trap for Parliament, because if the debate on the Tobacco Act is interrupted, Estonia will not be able to implement the EU Tobacco Directive’s Articles 15 and 16 for tracking and tracing at the right time and may be subject to sanctions.

Despite the knowledge of such a letter from the Minister of Health, Parliament decided to support the amendments that help reduce public health damage from cigarettes and encourage smoking cessation. The Parliament’s Board had to accept the Social Democrat Minister of Health request for a suspension of the reading of the Tobacco Act.

The Minister's request caused a legal dispute during the Plenary because the MPs were not convinced that the Minister had the right to suspend the discussion of the draft. As a result of the dispute, the work of Parliament stopped for 1,5 hours which has not happened for similar reasons never before.

Later it turned out that the Minister of Health does not have such a right on her own, such a proposal can be made by the Minister only if she has the support of the Government. During the parliamentary debate, the Social Democrats had persuaded the Prime Minister to support suspending the draft, despite the fact that a large majority of the MPs in his Center party had also voted in favour of the amendments. From media it appears the Prime Minister confirmed his support to suspension by an sms (!!) to the Parliament’s Board member.

The debate on the Tobacco Act in the Estonian Parliament was interrupted and, as Parliament has completed its work due to the elections this Sunday, the new Parliament must start with discussions from scratch. At the same time, Estonia will most likely not be able to implement the EU Tobacco Directive at the right time and may be subject to sanctions.

Ingmar Kurg
NNA Smoke Free Estonia - Member of board
INNCO - Member of board  

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Created: 11 December 2018

Mid-August saw the publication of a report by the influential House of Commons Science and Technology Committee on what the government’s approach to vaping and other safer nicotine alternatives should be. It was by far the busiest day of the year for the NNA as our spokespeople were in demand on media from morning till night, as we described in our newsletter that month.

The NNA was well prepared for the report and issued not one, but two, embargoed press releases to coincide with its publication. You can read our welcome for the report here and our release specifically on the issue of snus here. We also published a blog on the day describing the committee’s report as a potential “catalyst for a step change in the UK establishment’s approach to e-cigarettes and other safer nicotine products” which you can read here.

In line with the widespread media coverage the report attracted, NNA representatives were busy all day with media appearances. Supporters Doug Phillips and Niamh O’Farrell spoke on BBC Radio Five Live Breakfast and Channel 5 News respectively, while NNA Chair Sarah Jakes appeared on BBC2’s mid-morning current affairs show, Victoria Derbyshire, which you can watch here.

That wasn’t the end of it, though, Sarah went on to give another 9 interviews to regional BBC radio stations and Martin Cullip also spoke to BBC Radio Scotland. They are too numerous to mention here but you can view all our extensive media spots at the day’s NNA twitter stream here.

In the aftermath, NNA trustee Martin Cullip also wrote an article at Spiked countering the fears of those who were averse to the idea of vaping being allowed in public places following lurid and excitable tabloid headlines.

The opposition to the committee’s common-sense recommendations were mostly doomsayers from one institution because the BBC and others struggled to find people who could find a reason to go against the considered conclusions that Norman Lamb’s group of MPs had come to.

So, it is very encouraging to see that yesterday the government issued its response to the committee’s recommendations and accepted every single one of them.

In all there were seven.

About maintaining the government’s planned annual ‘evidence review’ on e-cigarettes and extending it to also cover heated tobacco products to be overseen by Public Health England and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, the government accepted the suggestion and said that it is “firmly committed to more research in this area”.

On reducing barriers to e-cigarette suppliers by way of MHRA being more receptive to vaping, the government also agreed, but added that “it is a commercial decision for e-cigarette manufacturers to make whether or not to apply for a medicinal licence. Despite the lack of a medicinal approved e cigarettes, there are around two and a half million e-cigarette users in England alone, which suggests that growth of the e-cigarette market has not been hindered due to e-cigarettes not being available on prescription”.

The recommendation that NHS England should appoint someone to include provision for e-cigarettes as part of the government’s tobacco control plan was also accepted, as was the proposal from the committee that NHS England “should set a clear central NHS policy on e-cigarettes in mental health facilities”.

Talking of opportunities post-Brexit, the government also broadly agreed that there are advantages that could be explored “in those areas identified by the Committee, such as the 20mg/ml maximum nicotine refill limit, a size restriction of 2ml on the tank, a block on advertising e-cigarettes’ relative harm-reduction potential and the notification scheme for e-cigarette ingredients”.

The government’s response also conceded that the Science and Technology Committee was correct in calling for a tax regime which favours reduced risk products according to a continuum of risk and also – admirably – committed to reviewing the counterproductive ban on snus, stating that “The Government’s goal will remain to achieve a proportionate approach to managing risk, one which protects the young and non-smokers, whilst giving smokers access to products which will reduce harm. As part of this the Government will consider reviewing the position on snus and whether the introduction of this product onto the UK market would promote that kind of proportionate harm reduction approach.”

There is very much to welcome in the government’s response and it is to Sir Norman Lamb’s credit that his gravitas has started a conversation which could lead to significant benefits to the public health of the country by way of a more enlightened thinking about nicotine and ways of reducing harm for those who find it hard to choose to quit smoking.

The NNA heartily congratulates the government on its response to the committee’s report.  We hope that the acceptance of the recommendations will one day translate into government policy offering pragmatism for a future in which novel alternatives for smokers are recognised and embraced. 

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Norman Lamb at the APPG on Vaping, November 2017

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Created: 21 November 2018

For immediate release

The New Nicotine Alliance brands ECJ decision to uphold the ban on snus a blow to the public health of EU citizens

• The NNA is disappointed that the ECJ has endorsed a political decision based on moral panic rather than defend the right of smokers to choose safer products
• The ban on snus, which carries negligible risk, while cigarettes remain widely available is illogical and disproportionate.
• The UK government’s support for maintaining a ban on snus which has helped migrate huge numbers of smokers away from tobacco in Sweden and Norway flies in the face of their recent commitment to tobacco harm reduction.

LUXEMBOURG: This morning’s decision by the European Court of Justice to maintain the EU ban on the oral tobacco product snus has been criticised by a UK harm reduction charity. The New Nicotine Alliance had intervened in the case on behalf of the EU’s 100 million smokers to defend their right to health in being able to choose safer nicotine products.

Snus is a popular and effective harm reduction product which has helped hundreds of thousands of former smokers in Sweden and Norway avoid the risks of combustible tobacco use. As a result, Sweden now has the lowest lung cancer and tobacco-related mortality in Europe and smoking rates in Norway are plummeting to record low levels, yet the oral tobacco products which have led to such success are banned in every other EU member state for no good scientific or health reason.

“It is scandalous that products such as snus, which carry a fraction of the risk of smoking, are banned while cigarettes are legal and widely available”, said Sarah Jakes, Chair of the NNA, “in light of the evidence from Sweden and Norway, there is no justification for continuing the ban and denying consumers in other countries the same right to choose a far safer alternative. The UK government’s support for the ban during the court case flies in the face of its tobacco control plan, which pledges to maximise the availability of safer nicotine products.”

There is huge consumer grass roots support for tobacco harm reduction, from ex-smokers who now vape or use snus. Campaign group EUfor Snus was formed in 2017 to give a voice to snus users and it now boasts 4,000 members from 100 countries. Remarkable when sale of the product is banned in 27 of the EU member states.

“Giving European smokers, 100 million of them, the right to health and life by allowing 99% less harmful Swedish snus is an act of care for public health.”, said Bengt Wiberg, co-founder of EUforSnus, “To refuse Europeans products of substantially reduced harm which have a proven track record in aiding smoking cessation is an act of wanton negligence towards smokers and public health in the EU. More than 8 out of 10 snus users are former smokers, I am one of them. How many of Europe’s 100 million smokers could do the same if they could legally switch to snus?”

The NNA wants to see wide availability of all safer nicotine products as alternatives to smoking. “When smokers have the widest possible choice of reduced risk products it increases the likelihood of their finding an option that works for them”, said Jakes, “the EU ban on snus was a mistake based on flimsy evidence in the 1990s and it was shameful that the EU decided to maintain the ban in the Tobacco Products Directive of 2014. Today’s ECJ decision is likewise a miscarriage of justice for EU smokers who could benefit from using a far safer product which has helped so many Swedish and Norwegian smokers to quit. The fight will not stop here, the NNA will continue to campaign for what is right, and that is for snus to be available Europe-wide as an alternative to smoking.”

Issued on behalf of the New Nicotine Alliance

Contact: This email address is being protected from spambots. You need JavaScript enabled to view it.

Note to Editors: New Nicotine Alliance is a charity concerned with improving public health, through a greater understanding of “new” (risk-reduced) nicotine products and their uses.

Sources:

European Court of Justice judgement in Case C‑151/17 :
http://curia.europa.eu/juris/document/document.jsf;jsessionid=2A1C83343A360F2FB84838F0E797BAD0?text=&docid=207969&pageIndex=0&doclang=en&mode=req&dir=&occ=first&part=1&cid=2420873

Smoking in Sweden:
Daily smoking fell from 8% to 5% over the last three years. See page 27 of EU Eurobarometer 2017. http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2146

Snus use in Sweden:
20% of people are daily users of oral/chewed/nasal tobacco. See footnote on page 73 of EU Eurobarometer 2017 http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2146

Smoking in Norway:
Among young women smoking fell from 30% to 1% in seventeen years (2000 to 2017): Norwegian Smoking Data https://www.ssb.no/en/statbank/table/05307/?rxid=fba52324-e745-43b1-8740-058b118535f6

Snus use in Norway:
Use among young women in Norway grew from 5% to 14% in six years. https://www.ssb.no/en/statbank/table/07692/?rxid=fba52324-e745-43b1-8740-058b118535f6

Snus Health Impact:
The Lancet: Global Burden of Disease Study, 2017: No evidence of harm being done by long-term use of snus ”for any health outcome” See page 1364: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32366-8.pdf

UK Government Tobacco Control Plan
Towards a Smoke Free Generation, a Tobacco Control Plan for England
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/630217/Towards_a_Smoke_free_Generation_-_A_Tobacco_Control_Plan_for_England_2017-2022__2_.pdf

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Created: 19 November 2018

Press release 20 November 2018

The New Nicotine Alliance welcomes today’s Parliamentary report recommending more liberal workplace vaping policies

• The NNA applauds the report’s recommendation for the Parliamentary estate to lead the way by becoming vape-friendly.
• Public vaping bans create a false perception that e-cigarette vapour is dangerous, MPs are right to act to correct this misperception.
• There is a clear misunderstanding amongst the public about vaping, today’s recommendations – if adopted – could act as an example to other workplaces.
• UK health bodies recommend smokers switch completely to e-cigarettes, more liberal workplace vaping policies would facilitate this and be beneficial to public health.

 LONDON: Today sees the release of a report by the All-Party Parliamentary Group for Vaping which recommends a fundamental liberalisation of workplace vaping policies to encourage more smokers to switch. The NNA warmly welcomes this report and would urge its suggestions be implemented in full.

The report makes five policy recommendations:

1) Workplace vaping policies should balance the needs of vapers and smokers looking to switch with those of non-vapers.
2) Employers should have a workplace policy which permits vaping outdoors and makes provision for easily-accessible indoor vaping areas.
3) The Parliamentary Estate must lead the way and act as an example to other workplaces and public places by becoming vape friendly.
4) Public Health England should work to educate employers and owners of public places of the positive public health potential of vaping.
5) Vapers should vape in a responsible way

The recommendations are sensible and evidence-based and would go a long way to settling the confusion that large sections of the public have towards the nation’s most popular method of quitting smoking.

“There are currently 3.2 million vapers in the UK, 1.7 million of whom have quit smoking entirely using e-cigarettes”, said Sarah Jakes – Chair of the New Nicotine Alliance (NNA) – on welcoming today’s report, “this has contributed to the rate of smoking prevalence plummeting, but many smokers are still hesitant due to misperceptions surrounding vaping. More liberal workplace policies can have the dual benefit of correcting these misperceptions while also providing a more encouraging environment for vapers to prevent relapse, as well as for smokers considering vaping instead.

“Public vaping bans give the impression that vaping is as harmful as smoking, which is entirely untrue”, said Jakes, “In fact, vaping is believed to be at least 95% safer than smoking and the government’s stop smoking campaigns recommend e-cigarettes as a means to quit. It is daft that on the one hand smokers are being encouraged to vape instead, only to then be told they are banned from vaping just about everywhere.

“The Parliamentary estate becoming vape-friendly would send a strong message to other employers and venue owners that vapers should be encouraged, not harassed, and would help to educate the public that vapers are simply former smokers doing something that is good for their health.”

The NNA welcomes this report by Mark Pawsey MP and his APPG. It is a timely and well-researched document which dispels many myths about e-cigarettes and adds to the growing public health consensus that vaping is a valid choice for smokers looking to quit.

Issued on behalf of the New Nicotine Alliance

Contact
This email address is being protected from spambots. You need JavaScript enabled to view it.

Note to editors
The New Nicotine Alliance is a charity concerned with improving public health, through a greater understanding of “new” (risk-reduced) nicotine products and their uses.

Sources

The All-Party Parliamentary Group for Vaping report “Vaping in Workplaces and Public Places” published 20 November 2018.

1.7 million e-cigarette users in the UK are ex smokers
ASH Fact Sheet: Use of e-cigarettes (vapourisers) among adults in Great Britain, September 2018, accessed via “New data shows smokers are getting the message on e-cigarettes”
http://ash.org.uk/media-and-news/press-releases-media-and-news/ash-news-release-new-data-shows-smokers-are-getting-the-message-on-e-cigarettes/

Vaping is at least 95% safer than smoking
Evidence review of e-cigarettes and heated tobacco products, Public Health England March 2018
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/684963/Evidence_review_of_e-cigarettes_and_heated_tobacco_products_2018.pdf

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Created: 16 November 2018

Perceptions & Misperceptions:  communication has become a battleground

Here is the text from Sarah's talk at the E-Cigarette Summit at the Royal Society on 15 November 2018:

The veterans of harm reduction will tell you that they’ve seen all this before. Some see it as a battle between absolutism and pragmatism, and that a pragmatic view necessitates the involvement of all parties, including industry.

Others see it as a fight for the vulnerable against powerful commercial interests, and so those interests must be excluded and fought at all costs.

These fundamental differences in what are essentially opinions, have led to a war of words which has spilt into arenas which are accessible to the public, and in particular, to those who are at risk of harm and could benefit the most from harm reduction strategies.

At the moment in the U.K. there are parallel battles going on over illicit drug use and cannabis in particular.

I know very little about cannabis, but I see the same tactics employed – stigmatisation of consumers, inflation of often minimal risks and denial of benefits, plus real harm caused by the criminalisation of an activity which many people find pleasurable and beneficial enough to take their chances with the law.

Much like vapers in countries like Australia and Brazil.

The public, and in particular the consumers of whatever substance is currently under the spotlight, need to be able to trust that the information given to us by public health authorities is accurate and complete.

In the days before the internet there was an inherent trust in health organisations, and few people questioned their motives. But times have changed.

Like never before, the internet has given a global platform to dissenting voices and opposing views. Sometimes this is a force for good, but not always.

Consider where the vocal antivaxxer movement would be today without the internet. Or indeed, Donald Trump.

On the good side though, it is now easier than ever before to scrutinise evidence and commentary and highlight any failings – if you have the time and energy to do so.

However, because most people don’t have those resources, what this abundance of information has led to is confusion and mistrust.

When people distrust the information they’re given they tend to stick with the status quo, even if they know that what they’re doing (or not doing) is harmful. This much should be obvious since we’re all human.

But what happens when in order to discourage the use of a product, evidence is …shall we say…selectively presented?

We can look to America for an example of this.

For years, public health groups there have been demonising vaping by amplifying possible harmful effects and largely ignoring the benefits for smokers, and then using that imbalanced view to call for a political agenda of far greater restriction.

Despite this, the vape industry continued to grow, smoking continued to decline as smokers switched to vapour products, and kids continued to experiment but not become regular users in significant numbers.

Then, about a year ago The public health focus turned to a product called Juul, a high tech pod system which is sleek, discreet and simple to use.

Unfortunately, those features apparently appeal to kids as much as adults. Who’d have guessed that the adult and young of the same species could like the same things.

What followed was an epidemic of panic.

Almost as one, health departments and organisations across the states turned their sights on Juul. They were rarely out of the news for months. We were told that they were marketing to kids. That flavours are clearly for kids (adults don’t need them apparently).

Several complaints were filed by parents alleging that Juul had addicted their offspring. Even from a viewpoint several thousand miles away, the media hysteria over Juul appeared to reach fever pitch.

Not wishing to be left out, the FDA chimed in with ever more hyperbolic claims of, in Scott Gottlieb’s words, a “tragic epidemic of nicotine use among kids” and threats of extinction if the vapour industry doesn’t come up with a solution.

So, what happened in the real world whilst all this anti-Juul rhetoric was going on? Juul’s estimated value saw a stratospheric increase in the space of just a few months.

Of course, If you’re in the business of advertising to kids, having your product perceived as dangerous and frowned upon by the grown ups in the government would be the perfect hook to appeal to their risk taking and rebellious natures.

You could almost believe it was a clever double bluff by Gottlieb to popularise the safer alternative by demonising it, but apparently not.

In response to an apparent, and if true, perhaps predictable increase in youth vaping, the FDA now intends to impose further restrictions. In Gottlieb’s words, “in light of growing youth use, we may have to narrow the off ramp for adults, to close the on ramp for kids”

Tobacco stocks soared on the news of the regulatory obliteration of the competition. Juul responded by committing corporate suicide.

Compare this to the UK situation where vaping is treated as an opportunity not a threat, and vapers as allies in the effort to reduce the harm of smoking and not as enemies.

A country where at policy level at least, the health and lives of adults are considered valuable, and not something to be sacrificed in order to avoid minimal unproven but theoretical risks to children. After all, there can be few things more harmful to a child than the loss of a parent.

Perception in the context of public health is not just about who’s wrong and who’s right about relative risks. The vast majority of the public are not scientists, so they go with what they perceive to be a trustworthy source of information. But who can you trust when the authorities and experts are so divided?

There is one group of perceptions that stand in the way of progress in harm reduction like no other. They prevent us from engaging, discussing and sharing ideas.

They prevent us from properly considering alternative views and result in ever more entrenched positions. Those are the perceptions which we have of each other.

Some academics, politicians and others who support vaping for harm reduction are under constant attack. Regularly accused of being industry shills, the insults don’t stop there – words like quisling and collaborator are thrown around like confetti at a wedding.

The motives behind this are as transparent as they are lazy – rather than address the substantive arguments they prefer to shift perception to discredit the source. Consumers aren’t immune to this either.

Depending who you ask, vapers are either loudmouthed ill informed trolls who advocate for vaping because we are hopeless nicotine addicts seduced into doing so by our evil overlords, the tobacco industry, or we are experts by experience fighting for our lives and those of people like us.

Actually, most of us are neither of those things for the most part. The vast majority of vapers don’t advocate, or even identify as vapers. They are simply people getting on with their lives who also happen to vape.

This silent majority are mothers, fathers, grandparents, brothers and sisters with ordinary and extraordinary lives to lead but our humanity is often obscured from view when the label of ‘vaper’ is applied.

We become numbers in a dataset, or a trend on a graph, defined more by what we do than who we are. We must never lose sight of the fact that behind every data point is a real person with strengths and weaknesses, desires and ambitions, and that every life is precious.

Engaged vapers see opponents as dogmatic ideologues who are happy to lie in order to win the debate, no matter who is harmed in the process. This comes from years of watching the same people manipulate evidence and publicise conclusions that no honest expert would be expected to come to.

At this point I’d have liked to be able to say that that view is clearly wrong. That the objections raised by opponents are honestly held beliefs and that they say what they do because they want to protect people from harm. I prefer to look for the good in people so I’m sure that’s true of many, but it certainly isn’t true for everyone.

People who care don’t shy away from engagement with the people they claim to care about. They don’t belittle and insult them or attempt to have them excluded from debate.

And they don’t discredit the value of the choices they make in order to stop others making those same choices.

As Martin Dockrell has said in the past, They support people to be as safe as they want to be, and respect their right to decide how to balance the risks and rewards of whatever they choose to do.

It’s easy for those of us engaged in this battle to think that the public is watching from the sidelines waiting to see who will win, but they’re not. They simply glance over every time it gets a bit noisy. Then they shrug their shoulders and say ‘I guess we still don’t know’.

As long as the apparent controversy continues, the public will trust only what they see with their own eyes, and what they see is bans, restrictions, warning labels and something that looks like smoking.

They perceive something dangerous, or at the very least, something antisocial and to be avoided.

They see addicts. Weak willed, social exiles just like smokers. Other people who should be prevented from doing something they don’t like – so who cares if their habit kills them – right? Just so long as they don’t do it near me.

They don’t see people who have given up smoking, or people who enjoy the use of nicotine just as they enjoy their morning coffee. They don’t see people who have given themselves the chance of a longer, healthier life.

Misperceptions are harmful in more ways then one. They breed intolerance, which supports restrictive policy, which in turn creates more misperceptions and more intolerance. Is it any wonder that many smokers don’t see the point of switching.

Those veterans I mentioned at the start say that harm reduction proposals are always met with denial and obstruction at the start but that common sense and pragmatism usually prevails eventually. I do hope they’re right.

But even in the U.K., which is supportive of harm reduction, the battle for hearts and minds is very far from being won.

 Watch the video of Sarah's talk here:

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Created: 14 November 2018

Press Release 15th November 2018

The New Nicotine Alliance calls for a new approach from public health towards vaping and other safer nicotine products

• Warring factions in public health are contributing to confusion and mistrust of effective alternatives to smoking
• If the public’s health is to be properly served by state-funded organisations, accurate and impartial information is key
• Misperceptions are harmful, breed intolerance, and are exacerbated by bans and restrictions on proven safer products
• If public health advocates wish to see further reductions in smoking, public health needs to come together and win over hearts and minds.

Speaking at the E-Cigarette Summit at the Royal Society on 15th November, Sarah Jakes – Chair of the New Nicotine Alliance (NNA) – will call for a new approach towards safer nicotine products.

Along with the increased availability of online information, the public has also been bombarded with less than honest propaganda from ideologically-motivated sources on products which carry a reduced risk, and which have contributed to the lowest smoking prevalence rates in the UK’s history.

“The public need to be able to trust that the information given to us by public health authorities is accurate and complete”, Jakes will say,” the vast majority of the public are not scientists, so they go with what they perceive to be a trustworthy source of information. But who can you trust when the authorities and experts are so divided?”

Jakes will highlight the febrile political debate currently taking place in the US, where truth about vaping has been abandoned in favour of moral posturing which serves no positive purpose for American smokers and urge campaigners to settle their ideological differences for the benefit of those they are tasked to help.

“The vast majority of vapers don’t advocate, or even identify as vapers. They are simply people getting on with their lives who also happen to vape. This silent majority are mothers, fathers, grandparents, brothers and sisters with ordinary and extraordinary lives to lead but our humanity is often obscured from view when the label of ‘vaper’ is applied.

“As long as the apparent controversy continues, the public will trust only what they see with their own eyes, and what they see is bans, restrictions, warning labels and something that looks like smoking.

“Misperceptions are harmful in more ways than one. They breed intolerance, which supports restrictive policy, which in turn creates more misperceptions and more intolerance. Is it any wonder that many smokers don’t see the point of switching?”

Smokers and vapers are not merely numbers in a dataset, or a trend on a graph, they are real people and should not be pawns in a political power game between different factions of the public health community. A new, more sympathetic approach is required.

“We must never lose sight of the fact that behind every data point is a real person with strengths and weaknesses, desires and ambitions,” Jakes will say, “and that every life is precious.

The NNA would like to see a new approach which places the consumer over and above dogma and insular point-scoring, one which treats nicotine users with more respect.

Issued on behalf of the New Nicotine Alliance

Contact: This email address is being protected from spambots. You need JavaScript enabled to view it.

Note to Editors: The New Nicotine Alliance is a charity concerned with improving public health, through a greater understanding of “new” (risk-reduced) nicotine products and their uses.

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Created: 28 September 2018

Press release

The New Nicotine Alliance calls on the UK delegation to promote our country’s remarkable success with safer nicotine products at the World Health Organization’s COP8 summit in Geneva.

• The WHO Framework Convention on Tobacco Control (FCTC) is holding its eighth biennial Conference of the Parties (COP) in Geneva from 1st to 6th October
• The NNA calls on the UK delegation to take this opportunity to raise global awareness about the significant reduction in smoking prevalence enjoyed by this country as a result of light touch regulation of e-cigarettes and other alternatives to smoking
• Developed nations are reaping great dividends from tobacco harm reduction, smokers in less affluent countries have a right to be afforded the same opportunities
• The NNA encourages the UK delegation to resist prohibition of safer nicotine delivery products and reject bans on publicising them

LONDON, 28 September, 2018: The FCTC’s COP8 summit in Geneva presents a great opportunity for UK delegates to promote the UK’s dramatic success with e-cigarettes. The New Nicotine Alliance (NNA) is calling on UK delegates to communicate to global public health representatives the clear and unequivocal message that e-cigarettes and other alternative nicotine products are far safer than combustible tobacco and should be treated as such.

“E-cigarettes are a proven safer alternative to smoking and the UK boasts over 1.7 million former smokers who have converted from combustible tobacco to exclusively vaping instead. In the UK, the government has wisely recognised the significant benefits that tobacco harm reduction strategies can achieve and, as a result of positive messaging towards vaping with campaigns such as Stoptober, has seen smoking prevalence dramatically plummet in recent years.” said NNA Chair Sarah Jakes.

“COP8 is a perfect opportunity for the UK to showcase this success and share our positive experience with the world. How can it be right that developed nations are enjoying great results in reducing the use of combustible tobacco by making safer alternatives available to smokers but sit by as less affluent nations are being railroaded into banning them by the WHO?”

The UK government’s Tobacco Control Plan committed to back innovative products in its drive to encourage smokers to quit, and its recommendations are evidence-based and designed to maximise the benefits of safer nicotine delivery. The World Health Organization recognises tobacco harm reduction as a guiding principle of its Framework Convention on Tobacco Control, so it is quite wrong that it currently invites nations to prohibit use of these products.

“The WHO likes to talk about the right to health, but why is a smoker in India or Africa less entitled to access products which could help them quit smoking than a smoker in the UK or Canada?”, said Jakes, “Furthermore, we have heard worrying reports that the EU is planning to petition the FCTC to call for a global ban on e-cigarette advertising. It would be scandalous if the UK delegation is complicit in such an unwise move and goes against the government’s commitment to improve availability of innovative products. What is the point of talking positively of safer alternatives while simultaneously stopping smokers from seeing any publicity about them?

“In Geneva, the UK’s representatives have a golden opportunity to promote the UK’s success with safer nicotine products. We provide the FCTC with generous funding to reduce smoking rates in underdeveloped nations. We would therefore urge the government to use the influence our financial contribution brings and do the right thing. That is to reject prohibition of harm reduction which less affluent nations feel obliged to implement due to WHO misinformation, urge the FCTC to adhere to its own articles on the subject, and resist restrictions on promotion of less harmful alternatives to smoking”

Issued on behalf of the New Nicotine Alliance

Sources

1.7 million e-cigarette users in the UK are ex smokers
ASH Fact Sheet: Use of e-cigarettes (vapourisers) among adults in Great Britain, September 2018, accessed via “New data shows smokers are getting the message on e-cigarettes” http://ash.org.uk/media-and-news/press-releases-media-and-news/ash-news-release-new-data-shows-smokers-are-getting-the-message-on-e-cigarettes/

UK Tobacco Control Plan: “Backing evidence based innovations to support quitting” (page 5) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/630217/Towards_a_Smoke_free_Generation_-_A_Tobacco_Control_Plan_for_England_2017-2022__2_.pdf  

The EU throws vapers under the bus again
https://velvetgloveironfist.blogspot.com/2018/09/the-eu-throws-vapers-under-bus-again.html  

£15 million contribution to FCTC
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/639372/FCTC_2030.pdf

WHO recognises tobacco harm reduction as a guiding principle of FCTC
Article 1(d) of the FCTC
http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf

Details

Created: 16 August 2018

Embargoed to 00:01 BST on 17th August 2018

The New Nicotine Alliance warmly welcomes the Science and Technology Committee’s report on e-cigarettes as a “beacon of enlightenment” for public health

• The Committee is right to highlight misconceptions surrounding e-cigarettes and the NNA echoes the Committee’s call for risk-based regulation to encourage more smokers to switch to safer nicotine products
• Streamlining MHRA processes for approving medically licensed products and permitting vaping in mental health facilities by default are brave proposals that could have a dramatic positive effect on how the public views their relative safety
• Public perception of the benefits of vaping has stalled, so the NNA welcomes the Committee’s recommendations to liberalise advertising rules to allow health claims and its call for the benefits of e-cigarettes to be recognised by allowing their use more widely
• The Committee’s proposals to review provisions in the Tobacco and Related Products Regulations, to include heated tobacco products in the Government’s annual review of safer nicotine products, and its call for a review on the evidence supporting the ban on snus are also greatly welcomed

LONDON, August 17nd, 2018: The Government’s Science and Technology Committee – chaired by Sir Norman Lamb – today released a report on e-cigarettes containing several evidence-based policy proposals which would positively transform the way vaping is viewed by businesses, institutions and the public alike.

The New Nicotine Alliance (NNA) warmly welcomes this report for its clear and unequivocal message that e-cigarettes and other alternative nicotine products are far safer than combustible tobacco and should be treated as such.

“E-cigarettes are a proven safer alternative to smoking and the UK boasts 1.5 million former smokers who have converted from combustible tobacco to exclusively vaping instead. The Science and Technology Committee has wisely recognised that misconceptions about e-cigarettes are threatening further progress in encouraging their use by smokers who choose to quit.” said NNA Chair Sarah Jakes.

“We welcome the Committee’s call for a root and branch review of how risk-reduced products are treated by businesses, institutions and government itself. The report is a beacon of enlightenment in an area of public health which is often burdened by dogma and outdated thinking towards the use of nicotine.

“This report dovetails with the government’s Tobacco Control Plan commitment to back innovative products in its drive to encourage smokers to quit, and its recommendations are evidence-based and designed to maximise the benefits of safer nicotine delivery. The World Health Organisation recognises tobacco harm reduction as a guiding principle of its Framework Convention on Tobacco Control, so we welcome the Committee’s call for the UK to become an even greater world leader in this field than is already the case.”

“There is a lot of confusion about e-cigarettes amongst the public, health institutions and businesses”, said Jakes, “this report is therefore timely and could have hugely positive implications for public health if its recommendations are implemented in full. Sir Norman’s committee has done an excellent job of peering through the mist of misunderstanding surrounding e-cigarettes and its policy proposals can go a long way to dispel the - often deliberately fabricated - misconceptions that are deterring many thousands of smokers from switching. We would urge the government to read the Committee’s findings carefully and act on them without delay”

Issued on behalf of the New Nicotine Alliance

Contact:
This email address is being protected from spambots. You need JavaScript enabled to view it.

Note to Editors: The NNA is a registered UK charity staffed by consumer volunteers, formed to increase understanding about the benefits of “new” (risk-reduced) nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation.

Sources

Committee Report: House of Commons Science and Technology Committee “E-cigarettes - Seventh Report of Session 2017–19” 
https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/505/505.pdf

Promote e-cigarettes widely as substitute for smoking (Royal College of Physicians)
https://www.rcplondon.ac.uk/news/promote-e-cigarettes-widely-substitute-smoking-says-new-rcp-report

UK Tobacco Control Plan: “Backing evidence based innovations to support quitting” (page 5)
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/630217/Towards_a_Smoke_free_Generation_-_A_Tobacco_Control_Plan_for_England_2017-2022__2_.pdf

Increased public misperceptions about nicotine as harmful
Public Health England, Evidence review of e-cigarettes and heated tobacco products - McNeill A, Brose LS, Calder R, Bauld L & Robson D (2018). https://www.gov.uk/government/news/phe-publishes-independent-expert-e-cigarettes-evidence-review

Article 1(d) of the FCTC http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf

Details

Created: 16 August 2018

Tobacco Policy: Commons Committee Urges Review Of Snus Ban

Embargo 00.01 Friday 17 August 2018

• Commons Committee says government should reassess the ban on snus
• The oral tobacco product has seen smoking rates in Sweden fall to 5%
• Scientists describe the ban as “entirely disproportionate”
• UK users of snus say it keeps them from smoking deadly cigarettes
• Department of Health wants the ban to continue

A House of Commons Select Committee has urged the government to consider ending the 28 year old ban [1] on the oral tobacco product snus.

The Science and Technology Committee called for “an evidence-based assessment of the case for discontinuing the ban on ‘snus’ oral tobacco” to go alongside a comprehensive review of e-cigarette regulation. [2]

Snus is banned across the EU but its use in Scandinavia has been accompanied by huge reductions in smoking. In Sweden, which has an exemption from the EU ban, the smoking rate has plummeted to 5% - by far the lowest in the EU. [3] Snus is used by 20% of Swedish adults [4] and the country has the lowest level of tobacco-related deaths in Europe according to World Health Organisation figures. [5] In neighbouring Norway the smoking rate among young women has fallen from 30% to just 1% over the last 16 years. [6]

A succession of scientific reports [7] has found no evidence of mortality associated with snus use - including no link to oral cancer. [8] Action on Smoking and Heath says snus is “over 100 times less harmful” than smoking [9] and the World Health Organisation also regards it as far safer. [10]

Professor Riccardo Polosa, who gave oral evidence to the Select Committee, said that “there is a strong consensus among the scientific community that the ban on snus is entirely disproportionate. Without a shadow of a doubt snus is vastly safer than smoking.” [11]

Snus can be legally used in the UK but not sold. This has led to a lot of users importing it themselves including Premier League footballers [12] and Scandinavians living in the UK.

“I am very excited by the possible end of the snus ban. Snus has saved my life,” says Nikki Hallam who has used snus for the last two years. “Snus is the only thing which keeps me from going back to smoking,” she added.

Many non-Scandinavians also bring snus into the UK: “As soon as I get to the US where the FDA has authorised snus I buy an armful of tins which help keep me off the fags when I’m back in the UK” says Neil McLaren who lives in Kent and is the co-founder of Vaping. com.

Professor Gerry Stimson of the New Nicotine Alliance charity said: “This report is a milestone for harm reduction pointing the way to pragmatic, proportionate regulation of e-cigarettes. It is also the beginning of the end for the grotesque mistake of banning snus which has been hugely successful in reducing smoking and saving lives.” [13]

The European Court of Justice is currently reviewing the EU ban on snus. [14] The Department of Health told the Commons Committee that it opposed the EU legalising snus because of “controversy”. [15] Chewed tobacco which is used by half a million South Asians in the UK remains legal despite it being highly carcinogenic. [16]

Issued on behalf of the New Nicotine Alliance

Contact

This email address is being protected from spambots. You need JavaScript enabled to view it.

Sources

[1] Snus Ban: It was banned in the UK in 1990 and the EU in 1992. Sweden had an exemption when it joined the EU in 1995. https://www.legislation.gov.uk/uksi/1989/2347/introduction/made
http://europa.eu/rapid/press-release_MEMO-14-134_en.htm
[2] Committee Report: House of Commons Science and Technology Committee “E-cigarettes - Seventh Report of Session 2017–19”: snus is mentioned on page 4 https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/505/505.pdf
[3] Sweden Smoking Fall: Daily smoking fell in Sweden from 8% to 5% over the last three years. See page 27 of EU Eurobarometer 2017. http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2146
[4] Sweden Snus Use: Snus is legal in Sweden and 20% of people are daily users of oral/chewed/nasal tobacco. See footnote on page 73 of EU Eurobarometer 2017. http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2146
[5] Sweden Lowest Tobacco Mortality in Europe: Lars Ramström, Institute for Tobacco Studies, Sweden. Sweden’s pathway to Europe’s lowest level of tobacco-related mortality. Data from The Global Burden of Diseases, Injuries, and Risk Factors Study 2016, Lancet 2017; 390: 1345–422
[6] Norway 1% smoking rate: among young women smoking fell from 30% to 1% in sixteen years: Norwegian Smoking Data (select data using tick icons and then download to Excel). https://www.ssb.no/en/statbank/table/05307/?rxid=fba52324-e745-43b1-8740-058b118535f6
[7] Snus Health Impact: The Lancet: Global Burden of Disease Study, 2017: No evidence of harm being done by long-term use of snus ”for any health outcome” See page 1364: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32366-8.pdf . Epidemiology: Two academic studies have shown that if snus were available in the rest of Europe it could save between 200,000 and 355,000 lives every year. Brad Rodu, 2004 https://www.ncbi.nlm.nih.gov/pubmed/15074568 Snus Commission report, 2017 http://snuskommissionen.se/wp-content/uploads/2017/06/Snuskommissionen_rapport3_eng_PRINT.pdf
[8] Oral cancer: for snus “no overall association is seen for oropharyngeal cancer”. See section 3.1 Regulatory Toxicology and Pharmacology: https://www.ncbi.nlm.nih.gov/pubmed/21163315
[9] Action on Smoking and Health: “the contradictory, illogical law on tobacco… leaves cigarettes legal while snus, which is over 100 times less harmful, is banned.” http://ash.org.uk/media-and-news/press-releases-media-and-news/eu-ruling-on-smokeless-tobacco-shows-need-for-independent-tobacco-regulation/
[10] World Health Organisation: Swedish snus is “considerably less hazardous than cigarettes”. Page 273 http://www.who.int/tobacco/global_interaction/tobreg/publications/9789241209519.pdf
[11] Professor Polosa Biography: https://www.e-cigarette-summit.com/speaker/professor-riccardo-polosa/
[12] Football: Jamie Vardy: snus use https://www.mirror.co.uk/sport/football/news/jamie-vardy-pictured-chewing-tobacco-81893422 Charlie Adams says snus is prevalent amongst footballers: https://www.bbc.co.uk/sport/football/43598615
[13] Professor Gerry Stimson: https://nnalliance.org/nna-uk/board/67-stimson-gerry
[14] European Court of Justice asked to lift ban on snus. Latest proceedings: https://uk.reuters.com/article/us-europe-court-swedish-match/eu-court-adviser-says-ban-on-swedish-snuff-tobacco-product-valid-idUKKBN1HJ11G
[15] Department of Health Back EU Ban: Committee Report: House of Commons Science and Technology Committee “E-cigarettes - Seventh Report of Session 2017–19”: see paragraph 76 on page 33 https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/505/505.pdf
[16] Chewed Tobacco Risks: Government chemist shows harmful chemicals: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563632/ Also: South Asian women suffer 3.7 times more oral cancer than non-South Asians: https://www.nature.com/articles/6604191