"I think this represents a new worldwide high point in the blending of evidence with empathy in official public health advice…"
Those were the words of Clive Bates on his excellent blog 'The Counterfactual' upon reading the new briefing for UK Stop Smoking Services from the National Centre for Smoking Cessation Training. We couldn't agree more.
Following an invitation from Nicola Hill, Stop Smoking Services Manager for the North East London NHS Foundation Trust, I attended their team meeting on the 19th of January to talk about e-cigarettes. In a refreshing change from my usual trog halfway across the country this one is local to me - it's good to see my local services finally taking an interest.
The meeting room was small, but packed with enthusiastic advisors from the two centres which provide services for NELFT. Discussions took place in a 'round table' setting, with me opening by telling the story of my journey from smoking to vaping, then explaining the different types of devices available and their use. There was then an opportunity for advisors to get 'hands on' with the demonstration devices I had brought with me before a lively Q & A ensued. I think we overran our allotted time by some considerable margin!
Some good questions were asked about a variety of topics, including the potential for harm to bystanders, youth uptake and long term use. On the whole the meeting was very positive, and I hope it was as enjoyable and useful for them as it was for me.
In a new study published in the journal Tobacco Control a group of scientists have examined how use of e-cigarettes is related to subsequent smoking behaviour, subsequently reporting that those who use e-cigarettes are more likely to start smoking cigarettes. This new study has once again garnered the attention of the media.
Everyone who attended the last Glasgow School of Vape agreed that it was a terrific event. There was something for everyone, from new vapers to experienced enthusiasts. Many of us have been badgering the organiser of the events to give us a repeat performance. Well that is about to happen and here are the details..........
NNA is seriously concerned at the lack of scientific rigour and absence of peer review of the paper ‘E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis’ published in the Lancet Respiratory Medicine journal. It makes assertions based on wildly unfounded assumptions drawn from data and serves only to heighten fears amongst smokers considering switching to the much safer practice of vaping.
We strongly recommend that everyone read the views on the piece expressed by a group of leading scientists published by the Science Media Centre - http://www.sciencemediacentre.org/expert-reaction-to-meta-analysis-looking-at-e-cigarette-use-and-smoking-cessation/
We believe the publication by the Lancet is irresponsible and not in the interests of either individual or public health.
A new study released in the January 2016 volume of Oral Oncology has garnered attention in the media. Unfortunately the attention it has garnered highlights several misleading points from the study leading to headlines in on-line media that will create a severely negative impression. After reading the study alongside the press releases, several things become abundantly clear.
After the E-Cigarette Summit and the Maudsley update of 2014 it was evident from the research presented that e-cigs were not only the chosen product that smokers were engaging with to help them become smokefree but we now had enough evidence to say that they were effective.
Report from National Assembly for Wales Health and Social Care Committee on Public Health (Wales) Bill
The NNA is disappointed to see, in the report released today, that the Welsh Health and Social Care Committee (http://www.assembly.wales/laid%20documents/cr-ld10456/cr-ld10456-e.pdf) has failed to make a concrete recommendation to remove the proposal to ban electronic cigarette use in enclosed public spaces from the Public Health (Wales) Bill. The lengthy content of the report clearly demonstrates the split in opinion between Labour and opposition AM’s despite overwhelming evidence against any proposed ban provided by the leading experts in the field of tobacco harm reduction. We will now watch the plenary debate on the 8th December with interest for possible amendments to the Bill.
No compelling evidence is put forward by the Welsh Government to proceed with the ban. The proposals relating to nicotine products will not contribute to improving public health in Wales – rather, the opposite.
Usage bans are not a matter for government, but for individual business and premises managers to decide for themselves whether to allow the use of e-cigarettes on their property. Smokers who wish to switch to safer products should be supported and encouraged to do so.
The Welsh Government aims to reduce smoking prevalence to 16% by 2020. This will not be achieved without embracing and supporting tobacco harm reduction products. Policies should ensure that those who choose to use e-cigarettes to help them quit are supported rather than prevented in their choice of how to quit smoking. Simon Thurlow, Trustee of NNA said ‘Bans act as a deterrent to those who wish to quit smoking by vaping, and stigmatises e-cigarette users in the same way that smokers are stigmatised’.
Why it is wrong to ban the use of e-cigarettes in public enclosed spaces
Smoke free legislation was enacted in order to protect employees and the public from the harmful effects of second hand smoke. With e-cigarettes there is no combustion and therefore no smoke. There is no evidence of any potential for harm to bystanders from e-cigarette use.
Compliance with existing smoke free legislation is high, and the use of e-cigarettes does not undermine this. E-cigarettes are easily distinguishable from tobacco cigarettes by appearance and smell. The general public is well acquainted with e-cigarettes and there is little chance of confusion by premises’ staff. The ability to use an e-cigarette where smoking is not permitted gives smokers a legal alternative and will assist in delivering greater compliance with smoke-free legislation.
Use of e-cigarettes differs from smoking tobacco cigarettes. Nicotine delivery is lower from e-cigarettes than tobacco cigarettes. A smoker will smoke an entire cigarette in a few minutes and then not again until nicotine levels have dropped. An e-cigarette user takes a few puffs every few minutes to keep nicotine levels up and prevent cravings. Forcing e-cigarette users to go outside to vape, where they will be among smokers and in time limited situations, may encourage them to relapse to smoking.
Sarah Jakes of NNA said ‘The ability to use e-cigarettes in enclosed public spaces is important in many smokers’ decision to try e-cigarettes, and leads many to switch completely. A ban discourages smokers from making the complete switch to the safer alternative’.
Contact: Simon Thurlow
30 Nov 2015
NNA1 is very concerned by the latest attempt by Jonathon Gornall, writing in the British Medical Journal2 , to undermine the report commissioned and published in August by Public Health England on the subject of e-cigarettes3.
There is no doubt that smoking is a harmful activity, however people smoke for the nicotine but die from the tar which is a by product of combustion. E-cigarettes and other harm reduced nicotine products have the potential to be a massive public health prize if smokers can be given the confidence to switch to them. In their recent evidence based report PHE estimate that e-cigarettes are 95% safer than smoking. Recent surveys however, have clearly shown that there are a significant and increasing number of people who incorrectly assess the relative safety of e-cigarettes as being overly harmful when compared to smoking traditional cigarettes4 . This misperception has the potential to cause real harm to those smokers who might otherwise switch.
Criticism of the report based on quibbles over the 95% figure and tenuous insinuations of conflicts of interest in relation to some of the authors of one study out of the 180 cited within it do nothing but create doubt in the public mind, which discourages smokers from switching to the safer product and ultimately, harms their health.
Lorien Jollye, Trustee of the New Nicotine Alliance and a vaper said:
“Whilst it is of course important to ensure that information such as the PHE estimate that e-cigarettes are 95% safer than smoking is as accurate as possible based on current evidence, it is more important still that consumers understand the message being put forward. This means that messaging must be clear and unambiguous and framed within their personal experience. This is what the PHE report sought to achieve”
Sarah Jakes, Trustee of the New Nicotine Alliance and a vaper said:
“As Professors of Public Health, scientists and journalists fight out their battles through the pages of scientific journals and newspapers, smokers and vapers are left unsure about how these products may benefit them. The negative health impact that such confusion brings to every smoker who is discouraged by it should weigh heavily on the conscience of all of those who put pen to paper without considering the consequences of their words.”
1. NNA is the New Nicotine Alliance (UK), a UK registered charity which is concerned with improving public health, through a greater understanding of “new” (risk-reduced) nicotine products and their uses. 6 out of 8 of the trustees of the charity are ex-smokers who have switched to using e-cigarettes. NNA has no ties or affiliations with any nicotine industry including the tobacco, pharmaceutical or e-cigarette industries.
2. Public Health England’s troubled trail: http://www.bmj.com/content/351/bmj.h5826
3. E-cigarettes: An Evidence Update: Link to report in PDF format
The Sun newspaper, closely followed by several other publications, ran a story on the 21st of October with the natty headline: "Vaping Burnt a Hole in My Lungs". We will not fall into the obvious clickbait trap by linking to it, if you saw it you will know the story we mean.
If you are a new vaper, or a smoker considering switching to e-cigarettes and are concerned about this story, fear not. It is completely impossible for an e-cigarette to burn a hole in your lung in the way described in the story, or indeed in any other way. Please feel free to contact us via this site if you are still concerned.
Following on from the successful launch of The Glasgow School of Vape earlier this year, Colin Robertson has come up trumps with a new venue at the Drury Bar and Kitchen just across the road from Glasgow Central Station, starting at 2pm on Sunday 30th August and running on to 10pm .......
The New Nicotine Alliance (NNA) welcomes the publication of ‘E-cigarettes: an evidence update’, a report commissioned by Public Health England, and we also welcome the extensive guidance and advice which arises from it.
The report, with its focus on the best available evidence and authored by Professor Ann McNeil (Kings College London) and Professor Peter Hajek (Queen Mary University London) will help counter much of the misinformation generated in the media by previous poorly designed studies, and by those with a prohibitionist agenda, which has lead to confusion and fear in the public mind as to the relative safety of these products. This has no doubt discouraged many smokers from switching to the safer products, and encouraged overly restrictive policies among employers and other decision makers to the detriment of the health of the smokers who might otherwise have benefitted.
Sarah Jakes – Secretary of the New Nicotine Alliance – says ‘This report confirms the weight of scientific evidence, and the experience of millions of consumers – that e-cigarettes save lives. The message is clear – e-cigarettes help people exit from smoking’.
The report concludes that e-cigarettes are around 95% less harmful than smoking tobacco. It highlights concerns that an increasingly large number of people incorrectly believe that e-cigarettes are equally or more harmful than smoking, and that almost half the population do not realise that in fact e-cigarettes are much less harmful than smoking. It also finds that there is no evidence so far that e-cigarettes are acting as a route to smoking for children or non smokers.
Prof Gerry Stimson – Chair of the New Nicotine Alliance and Emeritus Professor at Imperial College London commented that ‘Public Health England is taking the global lead in seeing the value of e-cigarettes to reduce the toll from smoking. It’s time for an end to scaremongering and for public health leaders – in the UK and globally – to support this consumer-led solution to a pressing public health issue.’
Based on the findings of the review PHE has issued wide ranging advice including that:
PHE has also called on local stop smoking services to engage actively with smokers who want to quit by using e-cigarettes, and for health and social care providers to provide accurate information on the relative risks of smoking and vaping.
On the 13th of August the Royal Society for Public Health published a new report entitled "Stopping Smoking by Using Other Sources of Nicotine", which can be read in detail here: RSPH Report (PDF)
NNA welcomes policy proposals which would serve to encourage smokers to switch from smoking to harm reduced products such as ecigs or snus. We do not believe that an extension of the current smoking ban in enclosed public spaces to outside spaces will be effective, and may in fact be counterproductive. Whilst enclosed space bans were a popular measure with the non smoking public, and even many smokers who appreciated the discomfort indoor smoking can cause non-smokers, outdoor bans serve no demonstrable health benefits and will be seen as an infringement on the choice to smoke which many will no doubt resist.
Choice is a key factor in the success of e-cigarettes as a harm reduction method because consumers feel empowered by the fact that they have taken ownership of their own health in a way that was not previously available to them. The substitution of choice with coercion and the inevitable stigmatism which outdoor bans will bring will erode this significant advantage. Public health policies in this area should aim to stimulate behaviour change through the provision of education and accurate information about nicotine and tobacco harm reduction, and to ensure that regulation does not stifle or discourage consumers' efforts to live a more healthy life should they choose to do so. Policies should be framed to encourage change in behaviour, rather than be about forcing change via increasing prohibition and general disapproval, which is likely to simply breed resistance and antagonism.
There is much to be applauded in the RSPH report. We wholeheartedly support their call for a better understanding about nicotine and the relative safety of harm reduced products such as e-cigarettes. The fact that (according to the RSPH survey) 69% of smokers do not know that NRT products are less dangerous than cigarettes is alarming. More alarming still is the fact that according to the most recent ONS data, 20% of people incorrectly believe that e-cigarettes are as dangerous as smoking regular cigarettes, and this percentage has increased from 6% in 2012. This is a monumental failure in public health messaging and there will undoubtedly be costs in terms of lives and health if the public misconceptions on this subject remain uncorrected. The fact that the use of e-cigarettes is at least 95% safer than smoking should be prominent in the minds of smokers everywhere.
We also welcome the RSPH's call for greater utilisation of e-cigarettes as a tool in the armoury of Smoking Cessation Services. Without doubt there are smokers for whom e-cigarettes might be effective as a cessation device, but who lack the confidence to try them without support. We believe it is essential that services do not discourage the use of e-cigarettes, and further, that advisors should be equipped with the knowledge and resources they require to be able to support service users who choose to try to quit smoking using e-cigarettes. This will ensure that clients are given the best possible chance of success. NNA has considerable experience in this area and is already working with a number of services to achieve this end.
Legislators in Tasmania are holding a public consultation on e-cigarettes. NNA joined forces with Clive Bates to submit a resonse in an effort to head off wildly inappropriate and overly burdonsome regulation. You can read our response here.
The UK Nicotine & Smoking Cessation Conference is the world's largest event for the smoking cessation field, and the conference in 2015 again brought world-class speakers to present and discuss the very latest in clinical, research and policy developments. Held at the Manchester Hilton, NNA associates Andy McEwen and Andrew Preston were part of the organisation team for the event and ensured we had a presence.
Today the media has been flooded with the news that the Welsh Government plans to introduce a ban on vaping in enclosed public spaces. This has led to a slew of scaremongering and misinformation which is a subject probably best left to another article. NNA believes that the proposed ban in Wales is unjustified, misguided and will lead to harm, not only for vapers, but for smokers who will be discouraged from switching to a safer product. The ban is unlikely to come into force before 2017 and it is important that we all understand the legislative process in order to effectively fight this policy. NNA trustee Simon Thurlow has been involved with fighting these proposals from the start. Here he describes the next steps:
The Global Forum on Nicotine returned to Warsaw for two days on the 5th and 6th of June. Would it be possible to match the success of last year? Most of our trustees attended, here Sarah Jakes gives her personal thoughts on the event.
In what is expected to be a first of it's kind, Glasgow is to see the launch a new "School of Vape" event on 3rd May 2015. This is a new concept in Vape Meets and is the branchild of Colin Robertson, a vaper of 18 months standing.
Are you a new e-cigarette user, thinking of trying one or a business supplying new users? If so, Lynne Dawkins needs you. A survey is being conducted by researchers in the School of Psychology at the University of East London (UEL) in collaboration with Queen Mary University of London and the University of Geneva into the patterns of electronic cigarette use in new users over 12 months.