Welcome from the Chair
Welcome and summary of UK developments including the RCP and PHE reports
- Professor Ann McNeill Professor of Tobacco Addiction - UK Centre for Tobacco and Alcohol Studies (UKCTAS), Kings College London
Welcome and summary of UK developments including the RCP and PHE reports
Probably the most important public health research question relating to e-cigarettes is what has been their impact on smoking prevalence and factors that contribute to this: smoking uptake and smoking cessation. This presentation summarises findings from a direct test of hypotheses concerning how changes in prevalence of e-cigarette use have impacted on key smoking cessation activities and outcomes, and smoking prevalence. It uses data from the Smoking Toolkit Study, a series of monthly household surveys of representative samples of the population of England aged 16+ years and time series analyses to assess how far changes in prevalence of use of e-cigarettes while smoking and in quit attempts are associated with changes in quit success rates, quit attempts, use of other aids to quitting such as the stop-smoking services, and smoking prevalence
Literature on e-cigarettes is plagued by misreporting. It is not unusual to see press releases with conclusions that have no relationship to study content; or even conclusions that claim the opposite of what the study actually found. Some common ‘tricks of the trade’ will be highlighted that enable use of innocuous or irrelevant findings to call for hostile e-cigarette regulation and to warn smokers against vaping. A checklist will be suggested for reviewers and journals handling submissions presenting data on e-cigarettes
E-cigarettes and other new types of nicotine vaporizers are alleged, or feared, to be a gateway to smoking in people who would not otherwise have smoked; consequently, regulators impose restrictions on e-cigarette design, content, use and marketing, with the aim of preventing gateway effects. We examine whether the gateway theory has value, whether the criteria to establish causality are met, and what type of evidence would be required to test this theory.
The emergence of e-cigarettes presents a challenge for doctors in helping their patients wanting to quit smoking. It is normal business for doctors to work with medically licensed products and to discuss the risks and benefits of treatments based on evidence of effectiveness. Yet research on e-cigarettes and discussions about the best way to regulate them is not keeping pace with their development and increasing levels of use. So what should a doctor be advising their patient? In the absence of any medically licensed product, what role do consumer-regulated products play in supporting smoking cessation? What advice should be given to parents concerned about their children experimenting or using e-cigarettes?
Decisions and opinions, whether personal or official, should ideally be informed by evidence combined with values. This means we need balanced communication of evidence, which is not framed or selected to arouse a particular emotion or persuade in one direction. But evidence that is relevant to individuals comprises more than science and statistics - it might also include information on what others think, whether authorities have addressed public concerns, and whether ‘experts’ share your values. It is particularly important to acknowledge this wider idea of evidence in contested areas, such as GMOs and fracking. Using this perspective, I will look at evidence communication for both e-cigarettes and other areas of contested science.
Self-titration (compensatory puffing behaviour) with lower nicotine yield cigarettes is well documented in the tobacco literature. The extent to which vapers are able to self-titrate has received little attention. With the recent implementation of the article 20 of TPD which stipulates a upper cut off of 20mg/mL nicotine concentration in e-liquids, many users will be obliged to reduce the nicotine content in their e-liquid. This session will present new data on the effects of switching to a lower nicotine concentration e-liquid on nicotine delivery, puffing behaviour and subjective effects.
Why do people smoke? We know that it is largely for the nicotine, and that tobacco in the form of cigarettes delivers nicotine very rapidly, together with other compounds that enhance its effects. However, different nicotine-containing products (including e-cigarettes, but also heat-not-burn and smokeless products) differ dramatically in the levels of harm associated with their use. Whether these products are likely to have a net beneficial impact on public health depends on a number of factors, including how effectively they help people switch from cigarettes, but also their relative harm compared to cigarettes.
Many of the concerns around e-cigarette relates to the impact and role of nicotine use, not just on health but also in the behaviour and intentions of users. This session will look at the questions surrounding e-cigarettes and nicotine use and also explore the opportunities that they may offer for tobacco control.
There is a lot of discussion about the application of the precautionary principle to ban use of e-cigarettes in closed public places. Passive exposure was one of the issues presented in the recent WHO report on e-cigarettes, to be discussed at COP-7, accompanied by a recommendation to prohibit by law the use of e-cigarettes in indoor spaces or at least where smoking is not permitted. This session will present current evidence on passive exposure and discuss whether it is justified to use the precautionary principle and apply restrictions to the use of e-cigarettes.
Electronic cigarettes (ECs) are gaining ground on conventional cigarettes due to their efficiency in reducing tobacco consumption, competitive prices, and the perception that they are a much less harmful smoking alternative.
Demonstration that EC use leads to reduction in smoking-related diseases will take many decades before the tobacco harm reduction potential of this products is confirmed
Nonetheless, changes in health outcomes can be measured in smokers switching to ECs. Acute studies do not appear to support negative health outcomes in EC users and findings from long-term evaluation of regular EC use are supportive of reversal of harm from tobacco smoking
In a watershed year for the E-Cigarette Industry in terms of regulation and continued consumer demand, this session will provide a synopsis of the global status of this disruptive market, with a look at incidence rate in key markets and growth prospects in a newly regulated environment, setting the scene for the afternoon's sessions.
As the UK completes its implementation of the TPD the DoH will provide a brief overview of the process including what the UK could do in the future.
This briefing session will cover CAP and BCAP’s consultation on reflecting the TPD and the Tobacco and Related Products Regulations in their Codes. The session will look at the nature of the advertising prohibitions and key issues raised in the consultation such as the effect of the prohibitions and the guidance that B/CAP will be producing
This session will cover progress on implementing the notification scheme for consumer products, what this will mean in the market over the next few months and how the MHRA monitor safety. It will also provide an update on the current status for medicines regulation
This session will provide an industry perspective on why a vibrant and competitive non tobacco owned independent vaping sector is important to consumers and ultimately public health. The independent UK vaping industry is one of the most established in the world and a primary vehicle in the UK’s successes to date in supporting smokers’ transition. This success is despite the regulatory uncertainty and often conflicting information surrounding vaping products. This session will present the argument that working together with relevant regulatory bodies and wider stakeholders, a suitably regulated and responsible independent industry base is vital if the full transformational potential of vaping is to be delivered
The tobacco industry has a history of distorting and even undermining academic science that is counter to its business interests. But with the changing regulatory environment, discussion and debate has increased about whether scientists dedicated to tobacco control should engage in any fashion with the tobacco industry. In this session, we will explore questions about academic scientist interaction with the tobacco industry (eg unpaid consulting, conference attendance), conducting research funded directly or indirectly by the tobacco industry, and publication of tobacco industry-funded science. Those questions and others will be explored in the context of an evolving environment where tobacco industry products are already approved to use for smoking cessation and could be approved as reduced harm products
Has “harm reduction” lost sight of public health? Martin Dockrell takes stock of some of the history and controversies in tobacco harm reduction and assesses tobacco harm reduction through the lens of public health, where it has come from and where it needs to go.
Tobacco harm reduction approaches are a priority for adult smokers who find it difficult to stop smoking but there are many barriers to providing e-cigarette access to groups such as cancer patients undergoing treatment, adults being treated for long standing mental health conditions, prisoners and pregnant women, amongst others. However, research is now underway to explore the promise that e-cigarettes may hold for all these groups. This presentation will describe the latest data from the UK and elsewhere on e-cigarette use in these groups and outline the studies that are underway to improve access and outcomes. Persuading research funders, health professionals and the public of the merits of this type of research is not easy but progress is being made. Emerging results, key questions for future studies and the importance of capacity-building for this type of research will be discussed.
Louise Ross, Stop Smoking Service Manager for Leicester City Council, talks about the impact that switching to vaping can have on some of the most vulnerable people in the city. The rules about what stop smoking services can and can’t do remain unclear, but Leicester has shown that not waiting for clarity can change people’s lives within weeks
Putting UK nicotine regulation in a global context following the WHO Framework Convention on Tobacco Control Conference of the Parties (COP) meeting in India which will have finished the week before the conference. Parties to the Treaty present at the COP include all EU Member States and all but 18 UN members covering over 80% of the world population. On the agenda for discussion by the 180 Parties to the Treaty is a WHO paper which puts forward regulatory options for Parties to the Treaty to consider. Reporting back on the outcomes and implications for e-cigarettes and nicotine products
Synopsis to follow
The duty of an Attorney General is to act as gatekeeper and steward for consumer protection and ensure that the best scientific knowledge is clearly and accurately communicated to the public so that they can make informed decisions. In this session Tom Miller will question whether consumers are being given accurate scientific information to support them in making an informed decision on the potential and relative harm of e-cigarettes and what the legal position could be. He will also explore the different perspectives that the USA and UK have on nicotine and tobacco harm reduction and ask what lessons can be mutually learned.