Registration and refreshments
We will be starting at 8.55am sharp, so please ensure you arrive in plenty of time to collect your badge
We will be starting at 8.55am sharp, so please ensure you arrive in plenty of time to collect your badge
Six out of the ten countries with the highest rate for smoking related deaths are in Asia and yet the climate for tobacco harm reduction is predominantly hostile. Progress towards acceptance of tobacco harm reduction consequently lags behind that seen in other countries. This session will explore the main challenges and barriers facing this diverse region which are related to political, economic, scientific, regulatory, cultural and social factors. The session will also address how these challenges might be overcome in the future through international solidarity, goodwill and collaboration. While there are unique challenges facing developing countries in Asia, some common challenges with other countries exist and collectively addressing them would benefit greatly from the sharing of experiences in other, mostly developed countries.
Since the release in February 2018 of the American Cancer Society Position Statement on Electronic Cigarettes, the landscape for vaping products has changed dramatically in the US and the controversy surrounding these products has grown more fraught. This presentation will discuss what is happening in the US and what this could mean for the harm reduction conversation in America. Cliff Douglas will explore the main controversies and consider how skyrocketing youth vaping has changed the dialogue. Specifically, this session will explore
Finally, this session will ask how these issues are being addressed in relationship to combustible tobacco product use, both for youth and adults
In November 2018 US Food and Drug Administration announced restrictions on e-cigarette manufacturers in response to a perceived epidemic of e-cigarette use among high school students. This session will explore if the NYTS data support claims of a new epidemic of nicotine addiction stemming from use of e-cigarettes or concerns that declines in youth tobacco addiction are being reversed after years of progress.
The ASH Smokefree GB survey is the longest running survey of adult and youth e-cigarette use, providing the most up to date evidence available on how vaping is evolving in Britain. The most recent data from Action on Smoking and Health (ASH) shows that as vaping has increased smoking has continued to decline, although as a cross-sectional survey it cannot prove causality. In 2019 around half as many Britons now vape as smoke, and the majority are ex-smokers. Although e-cigarettes are now the most popular quitting aid, the survey finds that in 2019 over a third of the 7.2 million smokers in the UK have never tried vaping. Public perception of the relative risks between smoking and vaping is still very poor and the recent news of an outbreak of serious vaping-related lung disease in the US may be driving vapers back to smoking. This presentation will look at how the UK should address this in order to support the 7.2 million smokers in the UK to stop smoking and end the tobacco epidemic which still causes nearly 100,000 deaths a year in the UK.
An extraordinary natural experiment is going on worldwide given the different regulatory frameworks in place for e-cigarettes. The International Tobacco Control Policy Evaluation Project (ITC), set up originally to evaluate the implementation and impact of tobacco control policies, has adapted to be able to now also examine the impact on smoking, vaping and nicotine use of e-cigarette policies as well. Prof. Borland will focus in particular on how Australia, which prohibits nicotine vaping products, and Canada, which recently liberalised their e-cigarette policies, are faring compared with England and the US. He will examine issues such as patterns of e-cigarette use and smoking, accessibility, and impact across the four countries.
Much e-cigarette research is of low quality with claims being made that are not warranted given the data collected. Findings are then being communicated and interpreted in ways that compound the problem so that national polices are being formed on the basis of misinformation. This presentation proposes two of a number of practical steps that should be taken that could mitigate this. The first is adoption of what have been termed ‘Open Science’ principles. This includes compulsory declaration of whether a given finding comes from a pre-registered analysis or after a succession of analyses not all of which are being reported. The second is adoption of a ‘controlled vocabulary’ when describing key constructs such as ‘vaping’, ‘current e-cigarette use’, ‘cardiovascular damage’, ‘youth uptake’ etc. Everyone involved in producing, interpreting, communicating or using e-cigarette research should make it absolutely clear what they are referring to and what inferences have been made to get there. An ‘E-Cigarette Ontology’ is currently being developed that will facilitate this.
The recent outbreak of serious and in some cases fatal lung disease, predominantly lipoid pneumonia, among vapers in the USA has caused widespread alarm among vapers, health professionals, advocates and political leaders in the USA and elsewhere around the world. In this presentation Prof Britton will summarise the available evidence on the likely cause or causes of this outbreak, the reported occurrence of other similar or potentially related severe lung disease outside this recent outbreak, and discuss the relevance of the outbreak to electronic cigarette policy and regulation.
Synopsis to follow: Presentation on the association between cardiovascular disease (heart attacks) and e-cigarette use
Concerns have been raised that the widespread availability and popularity of e-cigarettes may undermine smokers’ desire to quit. In this talk, I will discuss the evidence around these concerns, exploring (i) whether e-cigarettes are ‘renormalising’ smoking in public places, thus undoing some of the progress that has been achieved by Smokefree legislation, and (ii) whether dual use of e-cigarettes and tobacco perpetuates nicotine addiction, making smokers who vape less likely to try to quit.
The key issue concerning the impact of EC on public health is whether they promote or reduce smoking - in the population generally, and among young people in particular. The presentation will review existing evidence with focus on new data.
Tobacco is the leading cause of preventable death in the the world. Smoking cessation medications should be tried in all tobacco users. For those not wanting to quit, or desiring to reduce harm, the option to utilize electronic cigarettes exists. We conducted a randomized clinical trial (n=182) in the Midwest and southern California using JUUL, a 4th generation e-cigarette to see if those substituting e-cigarettes for combustible cigarettes would reduce NNAL levels, be able to completely switch to e-cigarettes, result in a change in cotinine levels, and reduce the number of cigarettes smoked. The presentation will also include some findings regarding dual users that are intriguing and hypothesis generating.
This presentation will look at the impact of the recent vaping deaths on the e-cigarette market in the US and worldwide. It will explore why the existing US cannabis vape market has been less affected than the nicotine vaping sector and how the conflation of numerous distinct issues are at play, specifically youth use, flavours and the shortened timetable for PMTA regulation. Finally it will consider what the likely implications will be for global policy and the future of the vaping sector.
Louise Ross draws on her experience as a Stop Smoking Service manager to illustrate the effect that tobacco harm reduction can have on individuals and whole families, many of whom thought they would probably smoke forever. Louise encourages people who have switched from smoking to vaping to tell their healthcare worker too, to change resistant mindsets and undo the harm that professional prejudice can cause. This session will also consider what message current regulation sends to consumers and would-be switchers?
Why are flavours important, and what considerations need to be made for a producer to satisfy themselves objectively that unnecessary risks are not presented to the consumer? Should such considerations be entirely optional, defined in formal standards, or enshrined in law? How is it that things have gone so badly wrong for THC vape products in the USA? Where did the popularity of nicotine salt rise from; are salt formulations of genuine benefit in a TPD regulated market? Can an independent vape industry survive in markets where prohibitions so firmly favour tobacco and pharmaceutical industry offerings? All of these controversies will be considered from the perspective of an independent e-cigarette business with the interest of its customers, almost all of whom are ex-smokers or smokers intending to quit, at the heart of everything it does.
The UK’s approach to tobacco harm reduction is based on a number of important pillars relating to science and policy. The priority is to support adult smokers to quit while protecting non-smokers and particularly children from any unintended consequences related to vaping products being available on the market. In order to achieve this, the first pillar is research and surveillance to ensure we have adequate, robust and transparent information about the products, health effects, patterns of use and changes in any of these through time. Proportionate regulation is the second pillar, focusing on safety but also access for groups who need the products and those for whom access needs to be restricted. The third is communication with the public and professionals to ensure accurate information is conveyed about risks and benefits. The relationship between these three elements is poorly understood and subject to challenge, particularly in an international context. This presentation will review why each is important, what is working and what can be improved in the UK, with lessons for other jurisdictions.
The Foundation for a Smoke Free World (FSFW) was launched 2 years ago and is supported by a grant from Philip Morris International (PMI). Professor Etter will discuss the FSFW’s scientific output after 2 years, how was the money spent, who are the grantees and the board of directors, whether the FSFW was able to collaborate with mainstream tobacco control scientists, how were some grantees treated by the tobacco control community, whether the FSFW acts independently from PMI, and what are the perspectives for the FSFW.
In 2016, the Royal College of Physicians (London) set out this problem: “A risk-averse, precautionary approach to e-cigarette regulation can be proposed as a means of minimising the risk of avoidable harm. However, if this approach also makes e-cigarettes less easily accessible, less palatable or acceptable, more expensive, less consumer friendly or pharmacologically less effective, or inhibits innovation and development of new and improved products, then it causes harm by perpetuating smoking” In this session Clive Bates will discuss the importance of getting this balance right and how regulators have been getting it wrong
While the harms of e-cigarettes are contested, there is consensus that they are less harmful than smoking. Hence supporting smokers to switch from tobacco to e-cigarettes offers an important harm reduction potential. However, there are concerns that e-cigarettes might act as a gateway to nicotine addiction, and future smoking, among children and adolescents who would not have otherwise smoked. There are also concerns that the growing visibility of e-cigarettes might act to renormalize smoking. This presentation will draw on data from two ongoing studies to understand recent trends in perceptions and use of tobacco among children and adolescents in the UK. The first is a study of secondary school-aged adolescents, focused on smoking and e-cigarette use before and after Tobacco Products Directive regulations. The second combines a new survey of primary school-aged children’s perceptions of tobacco and e-cigarettes with historical datasets to understand perceptions of tobacco and e-cigarettes among younger children from 2007 to 2019.
In this presentation Dr Notley will discuss pathways through smoking cessation by vaping, considering switching, patterns of dual use and more gradual approaches to cessation. Dr Notley is a social scientist who has led the ‘E Cigarette Trajectories’ (ECtra) project, initially funded by Cancer Research UK, alongside research with vape shops and a wider programme of work focused on developing interventions for relapse prevention. Collecting longitudinal mixed methods data this study has used qualitative data to understand and describe the user experience of stopping and staying stopped from smoking by switching to vaping. The study draws on the nuances of individual patterns of behaviour, identity transitions in quitting smoking, interactions with developing technology, and the fundamental importance of social context in supporting long term relapse prevention.
One of the biggest obstacles facing e-cigarettes is the misinformation and understanding of nicotine. Tobacco control campaigns have often demonised the addictiveness of nicotine rather than the devastating health consequences of combustion. Consequently most smokers fear nicotine, a fact that has also been seen in the past with NRT. The consequences were often under-dosage and a too short period of use. In order to avoid relapse and dual use, Jacques Le Houezec has spent the last four years training vape shop owners and staff and health professionals about effective strategies for helping smokers understand the importance of adequate dosing and utilising the unique public health resource that vape shops can offer smokers to achieve smoking cessation.
Historically, we have not offered a way out of smoking that appeals to people with a mental health condition and/ substance use problem. We have often excluded them from tobacco control research and indeed, smoking has often been facilitated to reward and punish behaviour. It’s important that we don’t repeat history by excluding these groups from research, but also from the potential vaping has to offer whilst at the same time, managing risks that may arise. Debbie will discuss the evolution of an e-cigarette friendly smoke-policy in mental health and substance use settings over the last 5 years. She will also discuss how smokers are enabled to find the support that’s right for them at what is one of the most difficult times in their lives.
So much of the current fight over e-cigarettes and tobacco harm reduction reminds me of the struggles over illicit drugs policy that were the focus of my life for the past three decades: concerns about adolescent drug use driving calls to prohibit all sales, even for adults; widening gaps between scientific research conclusions and public perceptions; indifference to the human rights of drug consumers as well as the ways in which poor people and disfavored minorities can be harmed by paternalistic policies; and failure to understand how bans undermine the ability of governments to regulate markets and protect the health of its citizens.
Both advocates and opponents of tobacco harm reduction may benefit from better understanding both how punitive prohibitionist drug policies often proved ineffective, costly and counter-productive, and how advocates of illicit drug harm reduction and drug policy reform prevailed on a variety of fronts.