Welcome from the Chair
- Professor Ann McNeill Professor of Tobacco Addiction - UK Centre for Tobacco and Alcohol Studies (UKCTAS), Kings College London
This session will outline the tobacco control plan to reduce smoking in England with the aim of creating a smoke-free generation through focussed action supporting smokers, particularly in disadvantaged groups, to quit. Including the use of evidence based innovation that minimise the risk of harm.
Research on e-cigarettes has suffered from a range of major problems in terms of the methods used and interpretation and reporting of the findings. Many of these are resolvable by researchers and those who use research findings adhering to well-established principles concerning conflicts of interest of all kinds, not just industry funding, a systematic and dispassionate approach to causal interpretation, accurate reporting of variables actually measured, and use of evidence of different kinds to triangulate on conclusions. This presentation will examine the issues, with examples, and consider how application of principles of good scientific practice (GSP) would have led to different conclusions.
Tobacco harm reduction has been a controversial issue for tobacco control and public health, however the last twelve month have seen a sea change in some countries who are now considering the benefits of taking this approach. This session will look at the changing global picture and also look at what the UK has done and how it has contributed to these changes, with a particular focus on countries who have or are proposing a more positive policy framework. This session will also touch on developments in low and middle income countries where tobacco harm reduction is not currently a priority and consider how the right balance can be struck to meet the needs of different groups and keep options open for the future.
Harm reduction and precaution have been ideas that sharply divided the tobacco control community. Yet the recent history is one of seeming unification around the idea of harm reduction. Despite increasing acceptance of Tobacco harm reduction at a policy and government level, proposals for how to reduce harm sometimes differ radically. For example, banning flavor or restricting sales to smokers at one end of the continuum, actively promoting e-cigarettes to smokers at the other. This session will explore the question of whether harm reduction and precaution continue to underpin, if less starkly, policy choices now often framed as the former
The announcement in September by Derek Yach of the creation of the Foundation for a Smoke-Free World was met with sharp criticism from many while cautiously welcomed by others who believe that there has been underinvestment in the science of harm reduction and smoking cessation in context of a rapidly evolving area of innovation. At the heart of the controversy is the fact that the Foundation will be funded by a 1-billion USD grant from Philip Morris International (PMI) over 12 years. Derek has maintained that the Foundation’s legal and financial frameworks are constructed to maintain independence but critics argue that the Foundation will serve the tobacco industry’s interests. Pr Etter will provide a neutral assessment of the available information and facts and examine the deeper ethical, emotional and ideological issues and ask whether the Foundation should be welcome or rejected, and whether or not researchers should apply for grants
One of the few methods for comparing the risks of cancer from smoking with vaping uses the chemical composition of their aerosols and known cancer potencies of individual carcinogens along with estimates of the quantities of aerosol to which a smoker or vaper is exposed each day. This presentation uses published chemical data from a wide range of sources to map out the spectrum of cancer risks over the range of nicotine-bearing aerosols. Cigarettes and heat-not-burn tobacco products occupy well-defined regions of the risk spectrum, in contrast e-cigarette vapours are broadly distributed spanning the range from the very low risk of a medicinal nicotine inhaler to the very high risk of cigarette smoke. The available chemical evidence indicates that the risk of cancer from vaping e-cigarettes is generally low (<1% of tobacco smoke) but vaping at high atomiser powers can lead to higher risks associated with excessive carbonyl production. Further research into hardware technologies and liquid ingredients could lead to e-cigarette emissions of consistently low cancer risk.
This talk will cover published and unpublished research on the association of exposure to known tobacco-related toxicants and carcinogens in long-term users of e-cigarettes, with or without concurrent combustible cigarette use, compared with long-term users of other harm reduction products, cigarette smokers and never smokers. It will also describe upcoming research evaluating the comparative exposure to toxicants and carcinogens in users of heat-not-burn products.
Cochrane reviews are accepted as the gold standard in evaluating scientific evidence on healthcare interventions. In this session, a lead Cochrane author will compare the Cochrane review of electronic cigarettes for smoking cessation with other meta-analyses of electronic cigarettes, exploring reasons for differing conclusions and the strengths and weaknesses of the varying approaches.
Smoking is a leading preventable risk factor for cardiovascular disease. However, there is some confusion concerning the contribution of nicotine to smoking-related cardiovascular disease.This presentation will focus on presenting evidence about the potential effects of nicotine on cardiovascular health. Studies evaluating nicotine intake from non-combustible products will be presented and the relative risk of harm reduction nicotine products compared to smoking will be discussed.
Under normal condition of use, electronic cigarettes (ECs) are a much less harmful alternative to tobacco cigarettes. Nonetheless, there is concern as to whether regular long-term use may carry some risk to lung health. The available evidence from retrospective as well as prospective studies of regular EC users shows no negative impact on lung health outcomes. In particular, studies of patients with pre-existing airways disease indicate overall respiratory improvement, whereas more recent work on long term exposure in EC users who have never smoked shows no deterioration. Consequently, ECs are unlikely to raise significant health concerns for the respiratory tract under normal condition of use. Former smokers using and smokers intending to use ECs should receive correct information about residual risks and potential benefits of these products. Promoting further access to ECs may substantially reduce individual risk and population harm.
TPD implementation has resulted in more than 100,000 notifications of individual products across the region at enormous cost to the industry in notification fees, toxicology and testing. Although this has given consumers more confidence that the products they are using are safe, poor enforcement, gaps in the regulations and consumer demand have led to products sitting outside the TPD, such as "shake and vape". Newly launched heated tobacco products with well-funded marketing campaigns give consumers more choice and may encourage switching from combustible tobacco but will change the regulatory and business backdrop for the sector.
‘Heat not burn’ tobacco products are relatively new on the UK market. What are the differences between ‘heat not burn’ products and e-cigarettes and what implications might this have, now and in the future, as the market continues to evolve? This presentation will include analysis of the different business models, marketing tactics, and regulatory frameworks for e-cigarettes compared to novel tobacco products in the UK.
The Committee of Advertising Practice (CAP) and the Broadcast Committee of Advertising Practice (BCAP) has recently concluded a consultation on removing the current ban on electronic cigarette advertisers making health claims, following a call for evidence last year. This session will outline some of the issues covered in that consultation and the next steps as well as looking at the wider advertising picture.
The independent vape sector - a unique relationship with smokers and vapers:
The number of people vaping has risen from virtually zero in 2008 to 2.9 million in 2017. Despite this growth many people still know very little about vapers or vape shop/online businesses. In this session Matthew Moden, an independent vaping business owner, will talk through the real world experiences of interacting with consumers and building a responsible business and constructive relationship with public health and regulators. This will be considered in context of the following questions:
The notification scheme for regulating e-cigarettes as consumer products has been in place for a year. This session will provide a brief update on where we are, what has happened and future focus:
While ENDS products appear to have had a significant impact on smoking within a tobacco regulatory framework, there has been zero progress in expanding market-available choice of such products within a medicinal framework. What opportunities exist to change this?
One in three British smokers in 2017 say they have never tried an e-cigarette and a further 42% have tried e-cigarettes but no longer use them.
Who are these smokers? What makes them different and what must Public Health to do to increase switching among smokers who do not vape? What are the opportunities for reducing health inequalities?
Martin will share some of what we know about smokers who do not vape and how they differ from those who do. He will also address some of the actions that public health is taking to reach those smokers from Stoptober to a Smokefree NHS, on the air and below the line.
In this session Louise Ross, Stop Smoking Service Manager for Leicester looks at the questions that e-cigarettes have raised for stop-smoking providers, clinicians, policy makers and consumers. This session will look at the challenges and outcomes this has had for her particular stop smoking service and explore the sometimes frustrating hurdles that needed to be overcome. Setting the scene with the numbers and demographics she will look at the current outcomes and benefits.
In this session, Professor Levy will present different modelling scenarios under which smokers adopt e-cigarettes, and project how many lives years can be saved under those scenarios. This session will discuss many of the contentious issues around e-cigarettes, including the magnitude of relative risks, dual use, slowing down cessation and the gateway effect, as well as potential effects of regulations on industry structure and behavior.
Over the past 30 years the daily smoking prevalence among Australian adults has declined to 13% thanks to very high tobacco taxes, bans on cigarette advertising, smoke-free policies in all public spaces, graphic health warnings and plain packaging of cigarettes. The advent of e-cigarettes or electronic nicotine delivery devices (ENDS) has been a disruptive technology that promises to provide smokers with a much lower risk way of obtaining nicotine than smoking cigarettes. Australia has banned the sale of ENDS to adults. This policy is supported by the most of the Australian tobacco control community. Australia’s policy contrasts with that in the UK where ENDS are freely available for sale and regulated as consumer goods. This paper explains how the Australian ban has come about, critically analyses the arguments offered to justify the policy and discusses the ethical and policy issues that it raises. It also describes ways in which the sale of ENDS could be regulated for recreational use that would address the more reasonable concerns of those who support a ban.
From the beginning e-cigarettes have been a contentious subject with the battle lines drawn between those who believe they will undermine tobacco control efforts, and those who believe that they have great potential to reduce the harms from smoking. Caught in the middle of this (not always polite) war of science and words are ordinary people attempting to make informed decisions about their lives and their health. Vapers have become passionate advocates for e-cigarettes, which many accredit for saving their lives. They are true experts in this field – and yet often their voices are missing from the debate. This presentation will cover the following topics, but from a consumer point of view:
Following the close of the Summit all participants are invited to join us for networking drinks