To ecig or not to ecig? Herts tobacco control conference 2016
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This document discusses the changing landscape of tobacco control and the role of e-cigarettes. It notes that traditional smoking cessation methods are becoming less effective and that the population is segmenting into different tobacco and nicotine product users. The document argues that e-cigarettes can play a key role in tobacco control by providing a less harmful alternative. It contends that embracing e-cigarettes could help reduce smoking rates and prevent smoking-related deaths and disease, while not normalizing smoking. The document suggests that local public health services should support e-cigarette use as part of a comprehensive tobacco control strategy.
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To ecig or not to ecig? Herts tobacco control conference 2016
- 1. www.hertsdirect.org To e-cig or not to e-cig? Hertfordshire Tobacco Control Alliance Conference, 21st January 2016 Prof. Jim McManus, CPsychol, Csci, AFBPsS, FFPH Director of Public Health for Hertfordshire Winners 2015
- 2. www.hertsdirect.org Changing World for tobacco control • Footfall for traditional smoking cessation plummeting nationally • Segmentation of the population – a long tail market? – E cigs - Roll ups – Shisha - Illicit tobacco – Young people still initiating smoking • National campaigns • Legislation, Regulation and Licensing changes
- 3. www.hertsdirect.org Where we are • A crowded and confused market of products and users which is becoming increasingly differentiated and fragmented while the prevalence of tobacco use and burden of disease, disability and death is still highest in – Routine and manual workers – Pregnant women – People with long term conditions including HIV – People with mental health problems – Some BME communities
- 4. www.hertsdirect.org What this requires • Some clear thinking about what our aims and objectives are • The use of new tools for a new social situation
- 5. www.hertsdirect.org Continued loss of healthy life References: 1. ASH Factsheet, Smoking Statistics: illness & death, October 2011 (http://ash.org.uk/files/documents/ASH_107.pdf) NB area represents value Obesity: 34,100 Smoking: 81,400 Alcohol: 6,541 Suicide: 5,377 Drug misuse: 1,738 HIV: 529 Traffic: 2,502 Each year smoking causes the greatest number of preventable deaths
- 6. www.hertsdirect.org Tobacco – A driver of Inequalities Smokers from the highest social class have a lower life expectancy than non-smokers in the lowest social class 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 I+II IV+V Social Class Relativemortality Male non-smokers Male smokers Highest Lowest The life expectancy between rich and poor smokers is similar Richer smokers have a lower life expectancy than poorer non- smokers
- 7. www.hertsdirect.org Driver of inequalities 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 Year 0 10 20 30 40 Cigarettesmoking% 35 33 32 32 34 31 31 30 29 30 28 29 27 32 Routi ne & manual 20 21 20 19 17 19 18 17 17 16 16 15 16 16 Non-routi ne 11. 3 25. 3
- 8. www.hertsdirect.org Herts Ambitions 2015-2017 Reduce Adult smoking prevalence • by 1% per year from 15.5% baseline* • in Routine and Manual workers by 2% per year from the 25.7% baseline* Reduce Young People uptake • continuous reduction in REGULAR and OCCASIONAL smoking in 15 year olds to 5% by 2017 (from a baseline of 10% in 2014) Reduce Smoking in Pregnancy • smoking prevalence at the time of delivery (SATOD) is less than: – 5% for women registered with HVCCG (from a baseline of 6.6% in14/15) and to – 7% for women registered with ENHCCG (from a baseline of 9.2% in 14/15).
- 9. www.hertsdirect.org Traditional methods are not going to be enough in the new social circumstances Tobacco control has showed itself to be innovative. It’s time to do that again What does that mean in 2016?
- 10. www.hertsdirect.org “The Big 4” issues going forward 1. Continue to control tobacco and its effects 2. Keep going with nuanced strategy – segment populations 3. Getting people into quitting by targeting and segmentating audiences 1. Harm reduction 2. Ecigs 3. Stoptober, Our Services..... 4. New technologies, new solutions, new markets, and new allies?
- 11. www.hertsdirect.org The fundamental question.... • What form do e-cigarettes play in a comprehensive local tobacco control framework? • Aims: – Less tobacco, fewer deaths, less disability – Stop people from taking up tobacco
- 12. www.hertsdirect.org My contention.... After more debate and reading bad and good science than I care to remember • E cigarettes have a fundamental part to play in a coherent whole system approach to tobacco control • We need to become friendly to their use and their distribution • The science supports this • Much, much, safer than tobacco • No convincing evidence of gateway or renormalisation
- 13. www.hertsdirect.org Where this leaves us • For me I have fundamentally changed my mind on e-cigarettes. I am convinced if we do not seize their benefits, we will see stop smoking services cuts drastically across England • Demographics have changed • Over 2.4m people have used ecigs to quit tobacco according to UK figures
- 14. www.hertsdirect.org Key questions 1. The end game for tobacco is still what we want, yes? Denormalising tobacco 2. Our current strategy is reducing in return 3. Quitting is NOT something some people will or can do. Nice recognised this on Harm guidance 4. The remaining core of tobacco smokers won’t or cant give up tobacco as things stand 5. Time to rethink our offer.....
- 15. www.hertsdirect.org Mental health as an example • Allowing people with mental health problems to just keep smoking perpetuates the myth that it’s a kindness and the fact that 64% of tobacco use, and associated disease and death, falls on this population. Early deaths are a sign of our failure. • Making people with mental health problems go cold turkey is inhuman • Offering enough real alternatives for people to find an easy way out of tobacco is the challenge. For people with MH issues who quite tobacco, major health benefits accrue Including the ability to reduce doses of many medicines
- 16. www.hertsdirect.org My reading of that context... Hertfordshire should follow the lead of Leicestershire and others and become as e-cigarette friendly as we can be, in the recognition that the public health gains from e-cigarettes significantly outweigh the risks. We will keep this under regular review
- 17. www.hertsdirect.org The Big Wins • E cigarettes as part of the tobacco control repertoire • Reduce deaths, disease and disabillity • An acceptable route for people with mental health issues • Normalising e-cigarette use does NOT mean renormalising smoking • Save some money in austerity climate • Help people to help themselves 1 Am J Public Health. 2015 Oct;105(10):1967-72. doi: 10.2105/AJPH.2015.302764. Epub 2015 Aug 13. Smoking Norms and the Regulation of E-Cigarettes. 1
- 18. www.hertsdirect.org How..... • Working with ecig users in our services taking their choice of tool (an ecig) seriously • Publicity about ecigs as a valid option for quitting • Looking at how and whether we can give ecig starter kits especially in MH facilities • Accrediting safe and knowledgeable retailers • Helping review vaping policies in workplaces and elsewhere
- 19. www.hertsdirect.org Safe Retailers are important, we should support them • Can we tell consumers that there are vendors they can trust to be of good quality and safety?
- 20. www.hertsdirect.org Could we go even further, what if..?? • In Hertfordshire trusted e cig vendors operated under explicit endorsement from us? “come here and quit tobacco” – directing would be quitters to knowledgeable and helpful vape vendors? Even a badge or quality mark? Endorsed by Hertfordshire Public Health Service Give up Tobacco Here! Ecigs – helping people quit tobaco in Herts Benefits to Taxpayers? Benefits to Quitters? Benefits to Vendors?
Editor's Notes
- You have 10 minutes in total and 5 mins for Questions
- JIM
- Ill-health caused by smoking is much more common amongst the poorest and most disadvantaged in society: smoking is the primary reason for the gap in life expectancy between the rich and the poor. The poorest in our communities smoke at higher rates and smoke more on an individual level – their habit is the single biggest reason for the difference in their life expectancy compared to the richest in our communities. To reduce health inequalities, we must specifically target poor smokers and smokers in marginalised and deprived communities. The cost of tobacco use affects everybody. Tackling tobacco use at a population level using community initiatives and targeting young and poorer smokers, as well as certain minorities, evidence shows is the most effective way of reducing youth up-take. References: 1. Gruer L et al. BMJ 2009;338;bmj.b480 (Relative mortality assessed at 2nd 14 year follow-up between male smokers & non-smokers of highest & lowest social class) 2. Insert the bit about Wanless from the Islington report.
- Jim Our ambitions were further developed as ‘stretch’ targets for Hertfordshire, based on the ambitions within Smoking Still Kills We recognise the importance of targeting specific populations that will have the biggest impact on reducing health inequalities and the difference in life expectancy between the wealthiest and the least well off: Routine and manual workers (largest population of smokers and more likely to be heavier and more addicted smokers) People with mental health conditions and learning disabilities Pregnant women, their partners and their families And other groups (prisoners and offenders; people with Long Term Conditions, unemployed, homeless and people with other addictions as well as tobacco; some BME groups; young people, including care leavers and those NEET; LGBT groups)
- TERRY So while we try to keep all this working, our next big areas of action are: Continuing to develop the alliance – obviously Keep going with nuanced strategy – segment populations Audit and monitor how well our Harm Reduction Guidance has gone down and the impact this has on services (are fewer people going onto quit? Are there changes in prescribing practice?) Increasing footfall into services – this is imperative and national campaigns need to do better at driving smokers into local services. We are implementing babyClear in July 2015 – to improve routine CO monitoring and referrals and have redesigned services so that we have a named stop smoking specialist for every single pregnant smoker.