This document discusses e-cigarettes and their potential role in tobacco control. It notes that e-cigarettes have changed the landscape of tobacco control and could be an important tool for harm reduction. While more research is still needed, the current evidence suggests that the benefits of e-cigarettes for helping smokers quit may outweigh the potential harms, especially when compared to the proven harms of smoking tobacco. The document advocates for a public health approach that engages with e-cigarettes as a harm reduction strategy but continues monitoring the evidence for any risks.

1. www.hertsdirect.org
Tobacco Control – changing the
game together
Jim McManus
Director of Public Health, Hertfordshire County Council
Elizabeth Fisher
Head of Stop Smoking Service
Hertfordshire County Council

2. www.hertsdirect.org
An endgame for tobacco
• The prize is still ever diminishing death and
disease due to tobacco
• E cigarettes in this context are important
• The world of tobacco control has changed
– Not just systems but culture and landscape changed
– E cigarettes, Stoptober and their impact on stop
smoking services
– Digital services and platforms (probably lower
impact than above)
– Diminishing returns and niche sub populations

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The Long tail of smoking quitting...
Kreuter et al (2014) AMJPublicHealth
Diagram from http://www.longtail.com/about.html

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Harm Reduction and the Long Tail
• NICE Harm reduction guidelines
• Our local guidelines
– They include a range of harm reduction
strategies including working with e
cigarettes, cutting down to quit etc
– The 4Es duty: Economy, Efficiency,
Effectiveness and Equity.
– If it works for our population and is safe,
what legitimate reason do we have not to
engage with it?

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An uncertain world...
• Needs science that can cope with change and
complexity
• Needs to take a different view of risk and
precautionary principle without at any time
sacrificing peoples
• Needs a situation where people debate from
evidence not fear
• Needs science that can plug the gaps in our
knowledge

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E cigarettes are a game changer in
tobacco control
• We have thought, read and reflected long and hard on
this
• The evidence points to the benefits being greater than
the harms
• We will keep evidence under review
• We will treat e cigarettes as a tool for public health gain
not a threat unless credible scientific evidence says
otherwise
• Most vapers care very much about their health, we
cannot ignore this

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E cigarettes 2
• Gateway theories and fears on e cigarettes are
not supported by the evidence so far
• Yes lets protect children proportionately
• Is public health at the forefront of making the
trend to vaping the healthiest it can be, and if
there is evidence of harm, reducing or
protecting the public from it?
• Or are we in denial? Because if we are, it will
happen without us