Wednesday 8th December 2021 Seminars

10:00 - 10:05

Welcome from the Chair

Chair

  • Martin Dockrell Tobacco Control Programme Lead - Office of Health Improvement & Disparities (OHID)
10:05 - 10:20

Nicotine policy in England: Recent developments and Future plans to make smoking obsolete

The pandemic has resulted in big changes in public health. Not only have structures changed as PHE transitions to the Office of Health Improvement and Disparities (OHID), but smoking behaviours have been in turmoil and the data on a new respiratory virus has had complex implications for smoking and health.  The Summit comes just after the publication of NICE guidance that will offer the clearest advice yet on providing e-cigarettes as a stop smoking aid which will result in revisions to the UK’s  CLeaR Tobacco Control system-led improvement tools. This talk will focus on the role of e-cigarettes in context of the UK’s comprehensive tobacco control environment that looks to maximise the opportunities for smoking cessation while managing risks.  It will look at other developments such as the recent Cochrane review, AJPH paper and John Newton's editorial in response

Speaker

  • Rosanna O’Connor Director, Addictions & Inclusion - Office for Health Improvement & Disparities, Department of Health and Social Care
10:20 - 10:35

England – the frontrunner on vaping, not the outlier

ASH welcomed the MHRA enhanced guidance on medical licensing for e-cigs supported by the Chief Executive of the MHRA. We agreed with the Secretary of State for Health who said, “Opening the door to a licensed e-cigarette prescribed on the NHS has the potential to tackle the stark disparities in smoking rates across the country, helping people stop smoking wherever they live and whatever their background.” However, the new guidance has been criticised from both sides. England was called the “outlier” by some, yet again too “laissez-faire on vaping”, others said that in fact the new guidance was not a step forward but a step back and would make it harder not easier for companies seeking a medicinal licence. This talk will look at why the process is the way it is, and the potential it has to change the shape of vaping, not just in the UK but also worldwide.

Speaker

10:35 - 10:50

The 2021 review of NICE’s tobacco guidelines

NICE – the National Institute for Health and Care Excellence – is an executive non-departmental public body of the Department of Health and Social Care. NICE's role is to improve outcomes for people using the NHS and other public health and social care services and produces evidence-based recommendations developed by independent committees, including professionals and lay members, and consulted on by stakeholders. The NICE Tobacco Guidelines expert committee was chaired by Paul Lincoln, OBE and consolidated 13 previously separate pieces of NICE tobacco guidance and updated areas where there was new research evidence. E-cigarettes was one of the areas of these reviews and the new comprehensive Guidance should be launched on 30 November 2021. In this session Paul will outline the new NICE recommendations on e- cigarettes including updated advice for healthcare professionals on what to say to smokers about vaping and the evidence base and rationale that underpins them.

Speaker

  • Paul Lincoln OBE Chair - Tobacco: preventing uptake, promoting quitting and treating tobacco dependence - (NICE) National Institute of Clinical and Health Excellence -
10:50 - 11:05

Combustible Tobacco Age-of-Sale Laws: An Opportunity?

Tobacco-21 is the law of the land in the United States and appears to be having the beneficial effect of reducing tobacco use among 18-20 year-olds, so is an important improvement over the status quo. However, is raising age of sales laws for all tobacco products optimal, or could additional benefit accrue to raising the age of sale for combustibles only? This concept could take the form of a Combustible-21 only law (similar to some European countries having separate ages for beer and liquor), or a law preventing the legal purchase of combustibles for people born after a certain date (as is currently being considered in New Zealand).

Speaker

  • Dr Michael Pesko Health Economist & Associate Professor - Department of Economics, Andrew Young School of Policy Studies, Georgia State University
11:05 - 11:20

AM BREAK

11:20 - 11:35

The potential role of the cigarette industry in the future of the e-cigarette market

In this session, Prof Levy will discuss the history of the cigarette market vis-à-vis other nicotine products distinguishing the period before and after e-cigarettes became more widely used. The role of the industry in the e-cigarette market will be given special attention. Finally, the current and potential future role of the cigarette industry will be discussed and the factors that are likely to influence that role. Cigarettes have historically not faced any competition. E-cigarettes have forced them to take a different approach.  Has the USA PMTA process handed the monopoly back to the cigarette industry.

Speaker

  • Prof David Levy Professor of Oncology - Lombardl Comprehensive Cancer Center, Georgetown University
11:35 - 12:10

Panel discussion and live Q&A

Is the UK a trailblazer or outlier - how will we know?

Session Responder

  • Louise Ross Interim Chair and Mental Health Lead for the New Nicotine Alliance - Business Development Manager - Smoke Free - Quit Smoking Now

Chair

  • Martin Dockrell Tobacco Control Programme Lead - Office of Health Improvement & Disparities (OHID)

Speakers

  • Rosanna O’Connor Director, Addictions & Inclusion - Office for Health Improvement & Disparities, Department of Health and Social Care
  • Deborah Arnott Chief Executive - Action on Smoking and Health
  • Dr Michael Pesko Health Economist & Associate Professor - Department of Economics, Andrew Young School of Policy Studies, Georgia State University
  • Prof David Levy Professor of Oncology - Lombardl Comprehensive Cancer Center, Georgetown University
12:10 - 12:50

LUNCH

12:50 - 12:55

Introduction from the Chair

Chair

12:55 - 13:10

E-cigarette research: Misinterpretation and selective use of evidence guiding regulatory decisions

Evidence-based decisions are necessary in order to tackle public health issues. Policy makers mostly rely on scientists and scientific organizations in order to come up with the best possible regulatory framework for smoking. E-cigarettes have been the focus of intense and conflicting debate over several years, with opposing views about being part of the problem or of the solution. In this presentation, I will focus on how evidence has been misinterpreted and selectively used in order to support statements that e-cigarettes are of similar or higher risk to smoking. Studies have been largely ignored, other studies have been over-emphasized while replication studies have failed to reproduce previous findings that were largely creating a misleading image about the absolute or relative risk of smoking. The presentation will end with a clear message that the totality of evidence should be carefully examined in order to provide balanced and reliable information to smokers and regulators about e-cigarettes, so that personal choices and policies will promote individual and public health.

Speaker

  • Dr Konstantinos Farsalinos M.D External Research Associate - University of Patras, Department of Public and Community Health, University of West Attica, Greece
13:10 - 13:25

Absolute and relative risks of electronic cigarettes

Despite the major impact of tobacco regulation on smoking prevalence, smoking conventional cigarettes continues to pose a significant public health concern. Among continuing efforts to mitigate this harm, methods to aid smoking cessation have an important role to play. Electronic nicotine delivery systems (ENDS or e-cigarettes) deliver nicotine at a rate and extent similar to those of conventional cigarettes and hence potentially provide an effective nicotine replacement. On request from the Department of Health and Social Care (DHSC) and Public Health England (PHE), the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) was asked to review the potential toxicological risks from ENDS to assist in the assessment of the possible public health benefit of these products. The Committee therefore assessed the relative risks, compared to smoking conventional cigarettes, in those switching products, as well as the absolute risks from use of ENDS to former cigarette smokers, naïve users, and bystander. ENDS are not without risk, although these are substantially less than those of conventional cigarettes, although the difference in risk depends on the health effect in question. There is little evidence that the short to medium term use of ENDS causes major harm, but there are significant data gaps, particularly on the effects of long-term use. In addition, the use of ENDS de novo by non-users of tobacco products is likely to be associated with some adverse health effects to which the user would not otherwise have been subject. The risks to bystanders for most health effects will be low in conventional exposure scenarios, although exposure to nicotine may result in pharmacological effects in some individuals. It is important that this information is not considered in isolation, but in the wider context of the public health consequences of smoking conventional cigarettes.

Speaker

  • Prof Alan Boobis, OBE Emeritus Professor of Toxicology & Chair - UK Committee on Toxicity - Imperial College London
13:25 - 13:40

Nicotine and pregnant smokers:

One of the controversies surrounding e-cigarettes (EC) is their use by pregnant smokers. Animal studies have demonstrated that nicotine on its own can damage pregnancy, but such studies typically use very large nicotine doses.  It is not clear to what extent doses used by human nicotine users affect pregnancy outcomes. The risk is considered much less than risks of smoking and nicotine patches are widely used to help pregnant smokers quit. Data from such use indicate the same or even better pregnancy outcomes in women using nicotine patches (NRT) compared to placebo, but NRT has only limited efficacy in pregnant smokers. E-cigarettes (EC) may represent a more effective option, but their safety and efficacy in pregnancy need checking. The presentation will review effects of nicotine on its own, without combustion chemicals from tobacco smoke, on pregnancy outcomes and consider the potential of EC to help pregnant smokers reduce or quit smoking.    

Speaker

  • Prof Peter Hajek Professor of Clinical Psychology - Wolfson Institute of Public Health, Queen Mary University of London
13:40 - 13:55

Depression causes vaping!

In this talk Professor Notley will discuss the latest evidence exploring associations between nicotine use and common mental health conditions, including depression. Complex intersectional relationships between nicotine use in different forms and depression will be explored, with consideration of alternative interpretations of observed associations in epidemiological datasets. Interpretive assumptions will be drawn out, including inappropriate claims of causal relationships between vaping and depression. The pleasure enhancing and beneficial self-soothing effects of using nicotine via different routes of administration, through smoking versus vaping, will be considered to underpin the thesis that habitual nicotine use can serve an important function in individuals lives, and that supporting those who are unable to stop using nicotine to use it in less harmful ways, is a social justice issue.

Speaker

13:55 - 14:10

The impact of the COVID-19 pandemic on e-cigarette and tobacco use in the UK

The COVID-19 pandemic led to strict lockdowns in the UK throughout 2020 and 2021, which impacted both access to tobacco-related services (e.g., Stop Smoking Services) as well as retail outlets (e.g., Vape Shops). Further, it is likely that the presence of a potentially deadly respiratory virus will have influenced smokers and vapers views on their product use. This talk will use data from the Smoking Toolkit Study as well the HEBECO study to assess the impact of the pandemic on e-cigarette and tobacco use in the UK, in terms of prevalence of use, attitudes, quitting activities, and support provided to smokers. It will argue that the pandemic has slowed down the decline in smoking prevalence, underlining the need for more action in relation to harm reduction to achieve the 2030 ‘smokefree’ target.

Speaker

  • Prof Lion Shahab Professor of Health Psychology - Department of Behavioural Science and Health, University College London
14:10 - 14:55

Panel discussion and live Q&A

Nicotine research in a politicised landscape - how do we maintain scientific integrity?

Chair

Speakers

  • Dr Konstantinos Farsalinos M.D External Research Associate - University of Patras, Department of Public and Community Health, University of West Attica, Greece
  • Prof Alan Boobis, OBE Emeritus Professor of Toxicology & Chair - UK Committee on Toxicity - Imperial College London
  • Prof Peter Hajek Professor of Clinical Psychology - Wolfson Institute of Public Health, Queen Mary University of London
  • Prof Caitlin Notley Chair of Addiction Sciences - University of East Anglia
  • Prof Lion Shahab Professor of Health Psychology - Department of Behavioural Science and Health, University College London
14:45 - 15:00

PM BREAK

15:00 - 15:05

Introduction from the Chair

Chair

  • Prof Ann McNeill Professor of Tobacco Addiction - Institute of Psychiatry, Psychology & Neuroscience,, Kings College London
15:05 - 15:20

Shifting the Paradigm: Tobacco Control and Tobacco Harm Reduction are Scientifically Complementary Approaches to Reducing Illness and Saving Lives

The US Food and Drug Administration’s recent authorization of certain e-cigarettes and other non combustible tobacco products under its premarket tobacco products application process confirmed the agency’s understanding that e-cigarettes and other alternative nicotine-containing consumer products are significantly less harmful than tobacco products that are burned. The FDA determined that these products can be good for the protection of public health, potentially helping millions of addicted adult smokers quit smoking. While imperfect, the PMTA process is now facilitating the transition to a new era in which adult consumers have access to far less harmful alternatives and develop greater, more accurate understanding regarding the risks and benefits of nicotine. The essence of this process is objective, nonpoliticized scientific inquiry and review. The scientific research community must take advantage of this new opportunity to disseminate credible scientific findings to better educate the public, the public health and medical communities, the media and decision-makers.

Speaker

  • Cliff Douglas JD Director, Tobacco Research Network, Adjunct Professor, Dep't of Health Management and Policy - University of Michigan School of Public Health
15:20 - 15:35

Parents: The Untapped Resource for Balancing Cessation and Prevention Needs:

This presentation will discuss the potential for parents to be the untapped link between smoking cessation and prevention of youth use of e-cigarettes and other tobacco products. Although there is substantial evidence for the association of parental smoking and youth smoking, less is known about ripple effects of parental smoking cessation on youth tobacco and e-cigarette use. This presentation will discuss how a refocus on parental smoking cessation may help to achieve the dual aims of reducing smoking and preventing underage e-cigarette use.

Speaker

  • Prof Robin Mermelstein Distinguished Professor of Psychology & Director, Institute for Health Research and Policy - University of Illinois, Chicago
15:35 - 15:50

Greater Manchester is making smoking history: Meeting people where they are and not where we think they should be

Greater Manchester’s Making Smoking History strategy was launched in 2017 to tackle inequalities by reducing smoking prevalence across the population. Since then, it has helped to improve the health, wellbeing, and wealth of thousands of residents and their families and is currently leading the way for tobacco control in England. Campaigns have focused on hard hitting, engaging, positive, non-patronising messages with a GM voice and feature local people telling their stories about stopping smoking and living with smoking related harm. Creating fair and equitable access to an integrated stop smoking system is still a work in progress. This includes universal access to advice, support and to stop smoking medications, Nicotine Replacement Therapy (NRT) and e-cigarettes.  E-cigarettes have been an important part of successful quit attempts and that has been promoted actively.  Most importantly, GM smokers are using e-cigarettes and want their quit attempts to be supported and reinforced.

Speaker

  • Andrea Crossfield MBE Independent Public Health Consultant and Population Health Policy Specialist - Greater Manchester Health and Social Care Partnership
15:50 - 16:05

The key role of vaping in medical practice. Time for doctors to get on board.

Smoking cessation is a core responsibility of medical practice, however traditional treatments have low long-term success rates. Tobacco harm reduction with safer nicotine products such as vaping nicotine is an additional, evidence-based tool for helping smokers quit and often works where other treatments have failed. However, doctors have been slow to embrace vaping and many remain misinformed about it and about the safety of nicotine. Medical practitioners have a duty of care to provide the best possible management at each patient encounter. Withholding a legitimate treatment option that could prevent a life-threatening illness is a breach of that obligation. This is especially important in disadvantaged populations for whom smoking is a major cause of health and financial inequalities. Vaping may have a special role in this population that is currently being left behind as we hasten slowly toward the endgame.

Speaker

16:05 - 16:20

CLOSING KEYNOTE: Covid-19 and tobacco harm reduction: are there lessons from the pandemic for the way ahead?

At various points since early 2020 it has become apparent that there are similarities between some of the challenges faced in tobacco harm reduction research and policy and those we've encountered during the Covid-19 pandemic. Both involve using complex and often conflicting sources of data and evidence to inform public health interventions. Both have particular effects on disadvantaged and marginalised groups. Each elicits strong opinions about personal autonomy, collective responsibility and the role of the state in public health. How individuals respond has been shaped by social norms and heavily influenced by the role of the media.  Levels of trust in government and in national and international public health organisations have influenced behaviour and the regulatory context. For both tobacco harm reduction and Covid-19, there have been vigorous and often heated debates between groups of scientists, and vested interests have sought to influence those debates. Attempts at consensus have had mixed success. This closing plenary will reflect on these similarities and differences from the perspective of a researcher who has worked with public health agencies, the media and governments on both issues. Are there any key lessons we can take from the pandemic for tobacco harm reduction now and in the future?

Speaker

  • Prof Linda Bauld, OBE Bruce and John Usher Chair in Public Health in the Usher Institute - College of Medicine, University of Edinburgh
16:20 - 16:50

Panel discussion and live Q&A

Why has THR been such a polarised area of science and policy - what could improve it?

Chair

  • Prof Ann McNeill Professor of Tobacco Addiction - Institute of Psychiatry, Psychology & Neuroscience,, Kings College London

Speakers

  • Cliff Douglas JD Director, Tobacco Research Network, Adjunct Professor, Dep't of Health Management and Policy - University of Michigan School of Public Health
  • Prof Robin Mermelstein Distinguished Professor of Psychology & Director, Institute for Health Research and Policy - University of Illinois, Chicago
  • Andrea Crossfield MBE Independent Public Health Consultant and Population Health Policy Specialist - Greater Manchester Health and Social Care Partnership
  • Prof Linda Bauld, OBE Bruce and John Usher Chair in Public Health in the Usher Institute - College of Medicine, University of Edinburgh
  • Dr Colin Mendelsohn MB BS (Hons) General practitioner, Founding Chairman - Australian Tobacco Harm Reduction Association
16:50 - 17:00

Closing Remarks from the Chair

Chair

  • Prof Ann McNeill Professor of Tobacco Addiction - Institute of Psychiatry, Psychology & Neuroscience,, Kings College London