Tobacco harm reduction for ‘priority’ groups: misaligned, misperceived or missing?

The Tobacco and Vapes Bill is about to reshape tobacco and vaping policy in the UK, alongside new investment in stop smoking services aimed at reaching ‘priority groups.’ But what does this mean for people with the most challenging lives, such as those with mental health conditions, people who use other substances, and individuals in prison? Tobacco dependence treatment and policy is rarely designed with their needs at the centre and THR is often positioned as what is offered when quitting is judged impossible, rather than as a valid and proactive route to reducing harm. Policies and treatment are frequently misaligned with lived realities, for example, in mental health services where smoke-free policies focus on compliance, in substance use settings where tobacco use has rarely been addressed, or in prisons where vaping is shaped by security and control rather than reducing harm. The needs of people in such services are misperceived, they are often seen as lacking motivation to quit tobacco, or services only treat ‘one addiction at a time.’ What is missing is care designed for the people most affected by smoking. This session will consider how current policy may affect ‘priority’ groups, and whether harm reduction will continue to be sidelined as second best, or recognised as central to reducing inequalities.