2024 Session 1 Seminars

Around a decade on from the EU Tobacco Products Directive entering into force, the nicotine landscape in England and in many countries around the world has changed – for example, vaping products and their user profile look very different. As a result, the UK government is introducing new primary legislation around smoking and vaping to improve the population’s health. This year’s summit will provide a forum to discuss, respectfully, these developments and the latest science and evidence around vaping, and smoking.

Peter will discuss the conceptual framework of total community harm reduction that involves the dynamic balance between products, practices, and policies that affect the availability and consumption of tobacco products. He will then describe project VECTOR (Vaping and Electronic Cigarette Toxicity Overview and Recommendations)  where his team used systematic and umbrella reviews and a consensus-driven approach with a panel of 30 international academics and individuals with lived experience. They voted on recommendations related to four key health outcomes: cancer, cardiovascular disease, respiratory health, and dependence. The consensus resulted in 14 recommendations, each assessed for evidence quality and strength. Four accompanying knowledge products were developed to support decision-making.  He will describe the recommendations and considerations for people who currently use or are thinking of using e-cigarettes, and discuss how these recommendations can be applied in clinical practice and population-level health considerations to balance absolute versus relative risk in a time of evolving evidence.

The Tobacco and Vapes Bill will be a landmark step towards achieving a smoke-free UK. It will deliver on the government’s manifesto commitment to ensure that the next generation will never legally be sold tobacco products and that vapes will be banned from being branded and advertised to appeal to children. The Bill will be the biggest public health intervention in a generation and will deliver on the government’s mission to improve healthy life expectancy and reduce the number of lives lost to the biggest killers, including cancer and cardiovascular diseases.

The presentation will (i) set out the context and evidence underpinning the Bill, (ii) outline the provisions that will be included on the face of the Bill as well as regulation-making powers requiring subsequent secondary legislation, and (iii) discuss the main challenges ahead for success, including where further consultation and engagement will be needed.

In this session, Jamie will provide an update on emerging trends in smoking and cessation in England in 2024 from the Smoking Toolkit Study. This long-term population study involves a monthly survey of a new sample of approximately 1,700 adults each month in England asking detailed questions on smoking, cessation and vaping. It has been running since 2006 and has collected data from over 400,000 adults across 215 monthly waves. A lot has changed in smoking, cessation and vaping profiles and trends, especially in the last 5 years. Jamie will synthesise emerging trends on topics including daily and non-daily smoking, non-cigarette smoking, menthol and hand-rolled smoking, overall use of inhaled nicotine, the use of smoking cessation aids - including newer products such as nicotine pouches and heated tobacco - and inequalities in smoking. He will conclude by reflecting on the possible implications of these findings for e-cigarette research and policy.

Nicola will describe the most up-to-date evidence from the Cochrane systematic review of e-cigarettes for smoking cessation. What do we know? What do we still need to know? What is the current status of this living review of the evidence? Nicola will also discuss a new Cochrane systematic review investigating methods of quitting vaping, initial observations, and what comes next.

Cigarette smoking is a major cause of morbidity and mortality in those who smoke. Helping smokers quit benefits public health. Ideally, smokers would just stop smoking, but this is not easily achieved due to the addictive nature of nicotine. An alternative would be to switch to a less harmful product, and e-cigarettes can fill this role. However, the harm reduction resulting from smokers switching needs to be balanced against any adverse effects in those who take up e-cigarettes but who would not otherwise have smoked. This is of particular concern in young people. A major consideration regarding e-cigarette policy is their potential toxicological impact. Some argue that the toxicity of many of the constituents of e-cigarettes is unknown, or such that significant harm might result in users. This is particularly true of flavourings. However, objective evidence is against this. The most commonly used flavourings do not appear to be markedly toxic, either directly or following thermal transformation in e-cigarettes. Suggesting otherwise would be a strong argument for people to avoid e-cigarettes. While this might help reduce uptake by non-users, it would also deter smokers from switching. In addition, exaggerating the harm could lead to lack of confidence in public health messaging regarding e-cigarettes. Hence, policy needs to be based on sound scientific evidence, and whilst the possible adverse health effects of flavourings should not be ignored, addressing behavioural aspects, such as appeal to young people versus adults, may be more important in developing an effective public health strategy.

The debate on the role of e-cigarettes in the UK and across the world has continued to evolve as trend data on vaping and smoking accumulates. Participants on all sides of the debate feel strongly about the lens they look through. Bringing people together toward a consensus view and proportionate regulation requires the use of the best current evidence available. The RCP report “ E-cigarettes: An Evidence Review’ published in 2024, examines the literature on numerous complex issues related to vaping including safety, efficacy, industry and regulation to make over 50 recommendations on how best to use e-cigarettes to treat tobacco dependency and discourage use amongst people who do not smoke, especially young people.

Balancing regulatory responsibilities to improve public health