2024 Session 4 Seminars

14:40 - 15:55

U.S kids no longer smoke. Why aren’t we celebrating?

The near disappearance of youth smoking in the U.S. is one of the great public health triumphs of the present century. Yet, it is rarely mentioned. Shouldn’t we be shouting it from the mountaintops? Why aren’t we? This presentation explores factors responsible for the silence that has greeted this remarkable accomplishment. One is the public’s (and professionals’) failure to distinguish the risks associated with smoking from those produced by other tobacco and nicotine products. Another, closely related, is the erroneous perception that nicotine causes the disease and death associated with smoking. The rise in the popularity of e-cigarettes has supplanted consideration of the disappearance of smoking, despite the ironic fact that youth smoking has fallen at its fastest rate ever during vaping’s ascendancy. As a result of the demise of youth smoking, the current generation will live longer, healthier lives than their parents and grandparents.

Speaker

  • Prof Ken Warner Avedis Donabedian Distinguished University Professor Emeritus and Dean Emeritus - School of Public Health, University of Michigan
15:55 - 16:10

Influences on smoking & vaping transitions

Dr Alexandria Andrayas will present evidence from the Avon Longitudinal Study of Parents and Children (ALSPAC), exploring how smoking behaviours evolve from adolescence into early adulthood. Her talk will also delve into the transitions young adults take from smoking to quitting with or without e-cigarettes or to dual use of both cigarettes and e-cigarettes. Dr Andrayas will give insights into how sociodemographic, psychological, lifestyle, and substance use factors shape these smoking patterns and vaping transitions and will engage with the broader literature on youth vaping, highlighting shared influences and discussing the implications of these in the context of health inequalities. Such research has important implications for informing more tailored interventions and enhancing harm reduction strategies for both youth and adults.

Speaker

16:10 - 16:25

When unintended consequences are the main consequence: Rethinking regulation

Has the nicotine market become ungovernable? When regulatory superpowers like the United States and Australia have over 90% of the e-cigarette market supplied through unauthorised channels, what’s going on, and what can we learn? Is there a guiding principle we can draw for regulation? Everyone wants to square the circle between preventing youth uptake and promoting smoking cessation, but are they missing the point, doomed to fail, and what is the cost of getting it wrong?

Speaker

16:25 - 16:40

Where great opportunities met reality. Lessons from the U.S regulatory experience

The US Pre-Market Tobacco Application (PMTA) is a complex and expensive application process overseen by the FDA, designed to provide a path to market for reduced-harm products.  Rigorous FDA review of company PMTAs was intended to ensure that authorized products were safer for the individual user and did not present an initiation risk among the nicotine naïve – under a standard called "appropriate for the protection of public health." More than four years after the filing of the first PMTAs and more than three years since the first authorizations, the US vaping marketplace is increasingly chaotic and there is little evidence that PMTA authorizations have had the impact that had been expected or hoped for them.  In significant part, this is attributable to influential advocacy groups and health bodies that had previously supported the PMTA review framework (and indeed had a strong hand in designing it), but that have in recent years taken a stridently anti-harm reduction position – both based on youth initiation concerns and out of hostility to industry.  Their advocacy has influenced public opinion and has placed significant political pressure on the FDA to limit authorizations, particularly of flavours.  Concurrently, the gap between perception and reality regarding the comparative harm of vaping and smoking continues to grow throughout the world – in the UK as well as in the US.  Where did the US go wrong?  And what is the path forward?  It is a time for new solutions, and an evidence-based implementation of THR will be central to that process.

Jeff Weiss is a former senior executive with NJOY, which was one of the first vaping companies to secure PMTA authorizations for vaping products and, to this point, the only one with authorizations for a non-tobacco flavour.

Speaker

  • Jeff Weiss Writer & Commentator - Former Chief Engagement Officer of NJOY
16:40 - 16:55

Accelerating the end of smoking

The WHO voluntary target of a 30% reduction in adult tobacco use by 2030 from a 2010 baseline will be reached, notably by women. However, the prevalence rate of tobacco use in men will still be 30% in 2030. The target does not acknowledge the vast differences in prevalence by country, gender, or type of tobacco used (smoked, smokeless), and its achievement will not significantly impact noncommunicable disease (NCD) mortality rates, the focus of Sustainable Development Goal 3.4.

More than half of the 130 countries with reliable trend data are on track to reach the tobacco target by 2030. Another third have declining tobacco use prevalence rates but will not reach the 30% reduction target by 2030. The prevalence of tobacco use has increased or remained unchanged since 2010 in the remaining countries.

The FCTC was initially associated with the rapid implementation of many measures, but progress in implementing key policies has slowed over the last ten years. Much more ambitious tobacco targets and a modernised FCTC are required to ensure reductions in NCD mortality.

The wide range of much less harmful, alternative nicotine delivery products now available since WHO set the global target has led to a rapid acceleration in the rate of decline in smoking in a few countries. Unfortunately, these innovations remain contested, including by WHO. Over the next two years, we must ensure that WHO aligns with the full range of evidence-based smoking reduction policies so that all countries contribute to accelerating the end of smoking.

Speaker

  • Prof Robert Beaglehole Emeritus Professor - University of Auckland, New Zealand & Chair ASH - Action for Smokefree 2025, NZ
16:55 - 17:10

CLOSING KEYNOTE: Real people living in real communities: Are we doing enough to make a smoke-free future a reality for everyone?

This session will reflect on the cultural norms experienced in the North East of England and how, two decades since the launch of Fresh and a collaborative approach to focus on tobacco smoking, rates have dropped 62%, the largest in England. Despite this significant progress, smoking is still killing too many loved ones each day, and there is still much to be done, with rates much higher within some groups. At the core are real people living in real communities whose stories need to be told and heard. With a clear regional vision for a smokefree future, free from the death and disease of tobacco, this presentation will explore whether we are doing enough to make this a reality.

Speaker

17:10 - 17:30

Panel Discussion with Q&A:

Is smoking still the main problem?

Chair

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

Speakers

  • Prof Ken Warner Avedis Donabedian Distinguished University Professor Emeritus and Dean Emeritus - School of Public Health, University of Michigan
  • Dr Alexandria Andrayas Senior Research Associate - Cancer Research UK - TARG, University of Bristol
  • Clive Bates Director - Counterfactual Consulting Ltd
  • Jeff Weiss Writer & Commentator - Former Chief Engagement Officer of NJOY
  • Prof Robert Beaglehole Emeritus Professor - University of Auckland, New Zealand & Chair ASH - Action for Smokefree 2025, NZ
  • Ailsa Rutter OBE Director - Fresh and Balance