Session 2: 2022 Seminars

This talk will look at what were the hopes and fears for the public health impact of e-cigarettes to 10 years ago, how far these have come to pass, and what we might expect in 10 years’ time, depending on policies adopted and technological change. It will take an international perspective, examining the landscape in countries where good population-level data are available. Neither the hopes nor the fears have yet been fully borne out. E-cigarettes appear to have contributed to reductions in smoking prevalence in countries with more permissive regulatory regimes but as yet the contribution has not been as great as some had hoped. Credible evidence has emerged that e-cigarettes are not harmless but the degree of harm appears likely to be an order of magnitude less than from cigarette smoking. At a population level, evidence has not supported the hypothesis that e-cigarettes would be a gateway to tobacco use among young people. There is evidence that some young people who would never have smoked have used e-cigarettes, but to date this use appears to be primarily occasional. E-cigarette technology continues to advance in terms of creating devices that deliver nicotine efficiently in a palatable form but there are challenges regarding their impact on the environment. The topic of e-cigarettes has become, if anything, more divisive among public health experts, with evidence often being distorted or misrepresented and personal attacks being launched both ways across the divide. It remains possible that with the right kind of regulation, e-cigarettes could contribute further to a reduction in tobacco-related harm as part of a comprehensive tobacco control policy. This will be more likely if protagonists sign up to a set of ethical standards regarding the conduct and interpretation of science and work collaboratively to the development of evidence-based policies.

Until recently, disposable e-cigarettes were considered of historic interest, made obsolete by rechargeable devices with better nicotine delivery. For instance, just 1 in 20 British vapers chose disposable e-cigarettes as their main device from 2016 to 2020. Yet over the past two years, we have witnessed the market become flooded with new disposable e-cigarettes that are cheap, convenient, and good at delivering nicotine. There is mounting concern that these modern disposable devices may be especially appealing to children and younger adults. Recent data from Great Britain show that the popularity of disposable e-cigarettes grew rapidly between 2021 and 2022, particularly among young people. Now more than half of 18-year-old vapers mainly use disposable products. The public health impact of this growth will depend on who uses disposable e-cigarettes: people who would otherwise smoke cigarettes, vape other types of e-cigarettes, or avoid nicotine entirely. Harry will examine the causes and consequences of this rise in disposable vaping, in the context of the changing prevalence of vaping and cigarette smoking.

It’s well-established that vaping helps some people quit smoking, but concerns over the unknown long-term health effects and rise in youth disposable vaping, has seen greater demand for tighter restrictions. But policy decisions have consequences and not all of them are intended.  In this session, Dr Jasmine Khouja will present a recent study that asked smokers and vapers how they would feel about flavours being banned in the UK. Study participants also made many unprompted suggestions for alternative policies with common themes that should be explored further.

Public health professionals in England recognise that vape products can play a useful role in helping smokers cut down or quit, but a recent rise in young people’s use of disposable devices has led to calls for increased regulation. This presentation will explore the rise of disposables from the point of view of ordinary smokers and quitters from routine and manual backgrounds. Based on eight months of fieldwork across the UK, fifty interviews with vapers aged 16+ and ten interviews with vape retailers, this session will explore the reality versus the rhetoric of disposable use. Questions considered will include: what potential might disposables have to address health inequalities linked to smoking? And which young people are really being considered in the pressure for regulatory action?

Tobacco smoking is a leading cause of poor health outcomes and inequalities amongst people experiencing extensive health and social needs (e.g., homelessness, substance dependencies). An erroneous perception exists that individuals living with such needs do not engage in health services and as such, are described as 'hard to reach', 'disengaged' or 'uninterested'. This talk highlights why these descriptors are not grounded in evidence.  It will also highlight how we can maximise existing opportunities to offer cessation support, including how tobacco harm reduction approaches are central to offering support and helping to reduce inequalities and long held misperceptions.

To paraphrase the Cheshire Cat in Alice in Wonderland, "if you don't know where you are going, any road will take you there". Are we thrashing about doing the wrong things in public health and tobacco control because we have wrong or outdated models of the phenomena we are dealing with? Many professionally engaged in tobacco control leadership roles had their formative experience in the heat of the tobacco wars. But is that experience a help or a hindrance now?  How should we understand the drug nicotine, nicotine addiction, the motivation of consumers, youth risk behaviours, the tobacco industry, and the intense opposition to tobacco harm reduction? This presentation goes in search of reliable foundations to underpin our approach to nicotine and public health.

• Disposables are cheap, accessible, and popular – is it time to legislate?
• Are disposables marketed to kids and if so, how and by whom?
• Should we legislate to ban disposables or flavours – both or neither?
• Is this a regulation or enforcement challenge?
• What evidence do we have that kids or adults respond to risk messaging?