Session 5: 2021 Seminars

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.

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.

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.    

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.

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.

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