Session 6: 2021 Seminars

The US Food and Drug Administration’s recent authorization of certain e-cigarettes and other non combustible tobacco products under its premarket tobacco products application process confirmed the agency’s understanding that e-cigarettes and other alternative nicotine-containing consumer products are significantly less harmful than tobacco products that are burned. The FDA determined that these products can be good for the protection of public health, potentially helping millions of addicted adult smokers quit smoking. While imperfect, the PMTA process is now facilitating the transition to a new era in which adult consumers have access to far less harmful alternatives and develop greater, more accurate understanding regarding the risks and benefits of nicotine. The essence of this process is objective, nonpoliticized scientific inquiry and review. The scientific research community must take advantage of this new opportunity to disseminate credible scientific findings to better educate the public, the public health and medical communities, the media and decision-makers.

This presentation will discuss the potential for parents to be the untapped link between smoking cessation and prevention of youth use of e-cigarettes and other tobacco products. Although there is substantial evidence for the association of parental smoking and youth smoking, less is known about ripple effects of parental smoking cessation on youth tobacco and e-cigarette use. This presentation will discuss how a refocus on parental smoking cessation may help to achieve the dual aims of reducing smoking and preventing underage e-cigarette use.

Greater Manchester’s Making Smoking History strategy was launched in 2017 to tackle inequalities by reducing smoking prevalence across the population. Since then, it has helped to improve the health, wellbeing, and wealth of thousands of residents and their families and is currently leading the way for tobacco control in England. Campaigns have focused on hard hitting, engaging, positive, non-patronising messages with a GM voice and feature local people telling their stories about stopping smoking and living with smoking related harm. Creating fair and equitable access to an integrated stop smoking system is still a work in progress. This includes universal access to advice, support and to stop smoking medications, Nicotine Replacement Therapy (NRT) and e-cigarettes.  E-cigarettes have been an important part of successful quit attempts and that has been promoted actively.  Most importantly, GM smokers are using e-cigarettes and want their quit attempts to be supported and reinforced.

Smoking cessation is a core responsibility of medical practice, however traditional treatments have low long-term success rates. Tobacco harm reduction with safer nicotine products such as vaping nicotine is an additional, evidence-based tool for helping smokers quit and often works where other treatments have failed. However, doctors have been slow to embrace vaping and many remain misinformed about it and about the safety of nicotine. Medical practitioners have a duty of care to provide the best possible management at each patient encounter. Withholding a legitimate treatment option that could prevent a life-threatening illness is a breach of that obligation. This is especially important in disadvantaged populations for whom smoking is a major cause of health and financial inequalities. Vaping may have a special role in this population that is currently being left behind as we hasten slowly toward the endgame.

At various points since early 2020 it has become apparent that there are similarities between some of the challenges faced in tobacco harm reduction research and policy and those we've encountered during the Covid-19 pandemic. Both involve using complex and often conflicting sources of data and evidence to inform public health interventions. Both have particular effects on disadvantaged and marginalised groups. Each elicits strong opinions about personal autonomy, collective responsibility and the role of the state in public health. How individuals respond has been shaped by social norms and heavily influenced by the role of the media.  Levels of trust in government and in national and international public health organisations have influenced behaviour and the regulatory context. For both tobacco harm reduction and Covid-19, there have been vigorous and often heated debates between groups of scientists, and vested interests have sought to influence those debates. Attempts at consensus have had mixed success. This closing plenary will reflect on these similarities and differences from the perspective of a researcher who has worked with public health agencies, the media and governments on both issues. Are there any key lessons we can take from the pandemic for tobacco harm reduction now and in the future?

Why has THR been such a polarised area of science and policy - what could improve it?