Session 6: Tobacco and health inequalities Seminars

There is growing and widespread concern about youth use of e-liquid flavours. Findings from a review of recent research evidence confirms that young people prefer fruit and sweet flavoured e-liquids. People like vaping liquids that taste and smell good. Do flavours, therefore, tempt young people to start using nicotine, on a pathway from vaping towards tobacco smoking dependence? Or  do flavoured e liquids divert young people away from harmful tobacco smoking, and support smoking quit attempts? For adult smokers, particularly perhaps those who are vulnerable and find it most difficult to quit, might enjoying using e-liquid flavours actually promote not only cessation, but sustained tobacco smoking abstinence? The evidence will be considered within a context where societal discourses of ‘protecting innocent children’ prevail, alongside deficit based moral discourses positioning nicotine addiction as ‘bad’.  Furthermore, international regulations categorising e-cigarettes as tobacco products cause considerable confusion, through implication by association that potential e-cigarette harms are on a par with the known serious harms of tobacco smoking. There is serious, consequential, misinterpretation of observational evidence. Might it be time to consider flavouring, as one aspect of the sensory pleasure of e-cigarette use, as a positive means to supporting long term smoking abstinence?

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Even before the Covid-19 pandemic the UK was a widely divided nation in terms of health outcomes and quality of life. Contributing to this is tobacco smoking and dependence. Smoking rates are disproportionately high amongst those living with substance disorders, without secure accommodation and with a severe mental illness. Early in the pandemic it was highlighted that smokers living with these comorbidities were at increased risk of infection and needed help to quit smoking and to reduce risky smoking practices. In this talk case examples and survey data will highlight some of the third sectors response through the offer of an e-cigarette to adults seeking shelter and using drug services. The precariousness of this 'tobacco teachable moment' will also be discussed, highlighting how poor science and media reporting can undermine these efforts.

When it comes to the vape industry, there are two contrasting public health narratives. According to one, plucky little vape shops are helping people stop smoking; according to the other, the tobacco industry uses e-cigarettes as a fiendish new way to enslave our kids. There is little understanding of the wide range of players in the industry, their changing market strategies and most importantly, the impact of these strategies on smokers deciding to switch. Drawing on research with smokers, vapers and vape shops in the North of England, I will outline some of the approaches used by industry players to survive in a crowded market, including offering specialist expertise, building consumer trust and ensuring good product distribution. I will contrast these strategies with the overwhelming customer emphasis on price, explain some of the reasons for this and draw some conclusions about the global prospects for tobacco harm reduction.