Supporting smokers to quit - the role of e-cigarettes. Susan Stewart Programme Manager Tobacco Control 2 September 2015

Transcription

1 Supporting smokers to quit - the role of e-cigarettes Susan Stewart Programme Manager Tobacco Control 2 September 2015

2 Agenda Hazel Cheeseman, Director of Policy, ASH on the current evidence supporting use of e-cigarettes in stop smoking services Sarah Jakes, Board Member, New Nicotine Alliance on What is Vaping? covering the different devices, characteristics of vapers, differing vaping techniques to smoking and general insight into the types of questions a smoker may have on using these devices Dr Rebecca Cooper, Public Health Consultant, Solutions 4 Health on how to support our smokers in West Sussex using electronic cigarettes within the stop smoking service guidelines

3 Aims of today more informed about the role of e-cigarettes in stop smoking services understand how policies can support quitters using e- cigarettes learn more about vaping and the devices available and feel confident encouraging and supporting smokers to quit with the use of e-cigarettes.

4 Why? Mounting evidence that e-cigarettes are successfully helping people to stop smoking harmful cigarettes Feedback from our service providers Experience of our colleagues in other local authorities More recently the Public Health England evidence update on e-cigarettes

5 What does being e-cig friendly mean? CAN support smokers who want to use e-cigarettes as an aid to quitting ENCOURAGE dual users (smokers and vapers) to access our services

6 West Sussex County Council Public health contacts Susan Stewart, Programme Manager Tobacco Control West Sussex County Council or Sue Carmichael, Public Health Lead Healthy Lifestyles West Sussex County Council or Key reference documents West Sussex e-cig friendly services - frequently asked questions More recently the Public Health England evidence update on e-cigarettes Regulating nicotine products Smokefree policies prohibiting or allowing e-cigarettes

7 Current policy evidence and debate on e-cigarettes Hazel Cheeseman Director of Policy Action on Smoking and Health

8 What we re going to cover How safe are e-cigarettes? Can they help people to quit smoking? Are they a gateway to smoking? How can our policies support quitting with e-cigarettes?

9 How safe are e-cigarettes?

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11 What s in them? Nicotine NICE evidence statement: The results of this multicentre randomised controlled trial suggest that long-term use of NRT is not associated with an increased incidence of harm, including cardiovascular events or cancer, with the latest analysis of outcome at 12.5 years from study outset. Intended contents Propylene glycol Glycerine Flavours Contaminants Various concerning chemicals as a result of heating or from metals in device

12 Electronic cigarette vapour has little or none of the harmful chemical components of tobacco smoke Toxins in conventional and electronic cigarettes Goniewicz et al, TC 2013;0:1 7. doi:

13 Courtesy of Prof John Britton, Nottingham

14 Courtesy of Prof John Britton, Nottingham

15 Can e-cigarettes help people to quit smoking?

16 NICE Guidance on smoking prevention and cessation PH10 Smoking cessation services PH48 Smoking cessation acute, maternity and mental health services PH45 Tobacco harm reduction Published June

17 Why are people vaping?

18 Cochrane Review What s a Cochrane Review? Systematic review of existing literature against a search strategy. Meta analysis of findings to provide a clear picture of current findings. Cochrane review of electronic cigarettes found: Very few studies which met the search criteria - RCTs Results indicated that EC containing nicotine improved quitting and cutting down But low confidence due to limited number of studies

19 Data from stop smoking services

20 Aids used in most recent quit attempt E-cigarette use for quitting is still increasing somewhat N=10078 adults who smoke and tried to stop or who stopped in the past year 20

21 Aids used in most recent quit attempt Least effective Moderately effective Most effective E-cigarettes have grown the use of moderately effective aids to cessation from 24% to 35%; use of most effective methods has decreased from 4% to 3% At stable quit attempt rate of 37% this contributed 0.05% to the decreased prevalence (~20,000 additional ex-smokers) Approx odds of success relative to nothing and NRT-OTC: 1.5 Moderately effective 3.0 Most effective N=9783 adults who smoke and tried to stop or who stopped in the past year; 2009 is Jul to Dec 21

22 Are they a gateway to smoking?

23 Source ASH Smokefree GB youth survey (11-18 years) (2015 March) Ever tried Use less than once a week (but not just once or twice) Use more than once a week Use (at least monthly) in never smokers Regular smokers who had tried e- cigarettes 12.7% 1.9% 0.5% 0.1% 77% Health Behaviour in Schoolaged Children, Wales (11-16 years) (Nov 2013 Feb 2014) 12.3% 1.5% (use at least monthly) 0.3% Not reported CHETS Wales survey (10 11 year olds) 2014 SALSUS Scotland survey (15 and 13 year olds) % Not reported Not reported Not reported Not reported 12% 0.6% 0.5% 0% 66% The smoking, drinking and drug use survey (11-15 year olds), % 3% 1% Not reported 89% What about YOUth Survey (15 year olds) % 2% 1% 0% 84%

24 Children who have never smoked rarely use electronic cigarettes Tried smoking 45% Regular smoker 77% Occasional smoker 61% Former smoker 34% Never smoker 4% % who have tried e-cigarettes 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 24

25 Which products are young people using first?

26 Youth smoking in England 26

27 How can our policies support quitting with e-cigarettes?

28 PHE recommendations E-cigarettes provide an opportunity to tackle high smoking rates particularly among deprived groups Appropriate regulation to ensure that e-cigarettes act as a gateway out of smoking for smokers without providing a route into smoking for children Stop smoking services should engage actively with smokers who want to quit using electronic cigarettes Clear and accurate information about the relative harm of nicotine, e-cigarettes and smoked tobacco

29 PHE commitments They will continue to monitor the evidence and will hold a second national symposium on e-cigarettes next year They will provide the public with clear and accurate information on the relative harm of nicotine, e-cigarettes and smoked tobacco Publish a framework to support evidence-based policies on use in enclosed spaces Commission NCSCT to develop training to support SSS to have confidence in advising clients on e-cigarettes Monitor tobacco industry involvement in the market

30 Cig arette smo kin g % Despite decades of progress gap between rich and poor is widening Rout i ne & m anual Non- rout i ne Ye a r

31 Electronic cigarette and NRT use across the social gradient Higher social grades are more likely to use e-cigarettes while there is no clear gradient for NRT N=8,263 adults who smoke or who stopped in the past year and were surveyed between 2013 and

32 By 2016 the UK market will look like this Tobacco Products Directive regulation of electronic cigarettes MHRA licenced Nicotine Containing Products (NCPs) including e-cigs Products not available on prescription Products available on prescription 20% VAT 5% VAT Cross border advertising banned by 2016; up to Member States to decide on domestic advertising (billboards, Point of Sale, buses etc.) Advertising allowed under OTC rules so no celebrity endorsement or free samples and must be targeted at adult smokers etc. Products widely available Can t make health claims Upper limits for nicotine content will be set and likely to be in force by % health warning on packs about nicotine on front and back of packs Member States retain powers e.g. on flavours, domestic advertising. Children and Families Bill allows for age of sale of 18 for nicotine products. Products available on general sale (GSL) Can make health claims MHRA regulation is flexible; there are no upper limits. No health warnings on packs Flavours require a marketing authorisation Age of sale 12 but can be varied by product so 32 could be higher for electronic cigarettes.

33 Walled garden and managed grounds

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35 Poor knowledge of nicotine 25% According to what you know or believe, what portion of the health risks of smoking comes from nicotine in cigarettes? 20% 15% 10% 5% 0% None or very small Some but well under half the risk Around half the risk Much more than half the risk Nearly all the risk Don t know

36 Perceptions of risk may undermine use

37 Summary Electronic cigarettes are not a panacea to the problem of how to get smokers to quit BUT they are making an important contribution to reducing smoking rates despite being of variable quality and relatively early in their development There is an important need to monitor use of products by non-smokers and young people Our policies, however, must balance the risks to nonsmokers with the opportunities for smokers

38 Vapers & E-cigarettes Who and what are they and how do we incorporate them into our armoury? Sarah Jakes Trustee NNA UK Vaper

39 The New Nicotine Alliance (UK) is a registered Charitable Incorporated Organisation in the UK. It is concerned with improving public health, through a greater understanding of new (risk-reduced) nicotine products and their uses. info@nnalliance.org

40 In the beginning there was smoke.. First cigarette at age 14 Regular smoker aged 16 Numerous attempts to quit over a period of 34 years. Gave up giving up. Cigarettes are poems for those who never know what to say Anonymous Twitter user

41 A New Discovery Did not intend to quit Bought starter kit on a whim Complete switch within 2 weeks In control Improved health Flavours and variety

42 Do e-cigarettes have a place within stop smoking services? Barriers to entry: Unfamiliarity Initial cost Lack of support Perception of risk How you can help: Opportunity to try Vouchers /prescription Behavioural / product Accurate information How do we support products we don t understand ourselves?

43 OMG there are so many! Variety is an important factor for success but can be overwhelming. Many devices not for beginners keep it simple! Establish a rapport with local retailers they can help.

44 1 st Generation Devices Cigalikes Disposable or rechargeable Look and sometimes feel like a cigarette Widely available in C-stores (or at least they were!) Cost anything from 1-7

45 1 st Generation Devices Cigalikes Advantages Less of a departure from a cigarette Users less self conscious Cheap introductory product Generally come in tobacco or menthol flavours Ease of use

46 1 st Generation Devices Cigalikes Disadvantages: Poor battery life Poor vapour production Over inflated equivalency claims Expensive to use exclusively Flavours are limited Tobacco flavour does not taste like smoke May cause disappointment!

47 2 nd Generation Devices Tank Systems Rechargeable batteries Selection of sizes & colours Refillable tanks E-liquid bought separately Parts sold separately Inter-compatible Push button operation Operates at about 7 watts Cost between 1-25

48 2 nd Generation Devices - Tanks

49 2 nd Generation Devices Tank Systems Advantages: Multiple batteries can be used on same tank Different capacity batteries available Different capacity and type of tanks available Huge selection of flavours & strengths available Replacement coil heads with choice of resistances Almost infinite ability to personalise

50 2 nd Generation Devices Tank Systems Disadvantages: Quality models more expensive More complicated to use Much larger than a cigarette Um..

51 3 rd Generation Devices Refers to the battery unit Variable watts or volts User adjusts for sweet spot Different liquids taste better at different power.

52 Generation X Rebuildables RBA / RDA Mech mods squonkers Temperature control Sub-ohming

53 E-Liquid Range of strengths commercially available Other variants include PG/VG ratio and thousands of flavours DIY Flavours important: Unflavoured liquid tastes bitter Creates distance from smoking Makes ecigs preferable to smoking

54 Techniques Vaping technique differs to smoking Smokers binge, vapers graze Mouth to lung Direct to lung - airflow Can differ with different devices and strengths

55 FAQs for Greater Glasgow & Clyde Smokefree Services Q: My E-Cigarette tastes burnt A: Atomiser needs replacing or insufficient liquid getting to the coil. Check liquid level and refill if necessary. Give the liquid time to wick to the coil. Change atomiser. Q: I m not getting enough vapour from my E-cigarette A: Insufficient power or liquid quantity. Check battery charge state and re-charge. Change liquid cartridge or refill.

56 FAQs for Greater Glasgow & Clyde Smokefree Services Q: My E-cigarette is giving me a headache or making me dizzy A: Tendency among new users to over vape because delivery is slower. Cease use for 15 minutes or so and headache will pass. Users adapt quickly. Consider reducing nicotine strength if this happens often. Q: I am not getting a strong enough throat hit from my E-cigarette compared to tobacco A: Try a liquid with a higher PG or nicotine content, or with a menthol flavour.

57 FAQs for Greater Glasgow & Clyde Smokefree Services Q: I can t taste my E-Cigarette A: Smoking dulls sense of taste, it will return. Vapers tongue a desensitisation to a particular flavour, try another one. If atomiser is old, replace it. Q: My battery runs out on me all the time A: Always have a spare charged ready. Consider buying a higher capacity battery. Rechargeable batteries degrade with use. Consider replacing.

58 Vapers Harm reductionists themselves and others Money savers Dual users smokers who vape & vapers who smoke Smoking cessation Accidental Instant Longer period Hobbyists

59 Vapefest!

60 Regulation As medicines No e-cigarette is anywhere close to achieving MA Medicinal products may provide confidence Medicinal products unlikely to have wow factor As consumer products TPD will place arbitrary restrictions for little to no health benefit Enclosed space bans (Wales) will be counter productive.

61 Conclusions All smokers are different and one size does not fit all. NRT or pharmaceuticals with support are most effective but lack mass appeal. E-cigarettes provide a diverse range of products and are appealing to smokers as a safer alternative. E-cigarettes offer autonomy and control over nicotine use and importantly are enjoyable to many smokers Refillable tank systems have been shown to be more effective for total switching than cigalike type products Combination of support, e-cigarettes and other products could be what makes the difference for many.

62 Thank you

63 West Sussex Stop Smoking Services E-Cig Friendly Rebecca Cooper and Lesley Berry, Smokefree West Sussex

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65 POSITIVE COMMS

66 Clear Information for Partners

67 Frequently Asked Questions Can a stop smoking provider make a claim for helping someone to quit tobacco products even if they used an unlicensed product such as an e- cigarette to help them quit? Can e- cigarettes be used in combination with any other stop smoking medication? Can people who use e-cigarettes only and have stopped smoking tobacco products still use the service? Should we recommend an e- cigarette product? Where can e- cigarettes be bought?

68 We Will Continue to work with all smokers who want to quit in West Sussex, including those who are already or who would like to use e-cigarettes as part of the quitting process Provide the same evidence based, Russell standard service to all smokers in West Sussex who wish to quit, regardless of whether they are using e- cigarettes or not Answer all queries about e-cigarette usage to the best of our ability and ensure that our partners are kept up to date and receive relevant training on e- cigarettes

69 We Will Not Prescribe e-cigarettes to people Recommend any brand of e- cigarettes Offer the service to people who are using e-cigarettes but who do not smoke tobacco

70 Thank you