To e-cig or not to e-cig?

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• To e-cig or not to e-cig?
• Hertfordshire Tobacco Control Alliance
• Conference, 21st January 2016
• Prof. Jim McManus, CPsychol, Csci, AFBPsS, FFPH
• Director of Public Health for Hertfordshire

Winners 2015
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Changing World for tobacco control

• Footfall for traditional smoking cessation
  plummeting nationally
• Segmentation of the population a long tail
  market?
• E cigs - Roll ups
• Shisha - Illicit tobacco
• Young people still initiating smoking
• National campaigns
• Legislation, Regulation and Licensing changes

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Where we are

• A crowded and confused market of products and
  users which is becoming increasingly
  differentiated and fragmented while the
  prevalence of tobacco use and burden of disease,
  disability and death is still highest in
• Routine and manual workers
• Pregnant women People with long term conditions
  including HIV
• People with mental health problems
• Some BME communities

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What this requires

• Some clear thinking about what our aims and
  objectives are
• The use of new tools for a new social situation

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Continued loss of healthy life
Each year smoking causes the greatest number of
preventable deaths
Alcohol 6,541
HIV 529
Traffic 2,502
Suicide 5,377
Drug misuse 1,738
Obesity 34,100
Smoking 81,400
References1. ASH Factsheet, Smoking Statistics
illness death, October 2011 (http//ash.org.uk/
files/documents/ASH_107.pdf) NB area represents
value
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Tobacco A driver of Inequalities
Smokers from the highest social class have a
lower life expectancy than non-smokers in the
lowest social class
3.50
3.00
2.50
The life expectancy between rich and poor smokers
is similar
2.00
Relative mortality
Richer smokers have a lower life expectancy than
poorer non-smokers
1.50
1.00
0.50
0.00
III
IVV
Social Class
Highest
Lowest
Male non-smokers
Male smokers
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Driver of inequalities
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Herts Ambitions 2015-2017

• Reduce Adult smoking prevalence
• by 1 per year from 15.5 baseline
• in Routine and Manual workers by 2 per year from
  the 25.7 baseline
• Reduce Young People uptake
• continuous reduction in REGULAR and OCCASIONAL
  smoking in 15 year olds to 5 by 2017 (from a
  baseline of 10 in 2014)
• Reduce Smoking in Pregnancy
• smoking prevalence at the time of delivery
  (SATOD) is less than
• 5 for women registered with HVCCG (from a
  baseline of 6.6 in14/15) and to
• 7 for women registered with ENHCCG (from a
  baseline of 9.2 in 14/15).

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• Traditional methods are not going to be enough in
  the new social circumstances
• Tobacco control has showed itself to be
  innovative. Its time to do that again
• What does that mean in 2016?

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The Big 4 issues going forward

• Continue to control tobacco and its effects
• Keep going with nuanced strategy segment
  populations
• Getting people into quitting by targeting and
  segmentating audiences
• Harm reduction
• Ecigs
• Stoptober, Our Services.....
• New technologies, new solutions, new markets, and
  new allies?

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The fundamental question....

• What form do e-cigarettes play in a comprehensive
  local tobacco control framework?
• Aims
• Less tobacco, fewer deaths, less disability
• Stop people from taking up tobacco

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My contention....After more debate and reading
bad and good science than I care to remember

• E cigarettes have a fundamental part to play in a
  coherent whole system approach to tobacco control
• We need to become friendly to their use and their
  distribution
• The science supports this
• Much, much, safer than tobacco
• No convincing evidence of gateway or
  renormalisation

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Where this leaves us

• For me I have fundamentally changed my mind on
  e-cigarettes. I am convinced if we do not seize
  their benefits, we will see stop smoking services
  cuts drastically across England
• Demographics have changed
• Currently there are 2.6 m vapers in Great
  Britain.
• 1.1m vapers have completely stopped smoking and
  of the remainder half are using e-cigarette as
  part of a quit attempt.

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Key questions

1. The end game for tobacco is still what we want,
   yes? Denormalising tobacco
2. Our current strategy is reducing in return
3. Quitting is NOT something some people will or can
   do. Nice recognised this on Harm guidance
4. The remaining core of tobacco smokers wont or
   cant give up tobacco as things stand
5. Time to rethink our offer.....

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Mental health as an example

• Allowing people with mental health problems to
  just keep smoking perpetuates the myth that its
  a kindness and the fact that 64 of tobacco use,
  and associated disease and death, falls on this
  population. Early deaths are a sign of our
  failure.

• Making people with mental health problems go cold
  turkey is inhuman
• Offering enough real alternatives for people to
  find an easy way out of tobacco is the challenge.

For people with MH issues who quite tobacco,
major health benefits accrue Including the
ability to reduce doses of many medicines
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My reading of that context...

• Hertfordshire should follow the lead of
  Leicestershire and others and become as
  e-cigarette friendly as we can be, in the
  recognition that the public health gains from
  e-cigarettes significantly outweigh the risks.
• We will keep this under regular review

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The Big Wins

• E cigarettes as part of the tobacco control
  repertoire
• Reduce deaths, disease and disabillity
• An acceptable route for people with mental health
  issues
• Normalising e-cigarette use does NOT mean
  renormalising smoking
• Save some money in austerity climate
• Help people to help themselves

1
Am J Public Health. 2015 Oct105(10)1967-72.
doi 10.2105/AJPH.2015.302764. Epub 2015 Aug
13. Smoking Norms and the Regulation of
E-Cigarettes.
1
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How.....

• Working with ecig users in our services taking
  their choice of tool (an ecig) seriously
• Publicity about ecigs as a valid option for
  quitting
• Looking at how and whether we can give ecig
  starter kits especially in MH facilities
• Accrediting safe and knowledgeable retailers
• Helping review vaping policies in workplaces and
  elsewhere

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Safe Retailers are important, we should support
them

• Can we tell consumers that there are vendors they
  can trust to be of good quality and safety?

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Could we go even further, what if..??

• In Hertfordshire trusted e cig vendors operated
  under explicit endorsement from us? come here
  and quit tobacco directing would be quitters
  to knowledgeable and helpful vape vendors? Even a
  badge or quality mark?

Give up Tobacco Here!
Benefits to Taxpayers? Benefits to
Quitters? Benefits to Vendors?
Endorsed by Hertfordshire Public Health Service
Ecigs helping people quit tobaco in Herts
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Thank you

• Jim.mcmanus_at_hertfordshire.gov.uk
• www.hertsdirect.org/healthinherts

Winners 2015