Q&A about stopping smoking with Linda Bauld and ASH (Action on Smoking and Health) - ANSWERS BACK

[LucilleMumsnet]

We're running a Q&A over the coming week about stopping smoking with Linda Bauld, Professor of Health Policy at the University of Stirling who is working alongside the organisation ASH (Action on Smoking and Health).

Linda Bauld has conducted studies on drug and alcohol use, inequalities in health and, most notably, on tobacco control and smoking cessation. She is a former scientific adviser on tobacco control to the UK government and currently chairs a number of public health advisory and funding committees for NICE, Cancer Research UK and the Scottish government.

Action on Smoking and Health (ASH) was established in 1971 by the Royal College of Physicians. It is a campaigning public health charity that works to eliminate the harm caused by tobacco. ASH say "We do not attack smokers or condemn smoking and while we aim to be innovative and agenda setting in our work, our policies are always evidence based and follow a dual approach, involving:
• Information and networking: To develop opinion and awareness about the 'tobacco epidemic'
• Advocacy and campaigning: To press for policy measures that will reduce the burden of addiction, disease and premature death attributable to tobacco.

Information on our activities as well as a wide range of information and resources on smoking can be found on our website"

Post your questions to Linda before midday on Wednesday 11 June and we'll post up her answers the following week on 18 June.

@ineedausername

As a new vaper (and an ex 20 a day, 15 year smoker!) i would just like to say that vaping has absolutely helped me stop. I tried will power, gum, that spray mist (awful), lozenges and patches. Nothing worked!

Is the best way to help smokers quit to over-regulate and effectively exercise an unrealistic amount of control over ecigs?

The cynic in me says this will give the government an opportunity to apply unnecessary tax to these items, thus driving the cost of e-cigs, liquids, all parts etc up.

Also, if costs of these items are to rise, surely people will resort to buying from, lets say, less regulated markets? Leading to buying cheap/fake liquids and parts?

hope that all makes sense :)

Again, congratulations on stopping smoking. Your experience adds to the body of evidence that electronic cigarettes have a major role to play in helping people quit tobacco. Although it is worth noting that they are not always a magic bullet – traditional nicotine replacement products have been on the market for decades and are still used successfully by many people trying to stop.

I understand your worries about over-regulation. As I said in my earlier answer, we need a sensible and evidence-based regulatory framework. Regulation is needed first of all to ensure that electronic cigarettes are not marketed at children, as seen in a recent Lilly Allen music video where she was paid to use and promote a particular brand of electronic cigarette. The optional medicines regulation route I discussed earlier would also ensure safe and reliable products that have been proven to help people quit. Many smokers want the reassurance that medicines regulation can offer. It’s also good news on the tax side - if companies elect to go down the medicines regulation route, they would attract only 5% VAT rather than the usual 20%.

@Allergictoironing

Not absolutely sure whether Linda would be able to have a view on this or not, but here goes...

There's much said about how vaping may be a "gateway" into cigarette smoking for young people, and that many young people have taken it up. Has there been any research done on the number of young people who vape but WOULD have taken up smoking before e-cigs were widely available and accepted? I know of at least 2 teens who made the decision to vape rather than smoke - their mates either smoked or vaped and they were going to end up doing one or the other.

As you say, the gateway argument is one of the main concerns that some people have about electronic cigarettes. So far, there is no evidence for any such effect. Although we do know that use of electronic cigarettes among young people is increasing in the US and UK, this is overwhelmingly among young people who are already smoking tobacco. In a recent ASH survey, only 1% of 16-18 year olds who have NEVER smoked had tried an electronic cigarette. And few, if any, of these children went on to use them again.

So, as you say, it looks like the children who are using electronic cigarettes are the ones who would have otherwise smoked. Even though it is too early to know the long-term effects of electronic cigarettes, it is clear that using electronic cigarettes is much safer than smoking tobacco. We don't yet have precise numbers on how many children are not smoking tobacco due to electronic cigarettes but we should have research on this in the future.

@Cantabile

I used to get through 40-50 fags a day, heavy heavy smoker. I got an ecig out of curiosity and a love of gadgets. I didn't expect anything from it at all. The day I started using it I found I had only smoked 12 cigarettes. I hadn't even wanted to give up or cut down as I knew I would fail, get bad tempered, eat more, and generally feel miserable (yes, I had tried a few times in 30 odd years). Over 6 months on, I'm still not trying, but I'm down to less than 5 fags a day, do not eat more (if anything, I eat less), am not bad tempered. I have a progressive debilitating condition, which will require certain operations and treatments over the coming years, a my cardiologist is happy, my gp is happy, I am fitter than I have been for years, my heart and lungs are improving, and my muscles are too.

Linda Bauld, I want first to say thank you for supporting us vapers. It seems that many people do not, or cannot, separate smoking from vaping; we need to separate nicotine from tobacco in the public's perception. There is evidence on this thread already that people need a pariah to focus on and as they think that hand to mouth movements and inhaling equals smoking and is therefore baaaad and must be stopped, I am wondering how this problem of misperception could best be handled.

I am really worried that ecigs will follow in the way of snus in the EU and thousands of people will be subject to unnecessary and messy (and expensive to the NHS) deaths as a result.

You are absolutely right. Electronic cigarettes are not cigarettes. First, they contain no tobacco. Second, they are not smoked. And while their resemblance to cigarettes helps some smokers feel comfortable switching to them, it also scares many others.

The good news is that I think national policy-makers are increasingly recognising that electronic cigarettes have a major role to play in reducing use of tobacco. You can see this is the recent Public Health England, NCSCT (National Centre for Smoking Cessation and Training) and MHRA (Medicines and Healthcare products Regulatory Authority) statements.

But what can we do to make a greater distinction with tobacco smoking? Ideally, we need a new name that shows they are not cigarettes. Vapers are already making this distinction. You may have noticed that I am referring to them as electronic cigarettes as I worry the term e-cigarettes can confuse some people. It would be good if we could settle on a new name that policy makers are happy to use too. The terms "Nicotine Containing Products" or "Electronic Nicotine Delivery Systems" have been suggested but they are understandably not quite catching on with users.

We could also do more to publicise the fact that using nicotine (as distinct from tobacco ) is safer. Although nicotine-containing products have been used for decades to help people quit, many people still think nicotine causes cancer.

@ICanSeeTheSun

Why doesn't there seem to be much information on the negatives of giving up smoking.

Giving up makes you feel crap.

Common problems seems to be headaches, bad chest, flu like symptoms, lack of concentration, sore throat and mood swings.

Luckily I am attending a group and know these are common problems, but I think these should be highlighted

People who successfully stop smoking do experience a range of withdrawal symptoms. There are several short term effects like the symptoms you mentioned. Some of these are listed in the FAQs section of the NHS Smokefree website. One of the most common is runny nose, which is actually mentioned less often than other symptoms such as irritability, feeling tired and low concentration. Luckily, in most people who try to stop smoking they all resolve quite quickly.

You are right that the negatives of quitting are mentioned less than the positives. In part, this reflects the fact that stopping smoking has such large overall benefits to health. Successful quitters often do not often talk about the withdrawal symptoms after quitting. However, health professional who support smokers to quit do talk about these issues during consultations. I would always recommend smokers to try to quit with support as their success rates are much higher. More information on the free NHS support available to help you quit is available here. And Robert West's new book, the Smokefree Formula, that I mentioned earlier is also very helpful on what to expect.

@PlentyOfPubeGardens

I have another question - as smoking rates have fallen, it has become increasingly apparent how much smoking is a social class issue and a mental health issue - i.e. poorer people and those with a MH diagnosis are much much more likely to be smokers than other groups. What new strategies are needed to help these groups of people to quit?

You are absolutely right. Smoking is increasingly concentrated in these groups. Smoking rates in poorer communities and in people who experience mental health issues are over double the rates in the general population. Even worse is the fact that death rates from tobacco are up to three times higher among disadvantaged social groups than among the better off.

What we can do? We definitely need to try harder in this area. As a first step, NHS Stop Smoking Services must be focussed in areas of deprivation and where people with mental health problems can access them. Recent research shows that the mental health community are just as responsive to stop smoking support that is designed for the general population. As NICE (the National Institute for Clinical Excellence) says in its guidance on smoking cessation in mental health services, this support is not as widely available as it should be.

We also need to make sure that local councils target their tobacco control work (i.e. work with schools, environmental health, trading standards etc) in the same way.

Finally, we should ensure that mental health service users are just as able to access smokefree healthcare services as the general population. This should involve routine provision of nicotine-replacement therapy on admission. In my view, we should also be open to allowing use of electronic cigarettes within mental health institutions.

Thanks for the responses Linda, there is much to feel positive about here. However ...

Without going into too much detail, the revised EU Tobacco Products Directive will take effect in 2016, meaning that electronic cigarettes will have to be regulated as a tobacco product (therefore no television, internet or other cross-border advertising). But it would still be possible for the UK to offer an additional medicines regulation route for companies that choose to opt into it. This would allow companies who want to make health claims about their products to apply to the MHRA (Medicines and Healthcare products Regulatory Agency) for their products to be regulated as medicines. Although this sounds like more red tape, the real advantage of the medicines route would be lower VAT rates of 5%, with advertising allowed as long as it promotes the products as aids to quit tobacco. It would also ensure that consumers are getting safe and reliable products, proven to help people quit. ASH and I support this dual approach as we believe it will ensure that smokers trying to quit have maximum access to high quality products.

I strongly disagree with this.

The TPD will not only restrict advertising, it will effectively ban everything on the market today except for disposable cig-alike cartridges (the most expensive and ineffective products) and the only companies who could afford to comply with the notification procedures are the big tobacco companies (currently only a small part of the market). It's a massive own goal which will ultimately cost lives.

Med regs similarly will result in all the small, innovative companies being unable to compete as it is simply too costly. Meanwhile, BAT are one of the first companies applying for a medicinal licence. In the words of Clive Bates, 'A limited authorised range of dull but perfectly safe medicalised products that no-one wants to use is worthless and counterproductive.'

Nobody gives a stuff about lower VAT rates. A decent, effective gen 2 or gen 3 device can cost as little as £3-4 per week to run.

The thing is, ecigs are not a tobacco product and neither are they a medicine. They need their own, properly thought out, bespoke regulation.

Please listen more carefully to vapers - don't just be moved by the personal stories of successfully quitting, listen to them when they tell you what works and what doesn't. Listen to the very sound arguments they are putting forward as to why this legislation is likely to spell the end for ecigs as a serious tool in harm reduction.

Hmm maybe your position means that you can't comment directly on what Sally Davies said. I can though

I think that for Sally Davies to say that smokers and vapers should just 'grow a backbone and quit' is not only heartless but completely ignorant. I don't think someone who says things like that is fit to be CMO. I think she should resign.

Anyway ...

We also know that using nicotine containing products, like those available from NHS Stop Smoking Services, really increases your chance of quitting. People who get help from NHS Stop Smoking Services are up to four times more likely to quit successfully than trying to do it on their own.

This isn't quite true though is it? As Professor Robert West's recent research shows, NRT itself doesn't work at all! People using NRT do worse than those using nothing:

'Non-smoking was reported among 20.0% (93/464) of those using e-cigarettes, 10.1% (194/1922) using NRT over-the-counter and 15.4% (535/3477) using no aid.'

I liked this from the discussion section -
The finding that smokers who had used an e-cigarette in their most recent quit attempt were more likely to report abstinence than those who used NRT bought over-the-counter, and that the latter did not appear to give better results than not using any aid [33], contributes to the debate about how far medicine regulation can go in ensuring that products used for smoking cessation are or continue to be effective in the real world

Makes you think, doesn't it?

It's fair to say those who use NHS Stop Smoking Services have a relatively good chance of successfully quitting. This is surely because of the support they receive though, not because of the useless NRT they are given.

I understand your worries about over-regulation. As I said in my earlier answer, we need a sensible and evidence-based regulatory framework.

Yes we do! This is not it though. Here is a letter by 15 scientists whose work was misused in the drafting of the TPD, pointing out all the scientific errors in the legislation.

Regulation is needed first of all to ensure that electronic cigarettes are not marketed at children, as seen in a recent Lilly Allen music video where she was paid to use and promote a particular brand of electronic cigarette.

That Lily Allen video was aimed at children? Really? We are talking about the one where she exploited lots of Black women's bodies in a misguided attempt at feminism? Wow, I am left wondering what a music video would look like that wasn't aimed at children.

Personally I don't much care if TV advertising and product placement were banned (although maybe if Peter and Deirdre Barlow switched to vaping it could send a positive message). Where I think the advertising ban will do serious damage is online - to all the forums and youtube channels that rely on tiny amounts of sponsorship from small ecig companies to keep going. These are the places vapers go to for the information and help they need to successfully switch.

Many smokers want the reassurance that medicines regulation can offer.

This is true and I don't think it's a bad thing to have some medically licenced products available. They won't be very good but they might give some smokers the confidence to give it a try. Once they have seen the possibilities they might be inspired to seek out better kit that will be more effective. Such a shame the better kit won't be available after 2016.

Ideally, we need a new name that shows they are not cigarettes.

My favourite suggestion is Personal Electronic Nicotine Inhalation System More seriously, quite a few people are going for Personal Vapouriser (PV) but whenever I've tried that, someone always says, 'oh you mean an ecig'.

We could also do more to publicise the fact that using nicotine (as distinct from tobacco ) is safer.
Yes, please do - this would be very helpful.

Thank you for the post on mental health and poverty. Really interesting stuff.

I especially like In my view, we should also be open to allowing use of electronic cigarettes within mental health institutions. I would expand this to include all hospitals and community settings. I read a very interesting piece in the Guardian a while back which suggests there's a lot of self-medicating going on.

It's frustrating that this is a Q&A rather than a webchat, I would welcome the chance to discuss this further.

I have one last suggestion for ASH (also for Professor West's Smoking Toolkit studies) - when you are collecting figures on who is using ecigs it would be very useful to record what sort of devices people are using. It wouldn't surprise me at all if we found that the 1/3 of vapers who are ex-smokers are mostly using gen 2 or 3 devices and that many more of the vapers who are still smoking are using cig-alike devices (gen 1). I don't believe we should be proposing any further legislation until we have a more complete picture, which this data would help provide.

Thanks once again for coming on Mumsnet. Professor West's book looks really interesting.

Very very interesting. Thank you MN and LB.

In our house we call them Vape Sticks. DH has a cialike but nothing else in the house, or among our friends' devices, looks even remotely like a fag. Let's face it, with more devices like MVPs, and clearos like protanks, alternative mouthpieces etc, they look less and less like cigarettes all the time.