NHS hospitals should sell e-cigarettes, says Government agency

Smoking shelters should become “vaping lounges” for less risky e-cigarette use, NHS bosses said

Hospitals should stock e-cigarettes for sale to patients and permit “vaping” in private rooms as part of the NHS ”smoke free” efforts, according to health chiefs.

The call comes from Public Health England, as part of an evidence update on the safety of tobacco alternatives which it says should be used more widely as quitting aids.

Meanwhile, Government officials should help manufacturers licence e-cigarettes as medical quitting aids.

Such a move would allow GPs to prescribe the devices to their patients who are trying to stop smoking.

In the independent review, which updates 2015 guidance, experts concluded that vaping only poses a small fraction of the risks of smoking and could be particularly helpful in mental health hospitals.

These patients are often on a long-term stay, and have high levels of smoking and tobacco related harm which could be mitigated by promoting vaping.

E-cigarettes could be contributing to 20,000 new quits each year, they estimated.

But the number of people using the products has “plateaued” and now stands at just under three million people in the UK, according to the review, which was conducted by experts from King’s College London and the UK Centre for Tobacco and Alcohol Studies, the University of Stirling and Cancer Research UK.

One reason behind the stall in uptake could be misconceptions about the levels of harm linked to the devices.

Researchers found that thousands of smokers “incorrectly” believe that vaping is as harmful as smoking and two in five smokers had not even tried an e-cigarette.

In a linked editorial, published in The Lancet, experts from PHE said: “Although not without risk, the overall risk of harm is estimated at less than 5% of that from smoking tobacco; the risk of cancer has been calculated to be less than 1%.”

PHE officials also warned about the risks of tobacco industry efforts to promote “heat not burn” tobacco products as a safer alternatives to regular cigarettes.

It warns that while these combustion-free alternatives currently appear to have some reduced risk, the majority of the research has been conducted the tobacco industry.

Following the review, PHE has made a number of recommendations about e-cigarettes, including a call for the Medicines and Healthcare products Regulatory Agency to support manufacturers to license the products as medical quit aids so they can be made available on the NHS; encouraging any smoker to switch to using e-cigarettes, and calling on NHS trusts to be “truly smoke free”, and as part of this, ensuring e-cigarettes are for sale in hospital shops.

Martin Dockrell, tobacco control lead for PHE, said: “We are saying no smoking anywhere on the grounds [of hospitals], no smoking in the smoking shelter – that shelter becomes a vaping shelter.

“There are two parts to being a smoke-free hospital, one is not allowing smoking on the premises, the other is helping every smoker to quit.

“Some hospitals will decide, especially with their longer-term patients or patients who don’t have a choice whether they are there or not, where it will be appropriate to have spaces indoors to have spaces where vaping is permitted.

“The strongest case for that is psychiatric hospitals because [these patients] have got the highest prevalence of smoking and the highest levels of smoking related harm.

“Single occupancy rooms are quite common in mental health trusts so that makes it very easy for people to vape in a single occupancy room without any annoyance to anybody else.”

On acute hospitals he added: “It is going to be for each hospital to make their own policy but yes, we would certainly encourage them to make at least some single occupancy rooms where people can vape. Of course smoking is prohibited everywhere.”

When asked about indoor communal rooms for vaping, Mr Dockrell said: “There is no reason why a hospital shouldn’t designate some indoor areas where patients and visitors can vape.”

Professor John Newton, director for health improvement at PHE, said: “Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders.

“Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know.

“It would be tragic if thousands of smokers who could quit with the help of an e-cigarette are being put off due to false fears about their safety.”

Ann McNeill, lead author and professor of tobacco addiction at King’s College London, said: “It’s of great concern that smokers still have such a poor understanding about what causes the harm from smoking.

“People smoke for the nicotine, but contrary to what the vast majority believe, nicotine causes little if any of the harm.

However pro-smoking groups argued PHE’s endorsement could be enough to keep people smoking tobacco, by making e-cigarettes “just another smoking cessation aid”.

“If that happens they will almost certainly lose their appeal to independent-minded smokers who don’t want the state dictating their behaviour,” said Simon Clark, director of the smokers’ group Forest.

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Let workers vape in office, Government plan suggests

Vaping 

Vaping should be allowed in offices and enclosed public spaces in order to “maximise” access to safer alternatives to smoking, a Government plan says.

Announcing a vision to create a “smokefree generation,” ministers set new targets to cut smoking rates by one quarter in adults – and to stamp out the habit among younger generations.

The Tobacco Control Plan pledges to “maximise the availability of safer alternatives to smoking” and to support smokers turning to nicotine substitutes.

In particular, it reminds employers that e-cigarette use is not covered by smokefree legislation – so should not be included in policies which ban smoking.

“The evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco,” the plan notes. “The government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products.”

The Department of Health also pledged to monitor evidence about the safety of nicotine delivery products, to be published on an annual basis, with messages about the relative safety of e-cigarettes included in stop-smoking campaigns.

Standardised packaging for cigarettes was introduced in May 2017
Standardised packaging for cigarettes was introduced in May 2017 CREDIT:  REUTERS

Health officials said it was down to individual organisations to choose their own policies, but highlighted Public Health England guidance which stresses that laws banning smoking in the workplace and enclosed public spaces do not cover e-cigarettes.

The plan sets out new targets to cut smoking. Six years ago, more than 20 per cent of adults smoked, which is now down to 15.5 per cent – -the lowest level since records began.

The new target is to cut this to 12 per cent or under by 2022, with a target to cut smoking among 15 year olds from 8 per cent to 3 per cent or less.

Ministers also want to almost halve smoking in pregnancy by 2022, from 10.7 per cent at present to 6 per cent or under.

The Government said it wants to set a “bold ambition for a smoke-free generation” as it unveiled its plan for England.

Being “smoke free” is defined as smoking rates of 5 per cent or less.

The plan also pledges to use the UK’s exit from the EU to “identify where we can sensibly deregulate without harming public health”.

The report said this would include looking again at the Tobacco Products Directive, with regard to e-cigarettes.

The directive introduced last year met with some criticism, amid concerns that regulations limiting the size and strength and e-cigarettes could push some consumers back to smoking. The regulations also  severely restricts the scope of manufacturers to advertise their products.

There are currently 7.3 million adult smokers in England and more than 200 people a day die from a smoking-related illness which could have been prevented. The difference in life expectancy between the poorest and the richest can be as much as nine years – with smoking accounting for about half of this difference.

Public health minister Steve Brine said: “Britain is a world leader in tobacco control, and our tough action in the past decade has seen smoking rates in England fall to an all-time low of 15.5 per cent.

“But our vision is to create a smoke-free generation.

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“Smoking continues to kill hundreds of people a day in England, and we know the harms fall hardest on some of the poorest and most vulnerable people in our society.”

Duncan Selbie, chief executive of PHE, said: “We are at a pivotal point where an end is in sight and a smoke-free generation a reality.

“But the final push, reaching the most vulnerable and disadvantaged, will undoubtedly be the hardest.

“Only by everyone pulling together can we hope to end the loss of life and suffering smoking has wreaked for far too long. Public Health England will do everything possible to make this happen.”

Simon Clark, director of smokers’ group Forest, said: “The most important stakeholder is the consumer, yet they are routinely ignored by Government.

“Ministers should stop lecturing smokers and engage with them.”

He added: “The Tobacco Control Plan should include a systematic review of the impact of measures such as the display ban and plain packaging.

“It’s time too to question the use of public money to fund stop-smoking services and other anti-smoking campaigns.”

Professor Parveen Kumar, from the British Medical Association, said services to help people give up smoking were seeing funding cuts, which must be reversed.

Dr Jennifer Mindell, from the UK Faculty of Public Health, said: “The publication of this plan is good news for the children of this country who risk becoming nicotine addicts and for current smokers whose lives and health are already at risk through nicotine addiction. We call upon the government to follow up the plan with sufficient resources to guarantee real action.”

How the tobacco and vaping industries responded to the government’s new tobacco control plan

FDA Proposes New Regulations On Electronic Cigarettes

The tobacco and vaping industries have largely welcomed a tobacco control plan released by the government today, which seeks to encourage a loosening of e-cigarette regulations after Brexit.

The report, produced by the Department of Health, said the government would identify ways to de-regulate vaping after the UK leaves the European Union. These could include scrapping regulations on refill container size Which came in with the latest EU directive and allowing office workers to smoke using e-cigarettes inside their buildings.

The vaping advocates

Mark Pawsey MP, chairman of the all-party parliamentary group on e-cigarettes, greeted the report and said e-cigarettes had a major role to play in reducing smoking rates.

“In particular I am pleased that Public Health England’s anti-smoking campaign’s will now positively reference their vaping advice, and that the government has committed to relook at relevant legislation as we exit the EU.”

Representatives of the vaping industry were also excited about the prospect of new opportunities for businesses after Brexit. Christian Mulcahy, business development director of multiCIG and multiVAPE, said: “The UK has the opportunity to lead the way on smoking cessation and in turn, support the incredible growth of the vaping market, now one of the fastest growing consumer goods industry in the world.”

Big Tobacco

Many of the world’s biggest tobacco firms have also got on board with the e-cigarette trend, as smoker numbers plummet while e-cigarette use grows

Will Hill, director of British American Tobacco (BAT) UK & Ireland Ltd welcomed the support for “lower risk products”.

“By adopting this more pragmatic approach and embracing innovation in the nicotine category, we believe the Government stands a much better chance of achieving its health objectives related to smoking.”

Giles Roca, director general of tobacco trade body the TMA, whose members include massive manufacturers BAT, Imperial Brands, and Japan Tobacco International, said: “It is right that the government will review the measures imposed by the EU following Brexit and recognises that they have not been effective in delivering what they set out in doing”.

The smoking pressure group

Smoker advocacy group Forest criticised the government for its “punitive” approach, particularly the proposal to ban smoking on-site at all prisons, mental health facilities and hospitals. Director Simon Clark said: “In the 21st century tobacco control policies should focus on harm reduction products, not prohibition and other restrictive practises.”

He added: “The tobacco control plan should include a systematic review of the impact of measures such as the display ban and plain packaging.”

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More than half of UK vapers ‘have given up smoking’

E-cigarette use among ex-smokers continues to rise

For the first time, more than half of the UK’s electronic-cigarette users have since given up smoking tobacco, a study suggests.

Some 1.5 million vapers are ex-smokers, compared with 1.3 million who still use tobacco, a survey of 12,000 adults for Action on Smoking and Health found.

But Ash said the message that vaping was much less harmful than smoking had not yet got through to all smokers.

Some nine million still smoke in the UK despite a big rise in e-cigarette use.

In 2012, there were 700,000 vapers in the UK; now there are 2.9 million.

Rise ‘has peaked’

The main reason ex-smokers give for vaping is to help them stop smoking.

Current smokers say they do it principally to reduce the amount they smoke.

Scientists say current evidence suggests that the risks of exposure to toxins for e-cigarette users are likely to be low – and much lower than with tobacco.

Deborah Arnott, the campaigning health charity’s chief executive, said the figures on vapers who had quit smoking were “excellent news” but that the rate of people switching to electronic versions had peaked.

“The rapid growth in e-cigarette use has come to an end,” she said.

‘Much less harmful’

This is because more than a third of smokers have still never tried e-cigarettes, as a result of concerns about the safety and addictiveness of e-cigarettes.

But research suggests that 26% of people think e-cigarettes are more – or equally as – harmful as smoking tobacco while only 13% believe they are a lot less harmful.

“It’s very important smokers realise that vaping is much, much less harmful than smoking,” she added.

Ex-smokers who vape are on the rise
Image captionNumbers of ex-smokers who vape have been rising but the trend appears to be levelling off

Ann McNeill, professor of tobacco addiction at King’s College London, said: “The message for the 1.3 million vapers who still smoke is that they need to go further and switch completely.”

People who combine electronic and standard cigarette smoking are still being exposed to the cancer-causing substances in tobacco smoke, increasing their risk of lung cancers, bronchitis and other diseases, although Public Health England believes levels of nicotine in e-cigarettes are unlikely to pose any significant health risk.

But critics say there is no convincing evidence that e-cigarettes help people quit smoking and argue they could even encourage non-smokers to start.

Vaping laws are changing next month – this is what you need to know

Credits: PA

New rules on vaping are coming into force within weeks – and if you’re a vaper you will need to be aware of these changes.

The new Tobacco and Related Products Regulations 2016 comes into force on Monday, May 20, and introduces a number of rules about the sale of e-cigarettes and e-liquids

Ahead of the changes to the law, the Plymouth Herald spoke to the local Trading Standards who want to make sure that all local manufacturers and retailers are aware of the changes.

Those changes include:

– All e-cigarettes and e-liquids must be registered with the Medicines and Healthcare products Regulatory Agency before they can be sold
– Refillable tanks for e-cigarettes must be no bigger than 2ml capacity
– E-liquids cannot be sold in quantities greater than 10ml
– Unless registered as a medicine the strength of nicotine in an E-liquid must not exceed 20mg/ml
– The packaging of E-liquids must be child-resistant and tamper evident
– Certain additives such as the stimulants caffeine and taurine or colourings are banned
– New labelling requirements

Anyone who does not comply could face imprisonment of up to two years and/or an unlimited fine.

These changes to the law apply to anyone who makes or sells e-cigarettes and e-liquids including those who sell online via social media, auction sites or from their own website.

Trading Standards are particularly keen to get the message out to people who brew e-liquids at home to sell online as these are the most difficult business to reach.

Trading Standards manager Alex Fry said: “We are finding that shops are aware of the changes to the law but small online retailers are not.

With millions of buyers ready and waiting, there’s no better place for you to sell than eBay.

“We have found online sellers selling e-liquids in 100ml bottles with a nicotine strength over 20mg/ml. After 20 May this will be illegal unless the e-liquid is registered as a medicine.”

Smoking numbers hit new low as Britons turn to vaping to help quit cigarettes

New data reveals a significant decline in number of smokers over last five years, while the daily number of cigarettes consumed has also fallen

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Half of the 2.3 million people who were users of e-cigarettes said they were doing it to quit smoking. Photograph: Yui Mok/PA

The number of smokers in Britain has reached its lowest point since records began in 1974, according to new data, while more than a million people say they are using e-cigarettes to help them quit smoking.

The latest data from the Office for National Statistics shows that 17.2% of adults in the UK smoked in 2015, down from 20.1% in 2010.

Smoking levels are highest in Scotland, at 19.1%, followed by Northern Ireland, where it is 19%, Wales on 18.1% and England on 16.9%. The numbers have been dropping fastest in recent years in Scotland and Wales. Among local authorities, Blackpool is the only one to feature consistently in the 10 heaviest smoking areas between 2012 and 2015. In 2015, 25.3% of adults in Blackpool smoked.

https://interactive.guim.co.uk/charts/embed/mar/2017-03-07T12:48:42/embed.html

The data also shows that 2.3 million people were e-cigarette users in England, Scotland and Wales in 2015, about 4% of the population. Their survey also shows that 4 million more people describe themselves as former e-cigarette users. A further 2.6 million say they have tried them but not gone on to use them regularly.

Half of the 2.3 million who were current users of e-cigarettes at the time of the survey said they were doing it to quit smoking. A further 22% said they were vaping because it was less harmful than smoking. Only 10% said they chose to vape because it was cheaper than buying cigarettes. Others – 9% – said they used e-cigarettes mainly because they were permitted indoors.

The figures will bolster the arguments of those who believe e-cigarettes have a major role to play in ending the tobacco epidemic. The issue has been hugely controversial among public health doctors and campaigners, some of whom consider e-cigarettes to be a stalking horse for the tobacco industry which hopes to make smoking acceptable again and has invested in vaping.

https://interactive.guim.co.uk/charts/embed/mar/2017-03-07T12:50:30/embed.html

The World Health Organisation has expressed concern over e-cigarettes, but Public Health England has said vaping may be 95% safer than smoking tobacco.

Half of current smokers say they have tried e-cigarettes, and 14.4% of current smokers also vape.

Some of the statistics suggest that it is often the heavier smokers who turn to e-cigarettes. Those who also vape smoke marginally more cigarettes per day on average than those who do not – 11.8 versus 11.3. Smokers who have given up on e-cigarettes smoke 12.2 per day versus 10.6 among those who have never used an e-cigarette. Smokers who have children at home are also more inclined to use e-cigarettes.

The ONS vaping data is from the opinions and lifestyle survey 2014-15 and relate just to Great Britain. The ONS figures on general smoking trends include northern Ireland.

https://interactive.guim.co.uk/charts/embed/mar/2017-03-07T12:51:24/embed.html

Men are more likely to smoke – 19.3% do, compared with 15.3% of women. Smoking is most common in the 25-34 age group, where 23% smoked in 2015. It is least common in the over-65s, among whom 8.8% smoke. But the biggest decline since 2010 has been among the 18-24 year-olds, where it has dropped five percentage points to 20.7% in five years.

Figures for Great Britain also show that smokers have been cutting back on the numbers of cigarettes they consume. Average consumption is down to 11.3 cigarettes per day, the lowest number since 1974.

Deborah Arnott, chief executive of ASH said: “The decline in smoking is very encouraging and shows that strong tobacco control measures are working. However, the government can’t leave it to individual smokers to try to quit on their own. If the downward trend is to continue we urgently need a new tobacco control plan for England, and proper funding for public health and for mass media campaigns. That’s essential if the prime minister is to live up to her promise to tackle health and social inequality.”