Www.hertsdirect.org To e-cig or not to e-cig? Hertfordshire Tobacco Control Alliance Conference, 21...
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www.hertsdirect .org To e-cig or not to e-cig? Hertfordshire Tobacco Control Alliance Conference, 21 st January 2016 Prof. Jim McManus, CPsychol, Csci, AFBPsS, FFPH Director of Public Health for Hertfordshire Winners 2015
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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
Transcript of Www.hertsdirect.org To e-cig or not to e-cig? Hertfordshire Tobacco Control Alliance Conference, 21...
www.hertsdirect.org
To e-cig or not to e-cig?Hertfordshire Tobacco Control AllianceConference, 21st January 2016
Prof. Jim McManus, CPsychol, Csci, AFBPsS, FFPH
Director of Public Health for Hertfordshire
Winners 2015
www.hertsdirect.org
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
www.hertsdirect.org
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
www.hertsdirect.org
What this requires• Some clear thinking about what our aims and
objectives are• The use of new tools for a new social situation
www.hertsdirect.org
Continued loss of healthy life
References:1. ASH Factsheet, Smoking Statistics: illness & death, October 2011 (http://ash.org.uk/files/documents/ASH_107.pdf) NB area represents value
Obesity: 34,100
Smoking: 81,400
Alcohol: 6,541
Suicide:5,377
Drug misuse: 1,738
HIV: 529
Traffic:2,502
Each year smoking causes the greatest number of preventable deaths
www.hertsdirect.org
Tobacco – A driver of Inequalities
Smokers from the highest social class have a lower life expectancy than non-smokers in the lowest social class
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
I+II IV+VSocial Class
Rel
ativ
e m
orta
lity
Male non-smokers Male smokers
Highest Lowest
The life expectancy
between rich and poor smokers is
similarRicher smokers have a lower life expectancy than
poorer non-smokers
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Driver of inequalities
2 0 0 0 2 0 0 2 2 0 0 4 2 0 0 6 2 0 0 8 2 0 1 0 2 0 1 2 2 0 1 4 2 0 1 6 2 0 1 8 2 0 2 0
Year
0
1 0
2 0
3 0
4 0
Ciga
rette
sm
okin
g %
3 53 3 3 2 3 2
3 43 1 3 1 3 0 2 9 3 0
2 82 9
2 7
3 2
Ro u tin e & m a n u a l
2 0 2 1 2 0 1 91 7
1 9 1 81 7 1 7 1 6 1 6 1 5 1 6 1 6
No n -ro u tin e
11.3
25.3
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Herts Ambitions 2015-2017Reduce 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).
www.hertsdirect.org
Traditional methods are not going to be enough in the new social circumstances
Tobacco control has showed itself to be innovative. It’s time to do that again
What does that mean in 2016?
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“The Big 4” issues going forward
1. Continue to control tobacco and its effects2. Keep going with nuanced strategy – segment
populations3. Getting people into quitting by targeting and
segmentating audiences1. Harm reduction2. Ecigs3. Stoptober, Our Services.....
4. 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• Over 2.4m people have used ecigs to quit
tobacco according to UK figures
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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 return3. Quitting is NOT something some people will or can do.
Nice recognised this on Harm guidance4. The remaining core of tobacco smokers won’t or cant
give up tobacco as things stand5. 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 it’s 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 accrueIncluding 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 Oct;105(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?
Endorsed by Hertfordshire Public Health Service
Give up Tobacco Here!
Ecigs – helping people quit tobaco in Herts
Benefits to Taxpayers?Benefits to Quitters?Benefits to Vendors?
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Thank you
www.hertsdirect.org/healthinherts
Winners 2015
