E-cigarettes – courage or caution?

It’s been announced today that e-cigarettes are 95% less harmful than tobacco. Public Health England’s report even suggests that they could become such a significant tool in the arsenal to help people stop smoking that they could even be prescribed on the NHS.

Whilst the evidence now clearly shows that it much more preferable for people to use e-cigarettes than smoke tobacco, am I being too much of a purist in being feeling uncomfortable about seemingly endorsing the use of e-cigarettes? Am I being too cautious in not recognising the significant public health value that could be gained by using e-cigarettes to further support smokers and to drive down incidences of smoking from the stubborn rate of around 20% of all adults?

I ordinarily embrace being courageous and I welcome change. But on this occasion I think there’s good reason to be tentative. Yes, e-cigarettes may represent a safer option than cigarettes, but as the public health experts acknowledge, they are not entirely risk-free. They have been in widespread use for less than five years, which means there’s not yet been time to conduct longitudinal studies to ensure that they don’t cause any long-term health consequence. It is also known that some problems come from the fact that the quality of the e-cigarettes being marketed varies significantly.

So before we rush for the prescription pad can we please ensure that there’s stronger regulation as well as tighter marketing controls so we don’t find our young people being deliberately targeted and the renormalising of addictions to nicotine. Otherwise I fear we could well come to regret our current enthusiasm.

Smoking promotion on our streets

I was taken aback and confused yesterday as I crossed the road in front of this London bus. It’s over a decade since The Tobacco Advertising & Promotion Act 2002 ended cigarette advertising on billboards, posters and the like. So what on earth is this all about. Here’s a packet of cigarettes with the brand name clearly enblazed in metre high letters and confidently peddling its wares down the high street. I stood looking incredulously.

And as I stared I then noticed that the get out of jail free card – this was an advert for e-cigarettes. I’m not interested in debating the relative health advantages of nicotine delivered without tobacco. In fact, although many users of e-cigarettes like to believe e-cigarettes eliminate the harm, my understanding is that it’s not yet possible to categorically state how much less harm they may cause as there have been no large-scale randomised controlled trials into their effects (there are also no regulations to standardise what manufacturers are/are not allowed to put in them) . But what I am very interested in is that a product that looks so remarkably similar to a product that has irrefutable health consequences is now being allowed to be promoted so openly.

Surely it makes a mockery of the government’s annual high cost stop smoking campaigns if smoking cigarettes can be normalised by continuing to appear on our streets. Whilst it’s still unproven whether e-cigarettes help smokers cut down from normal cigarettes we do know that images of cigarettes can trigger cravings and smoking behaviour. So if there’s any chance that images of e-cigarettes (especially when masquerading closely as normal cigarettes) may encourage young people to experiment with either form, or motivate a smoker to lit up another fag, them decisive action is needed. I would urge the government to urgently introduce much tighter regulation of the advertising of e-cigarettes. Let’s not allowed e-cigarette advertising any chance to make any form of smoking more familiar, acceptable and desirable.

Isle of Wight breastfeeding and smoking in pregnancy work attracts attention of Public Health England

We were delighted to hear that Duncan Selbie, Chief Executive of Public Health England was today visiting the Isle of Wight today to learn about local efforts to increase breastfeeding rates and reduce the high rates of smoking in pregnancy. We have had a long relationship with the Isle of Wight Public Health team and in 2012 undertook a significant social marketing project to understand the attitudes and behaviour of mothers to be and new mothers around breastfeeding and smoking. The findings and recommendations from our study have formed the basis for a new strategy and action plan which is now being successfully rolled out.  This has included embarking on the UNICEF Baby Friendly Initiative, embedded staff training, working more closely with children’s services and Children’s Centres and improving the information available. We are pleased the impact of this work is being nationally recognised. Simon Bryant, acting director of Public Health, says about the visit: “We are looking forward to welcoming Duncan Selbie and providing him with an overview of our work and the particular successes we have had on the Island in meeting local health needs.”

What impact will the new government stop smoking campaign have on quit rates?

This week the government has launched their new stop-smoking advertising. Featuring a cigarette that mutates into a cancerous tumour, the message to smokers is stark ‘if you smoke you increase your risk of developing cancer’.

The £2.7m campaign will feature across TV, billboards and online for the next two months. Smokers are encouraged to visit their local pharmacies to get a quit-pack.

It follows-on from the government backed Stoptober campaign which encouraged a mass quit attempt, and is reputed to have had 270,000 sign-ups (although there are no published statistics on successful four-week quitters at the end of the month).

Given that smokers have been calculated to contribute to over a quarter of all cancers it’s no surprise that the government is taking action.

These high profile, co-ordinated campaigns have an important contribution to make in providing a trigger for smokers to attempt to quit, as well as shifting our culture from one that has condoned smoking for most of the last century, to one that is more condemning.

We have experience of speaking with groups of smokers and from them we have gathered some interesting attitudes and behavior that providing valuable insights into motivators and barriers to quitting.

  • Smokers know the population-wide risks that are associated with smoking. However, they are skillful at deflecting the personal risks by celebrating the long ‘healthy’ lives of other smokers they know. The macro-data about the diseases smoking causes need to be made genuinely believable and relevant for each smoker.
  • Smokers can have a tendency to deflate the impact of smoking as compared with other risk-taking behavior, such as the consumption of drinks or drugs, which reduces their compulsion to take action, and heightens their sense of injustice that society ‘has got it in for smokers’.
  • Smokers feel that smoking provides them with ‘me’ time and that they have an entitlement to this pleasure, particularly if they are facing adversity in their life. Stopping smoking must therefore provide a suitable alternative that can become similarly highly valued.
  • Smokers who are attempting to quit feel they are easily derailed from their efforts by small set-backs. They require immediate encouragement, often from multiple sources, to persevere rather than opt out of their attempt.
  • Smokers who provide regular carbon monoxide readings find this a very motivating way to reducing, or ceasing their smoking.
  • For some smokers, nicotine replacement products, and other quitting aids can be essential props to becoming smoke free. The free, and easy availability of such products is therefore essential.
  • Smokers who are/have attempted to quit say that advertising provided a timely ‘reminder’ or ‘nudge’ to take action having previously contemplated wanting to stop. Impact on ‘committed’ smokers was minimal.
  • Smokers are not generally motivated to quit by the cost savings that they will make. Despite the high, and ever rising cost of cigarettes they are often perceived to be ‘good’ value for the pleasure they provide.
  • Smokers who would like to quit, but who live with other smokers who are not willing to stop, find it extremely difficult to sustain their efforts, and in most cases rarely succeed in their attempts. Stop smoking services need to be better able to take a co-ordinated whole household approach.

To us, the insights we have gathered from the public, illustrate strongly how it is essential that stop smoking campaigns need to combine national high profile messaging and reminders of the perils of smoking and the quit tools available, with a more local, personalised and ongoing support service that is tailored to the needs of particular smoking groups. Without this, advertising alone it’s unlikely to achieve sustained change.

From April-September 2012 we spoke with young women on the Isle of Wight who smoke whilst pregnant. We used our findings to draw up recommendations for adaptations to the local NHS stop smoking service. This builds on previous smoking research undertaken with a broader cross-section of adults in North-East Essex and people with lung cancer in the South-West of England.