The U.K. prime minister, Rishi Sunak, wants to raise the legal age for consuming cigarettes, gradually increasing it one year at a time until the next generation is no longer legally allowed to purchase the products, reports Bloomberg.
According to Sunak, the move would make it so that “a 14-year-old today would never legally be sold a cigarette.” Sunak spoke on the age increase at a Conservative Party conference in Manchester Wednesday, where plans to restrict availability of vapes and look at packaging and flavors of vapor products were also discussed.
Simon Clark, director of smokers’ rights group Forest, responded to the move, saying, “These are desperate measures by a desperate prime minister.
“Raising the age of sale of tobacco is creeping prohibition, but it won’t stop young people smoking because prohibition doesn’t work. Anyone who wants to smoke will buy tobacco abroad or from illicit sources.
“This is the opposite of leveling up; it’s dumbing down. Future generations of adults who are considered old enough to vote, pay taxes, drive a car and drink alcohol are going to be treated like children and denied the right to buy a product that can be purchased legally by people a year older than them.
“This is now a conservative government in name only because the prime minister has just taken a wrecking ball to the principles of choice and personal responsibility,” Clark said.
BAT has released a blueprint for how regulators and governments could better regulate vapor products and help smokers switch to less risky products.
During DTNF 2023, held from Sept 18-20 in Seoul, BAT’s Global Head of Business Communications, Jonathan Atwood, told attendees how BAT’s five-step plan for regulation could support achieving the right balance between harm reduction and the unintended consequences of access, including underage use.
Speaking on behalf of Kingsley Wheaton, BAT’s Chief Strategy & Growth Officer, Atwood said that reckless players in the market need to be penalized when they do not abide by the rules. He said the five suggestions are the areas that regulators should explore and establish “smart regulation” that is right for their market.
“First, on-device technology and functionality: vapor products should be accessible only to adults. Both underage prevention and restriction is crucial. On-device technology, when applied and enforced across entire markets, could help in this regard.
“Second, more recognition is needed that flavors are an important driver of adoption for smokers seeking alternatives. However, flavors in vapor products should not particularly appeal to anyone underage.
“Third is at the manufacturing and import level: ensuring that non-compliant products cannot reach the market in the first place.
“Fourth, where no restrictions exist already, regulators may want to look at who should be able to sell vapor products and where. Reasonable safeguards at the point-of-sale would help ensure these products are sold only to adult consumers. Solutions such as retail licensing and facial recognition technologies should be seriously considered.
“Lastly, enforcement and penalties: governments must wield their power and ensure consumers are purchasing legitimate products. Such measures should be rigorously enforced and those who fail to comply should face meaningful sanctions.”
Atwood said BAT was calling upon governments, regulators, and industry peers to rally towards a sustainable and progressive environment in which vaping products are sold and marketed responsibly.
The success of e-cigarettes as a switching tool in the U.K. offers valuable lessons for the United States.
By Kim Hesse
Electronic nicotine-delivery systems (ENDS) have been discussed and disparaged for years in public health and policy circles in the United States, especially regarding their potential health risks. For many, the legacy of distrust from tobacco companies’ historic lack of transparency on the health impact of cigarettes has led to skepticism about the safety of ENDS products. And yet, we could learn from the accumulation of research studies and real-world evidence, which now makes it hard to deny that ENDS products are a better choice than combustible cigarettes.
The U.S. can look to the United Kingdom and Sweden for a pathway to positive public health impact. The U.K. government recommends the use of e-cigarettes as a smoking cessation tool. For example, current advice from the U.K.’s National Institute for Health and Care Excellence supports the use of e-cigarettes as a stop-smoking intervention. Sweden further leads the way in transitioning smokers to less harmful pouched tobacco products such as snus.
Kim Hesse
The guidelines state that e-cigarettes are a safer alternative to traditional cigarettes and that they should be recommended as a quit-smoking aid to smokers who are unable or unwilling to quit using other methods. The guidelines also recommend that e-cigarettes should be used in conjunction with other smoking cessation services, such as counseling and nicotine-replacement therapy (NRT). Many studies have shown an association between e-cigarette use and a significant reduction in the number of people smoking traditional cigarettes, particularly among the young.
One of the main reasons for the positive impact of e-cigarettes in the U.K. is the way they have been regulated. E-cigarettes are subject to safety and quality standards and are available only to adults. In addition, e-cigarettes are taxed at a lower rate than traditional cigarettes, which makes them more affordable for smokers who are looking to quit. This combination of regulation, taxation and availability has made e-cigarettes a popular choice for U.K. smokers eager to give up their habit.
By comparison, the U.S. has work to do in order to achieve the same level of impact being seen in the U.K. The first task before us is to debunk the myths that stand in the way.
Myth 1: The risks associated with the use of ENDS products are unknown—untrue! According to Sairah Salim-Sartoni of Salim-Sartoni Associates, there is at least 10 years’ worth of studies providing evidence that ENDS products are less damaging than combustible cigarettes. Salim-Sartoni points to the independent evidence review conducted by Kings College London in the U.K., which included approximately 400 studies.[1]
The authors reported: “Vaping poses only a small fraction of the risk of smoking and is at least 95 percent less harmful than smoking (that is, smoking is at least 20 times more harmful to users than vaping).” Of course, it is important to note that e-cigarettes are not without risks. They still contain nicotine, which is an addictive substance. However, compared to traditional cigarettes, e-cigarettes are a safer alternative. As Robert M. Califf, head of the U.S. Food and Drug Administration, said in a Feb. 24, 2023, press release, “Certain e-cigarettes may help adult smokers transition completely away from, or significantly reduce their use of more harmful combusted cigarettes.”[2]
Myth 2: Big Tobacco started the vaping industry—false! The ENDS industry started with a few small companies creating products that slowly became popular with smokers who were trying to quit combustibles. The ENDS products helped smokers transition away from combustibles, and news spread until the industry became what it is today. In reality, the legacy cigarette companies have been in the alternative nicotine market for only a relatively short period of time. Initially, these multinational firms did not see e-cigarettes as a sustainable product and thought they would eventually disappear. It was only in more recent years that Big Tobacco began investing heavily in this market.
Myth 3: Nicotine causes cancer—not true! Tar from combustible cigarettes is the cancer-causing agent. Additionally, combustible cigarettes produce far greater harmful and potentially harmful constituents than those produced by ENDS products. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to nicotine and risk for cancer.3
If we can move beyond the myths and misconceptions to accept these truths, then stakeholders in the U.S. should be thinking about social media and other campaigns that spread the facts about the positive impact that e-cigarettes can have on public health. John Dunne, director general of the U.K. Vaping Industry Association, attributes the prevalence of the above myths in the U.S. in part to sensationalized headlines generating more clicks and attention than factual reporting. “‘Vaping causes you to grow a third ear’ will get more clicks than a headline reading ‘Vaping is the best thing in the world,’” he said.
“It seems the only ones wanting to speak positively about the vaping industry is the industry itself,” Dunne continued. “However, it is crucial to change this narrative and focus on education and good research to inform smokers, the public and physicians alike about the health benefits of switching to ENDS products.”
Credit: Fedorovacz
If the U.S. were to turn away from outdated myths and follow the U.K.’s guidelines on e-cigarettes, it could have a similarly positive impact on public health. Currently, e-cigarette regulations differ from state to state. However, if e-cigarettes were approved as a switching tool on a federal level, it could help to reduce the number of people smoking traditional cigarettes and improve public health.
In order to gain the benefits that the U.K. has seen, though, the U.S. must acknowledge and address concerns around the impact on youth. According to the study “Changes in Youth Smoking 1976–2002: A Time Series Analysis” by Fred C. Pampel and Jade Aguilar, youth cigarette smoking dropped in the late 1970s and leveled off to new lows in 1980. However, we saw an increase in smoking in the 1990s, and by 1997, a quarter of the youth population was reported to be smoking daily. While this news may seem alarming, let’s compare it to ENDS product use among youth today. “The youth vaping epidemic: addressing the risk of e-cigarettes in schools” reported that 27.5 percent of the youth population regularly use e-cigarettes. It further states that this number is approximately 22 percent higher than high schoolers who smoke normal cigarettes.”4 While the Brookings article does state that 27.5 percent of youth regularly use e-cigarettes, this does not match what is in the paper behind the data.
The 27.5 percent number applies only to high school students; middle school students were also surveyed and e-cigarette use within this group was much lower. From the data, 3,611 high school and middle school kids had past 30-day (i.e., “current”) e-cigarette use; this is approximately 19 percent of the kids’ population. The data also show that approximately 4 percent of kids smoked cigarettes in the past 30 days. But only a proportion of kids used e-cigarettes regularly (on 20 or more of the past 30 days). Given these data, rough calculations show that less than 6 percent of all kids were using e-cigarettes regularly, which is a lot lower than the reported 27.5 percent. Daily use of e-cigarettes is even lower, at approximately 3 percent.
Although individuals younger than 21 should not use tobacco products, youth who are experimenting are choosing a less harmful product than combustible cigarettes. If we remove these products from the U.S. market, this group of experimenters could go back to smoking cigarettes. With or without vape products, experimentation of some sort by youth will occur. This leads us back to the task at hand—to properly educate the public about the risks and benefits of ENDS products.
If we take the lead from our U.K. counterparts, we can learn from their experience in supporting e-cigarettes as a switching tool. There, they learned that the secret to getting people permanently off combustible products, such as traditional cigarettes, is to provide an enjoyable experience. Some of the side effects of NRTs can cause people to stop using them and go back to smoking. However, for some, e-cigarettes can provide an enjoyable experience without negative side effects.
The reason why ENDS products help many combustible smokers switch from traditional cigarettes is complex, according to both Dunne and Salim-Sartoni, who believe it is a combination of effective nicotine delivery and “the hand-to-mouth action.” For many smokers, this action is very important to keep when trying to limit or eliminate the smoking habit.
Others may want to eliminate the action and try to use only nicotine gum, patches, lozenges or pharmaceuticals. However, Salim-Sartoni said the chance of success increases if these cessation options are used in combination with ENDS or a spray.
A recent U.K. smoking cessation campaign supports this approach. Earlier this year, the Department of Health and Social Care announced it would provide nearly one in 5 of all smokers in England with a vape starter kit alongside behavioral support to help them kick the habit. Additionally, pregnant women are being offered financial incentives to quit smoking. The overarching goal is to reduce smoking rates in the U.K. to 5 percent or less by 2030.5
Despite support for ENDS as a cessation device, the U.K. medical community still has concerns, according to Salim-Sartoni. Physicians believe that ENDS have great potential, but they are unsure which product to recommend. They would like to see some standards and have assurances that the products they are recommending are truly safer alternatives.
The experience of the pharmaceutical industry may offer some guidance in this respect. When administering a drug, the pharmacist and physician know the potential side effects, and these are weighed against the benefit of the drug being prescribed. Pharmacists and physicians in the U.K. would like to see similar information on ENDS products and would like some reassurance that they are providing the best possible information to their patients and are guiding them to a safer alternative.
As an industry, we need to assess how people are using ENDS products on a wider scale. Creating acceptable levels of use or proper dosing formulas based on the specific products available on the market would be a good first step in educating the public on the impact of ENDS products. Sharing information regarding ingredients and compounds being produced by the products will allow consumers to compare and choose according to quality information.
Ultimately, the key is to work together to reduce the overall harm caused by tobacco use. This means educating the public, promoting switching from combustible cigarettes and investing in research to find new ways to ensure the safety of ENDS products. If we do not work together, more lives will be lost to combustible tobacco products.
The report highlights the Need for consumer participation in tobacco harm reduction policy making.
The Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) released its Shadow Report on the (NON)-Implementation of the Framework Convention on Tobacco Control (FCTC) Article 1 (d) on Harm Reduction Strategies.
The report is now available to policy makers, regulators in member states, and World Health Organization (WHO) FCTC officials.
The Shadow Report emphasizes the importance of consumer participation in policy making and highlights the benefits of tobacco harm reduction alternatives, including vaping, according to an emailed press release.
Nancy Loucas
“Tobacco Harm Reduction products have been shown to serve as a method of smoking cessation and as an alternative for smokers who are unable or unwilling to quit smoking altogether,” said Nancy Loucas, executive coordinator of CAPHRA.
“The WHO FCTC is meant to be an evidence-based treaty that reaffirms the right of all people to the highest standard of health. However, the current tobacco control measures have extensively promoted the abstinence-only approach, which has contributed to smokers’ inability to make informed choices about safer nicotine products,” said Loucas.
To access the full CAPHRA Shadow Report on the (NON)-Implementation of the FCTC Article 1 (d) on Harm Reduction Strategies click here.
Israel’s health ministry has issued a request for public comments on an “action plan for all tobacco and smoking products,” reports The Jerusalem Post. The plan includes eventually raising the legal smoking age to 21 from 18.
“The phenomenon of smoking is very worrying, and under my leadership, we are determined to promote measures to reduce it and increase awareness of the harm smoking causes,” said Health Minister Moshe Arbel. “This demands a complex and joint effort, and we are committed to implementing the policy in a variety of areas of prevention and encouraging quitting to promote public health and protect youngsters and adults alike from this serious damage to health.”
“Given the dimensions of the spread of smoking, we have examined all possible measures and continue to act in many ways in order to raise awareness of the dangers of using these products,” said Moshe Bar Siman Tov, health ministry director-general. “We recommend adopting a strict policy and dramatic measures required by the necessity of reality, but it’s clear to all of us that the best way to stop smoking is not to start smoking.”
The action plan includes decisions on the prohibition of flavors, giving the ministry powers to enforce the nicotine concentration limit, limiting the volume of the filling liquid allowed for import, marketing and sale, requiring graphic warnings on all tobacco and smoking products and visual uniformity to the smoking and vaping products, a ban on the sale of disposable electronic cigarettes, selling tobacco and smoking products in designated stores only and reducing the number of points of sale, raising the selling age to 21, giving authority to the ministry to enforce a ban on advertising on the internet, equalizing taxation on e-cigarettes and other tobacco products, and applying taxation to nicotine intended for nonmedical use.
The ministry’s statement said that “e-cigs are the gateway to smoking for young people who start experimenting with them at a young age; there is not strong evidence that e-cig use helps smokers kick the habit compared to the proven safety of other means of withdrawal, such as smoking cessation workshops, nicotine gums and patches and medical treatment. The scientific evidence on the health damage of e-cigs in the short[-term] and medium-term is known and described in the literature as affecting the respiratory system, cardiovascular system, trauma and burns, the developing brain in children and the creation of addiction.”
Consumer advocates are calling for the next New Zealand government to support greater consumer advocacy participation in the 10th Conference of the Parties (COP10) to the World Health Organization’s Framework Convention on Tobacco Control (FCTC) in Panama.
“The WHO Framework Convention on Tobacco Control has contributed to some progress in the implementation of tobacco control measures, but they need to provide honest, risk-proportionate communication and regulatory recommendations for Tobacco Harm Reduction [THR] products,” says Nancy Loucas, executive coordinator of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA).
“While not perfect, these THR products can be a less harmful alternative to smoking and can help smokers quit. It is critical that smokers have access to accurate information about these products and that regulations are proportionate to their risks,” says Loucas.
The WHO FCTC should stop denying smokers, vapers and other tobacco users of their right to have a meaningful participation and inclusion in the formulation of policies that hugely impact them.
“The WHO FCTC should stop denying smokers, vapers and other tobacco users of their right to have a meaningful participation and inclusion in the formulation of policies that hugely impact them.”
CAPHRA is calling on the New Zealand government and next minister of health to ask all member states who will be attending COP10 to reject the prohibitionist proposals contained in COP10 provisional agenda items 6.1 to 6.4 that the organization insists will just further contribute to millions more of unnecessary deaths from smoking.
“New Zealand should prioritize science-based inclusive policy making, including at the WHO Framework Convention on Tobacco Control. It is essential that policy making is based on the best available evidence and that all stakeholders—including consumer advocates are included in the decision-making process,” said Loucas.
In an article published in Addiction magazine, Brian King, director of the U.S. Food and Drug Administration’s Center for Tobacco Products (CTP), explores the chances and considerations for informing adults who smoke cigarettes about the relative dangers of tobacco products, including e-cigarettes. He collaborated with Benjamin Toll, director of the Medical University of South Carolina Tobacco Treatment Program and co-director of the Lung Cancer Screening Program.
The commentary highlights the findings of a recent survey about misperceptions of tobacco product harms, including cigarettes and e-cigarettes. The survey found that only about 20 percent of adults who smoke cigarettes believed e-cigarettes contain fewer harmful chemicals than cigarettes. While there are no safe tobacco products, the available scientific evidence indicates that tobacco products exist on a continuum of risk, with cigarettes being the most harmful.
The commentary notes that opportunities exist to educate adults who smoke about the relative risks of tobacco products, including e-cigarettes. However, these efforts should be accompanied by efforts to prevent youth tobacco product use; encourage first-line use of FDA-approved cessation therapies; and for adults who both smoke and use e-cigarettes, reinforce the importance of completely transitioning to e-cigarettes.
The commentary further emphasizes that any education efforts on the relative risks of tobacco products must be evidence-based. In particular, it is important to assess the benefits among the intended population (i.e., adults who smoke) and risks among unintended populations (e.g., youth). Currently, FDA is in the early stages of a research effort to assess messaging about the continuum of risk of tobacco products among adults who smoke.
Last week, the FDA announced a virtual listening session opportunity to verbally provide open public comment on the development of the new strategic plan, including proposed strategic goals. After introductions, the center will begin the listening session with an overview of the process used to develop the CTP’s strategic plan, including proposed goal areas.
Registration is open for the virtual listening session on the development of the CTP’s five-year strategic plan, which will take place on Aug. 22 beginning at 10 a.m. EDT.
The World Vapers’ Alliance (WVA), a global vaping consumer advocacy group, has great concern for the Hungarian Government’s draft decree which aims to amend the current regulation of nicotine pouches and vaping.
The proposed regulations, if enacted, would introduce restrictions that may hinder access to safer alternatives for smokers and harm reduction options, according to an emailed press release.
Michael Landl, director of the World Vapers’ Alliance, said, “While it’s important to ensure the safety and proper labelling of nicotine products, it’s equally crucial to avoid excessive regulation that could impede the availability of harm reduction products for smokers looking to transition away from combustible cigarettes.”
The proposed amendments, with a maximum nicotine content of 17mg per consumption unit reflect an approach that may inadvertently limit the appeal of nicotine pouches to smokers seeking alternatives.
“Moreover, the WVA expresses concerns about the potential implications of the draft Decree’s proposed modifications to vaping product regulations,” the release states. “The amendments, which target unit packet definitions, nicotine amounts, and labelling requirements, could impose unwarranted restrictions on vaping products. While addressing health concerns is important, the proposed changes should be carefully evaluated to ensure they do not deter smokers from adopting less harmful alternatives.”
Whilst health and safety standards are crucial, regulations should be crafted with a balanced approach that considers both consumer health and the potential of these products to save lives, according to Landl.
“We encourage the Hungarian Government to start accepting reality: harm reduction works! This year, Sweden is becoming the first smoke-free country due to a consumer-friendly harm reduction approach,” he said. “It is high time to learn from the Swedish experience and thereby save thousands of Hungarian lives. With a smart harm reduction approach, Hungary can become smoke-free.”
The standstill period for review and objection by the European Commission and Member States ends on 8th November 2023, after which the Hungarian Government may enact the proposed regulations. The WVA remains committed to advocating for evidence-based policies prioritizing public health and consumer choice.
A large portion of smokers have misperceptions about vaping, thinking it is just as harmful or more harmful than smoking, according to the most recent Action on Smoking and Health (ASH) survey data.
The data shows that “among the 1.8 million smokers who are yet to try vaping, 43 percent believe e-cigarettes are as harmful or more than smoking, up from 27 percent in 2019.” It also shows that “among the 2.9 million smokers who have tried vaping but stopped, 44 percent believe vaping is as harmful or more than smoking, up from 25 percent in 2019.”
Due to the large proportion of misperception, ASH feels that its swap to stop program is “threatened by growing concerns among smokers that vaping is as or more risky than smoking.”
“The government has backed a vaping strategy as its path to reduce rates of smoking, but this approach will be undermined if smokers don’t try vapes due to safety fears or stop vaping too soon and revert to smoking. The government must act quickly to improve public understanding that vaping poses a fraction of the risk of smoking,” said Hazel Cheeseman, deputy chief executive of ASH.
Groups such as the Independent European Vape Alliance (IEVA) and the U.K. Vaping Industry Association (UKVIA) support ASH’s stance on government action.
“It is abundantly clear that the lack of knowledge amongst smokers about the relative risks about smoking and vaping is a public health issue that the government can no longer ignore,” said John Dunne, UKVIA director general. “The ASH report highlights that misleading and inaccurate stories and headlines about vaping in the mainstream media plays a huge part in this knowledge gap, which is preventing smokers’ switch to a much less harmful alternative to cigarettes.
“The public needs to know that the scare stories regularly reported in the mainstream media are simply not true, and we urgently need an antidote to this highly damaging misinformation.
“The industry is not permitted to make health claims about the relative harms of smoking and vaping, but keeping the public in the dark about this means hundreds of smokers continue to needlessly die in the U.K. every day because they don’t have the information they need to switch.
“We must be allowed to set the record straight, and the government should launch a nationwide public information campaign so that the relative risks of smoking and vaping are accurately communicated.”
Ann McNeill, professor at King’s College London and author of a government-commissioned review on the harms from vaping, according to Talking Retail, commented: “Anxiety over youth vaping is obscuring the fact that switching from smoking to vaping will be much better for an individual’s health. It is wrong to say we have no idea what the future risks from vaping will be.
“On the contrary, levels of exposure to cancer-causing and other toxicants are drastically lower in people who vape compared with those who smoke, which indicates that any risks to health are likely to be a fraction of those posed by smoking.
“We must not be complacent about youth vaping, and further regulation is needed, but so, too, is work to ensure many more adults stop smoking, and vaping is an effective means of doing that.”
Illinois now has a law that bans the use of electronic cigarettes in indoor public spaces, but a consumer advocacy group warns such laws could backfire.
Gov. J.B. Pritzker recently signed into law a measure that adds electronic smoking devices to the 2008 Smoke-Free Illinois Act, which banned smoking in most public spaces in the state.
Elizabeth Hicks with the Consumer Choice Center says vaping should not be compared with smoking regular cigarettes, according to media reports.
Hicks says the assault on vaping may push Illinoisans back to cigarettes, leaving taxpayers to pick up the tab.
“Taxpayers unfortunately also suffer in addition to consumers,” said Hicks. “The annual Medicaid costs for smoking-related illnesses in Illinois is over $2 billion, which is one of the highest throughout the country.”
The Illinois Department of Public Health noted that e-cigarettes can cause lung damage and addiction to nicotine. The law goes into effect January 2024.
