e-cigarettes friend or

foe?

To set the development of e-cigarettes in the context of

tobacco use and its impact on health and health

inequalities

To review the arguments that have been advanced in

favour of and against the use of e-cigarettes

To share participant views about e-cigarettes and

responses to the information presented

E-cigarettes: friend or foe?

Session aims

Major causes of death in England

Impact of tobacco smoking

Single largest preventable cause of ill health,

premature death & health inequalities in Lancashire

- Kills 1,673 adults aged 35 and over each year1,2

Smoking accounts for half of the difference in life

expectancy between social classes I and V3,4

Smoking rates are higher in:

Routine & manual workers (30%)5

Offenders (80%)6

People living with a mental health condition

(32-70%)7,8

Smoking rates remain higher in Lancashire than

England in:

Adults5 – 21.2% vs 20%

Pregnant women9 – 16.8% vs 12.0%

Young people10,11 – 16% vs 11%

Financial impact of tobacco smoking

1 in 20 hospital admissions are smoking

related12

Nationally costs the NHS 2.7 billion

each year13 & £41.49 million in

Lancashire14 (£22.6 million primary care

& £18.83 million secondary care)

Exposure of adults and children to

secondhand smoke in Lancashire costs

the NHS a further £15.67 million to treat

annually14

Total cost of smoking is estimated to be

£316.6 million each year14

Novel nicotine delivery devices that were developed in China more

than 10 years ago.20

Battery operated devices that aim to simulate combustible cigarettes.

Don’t contain tobacco, operate by heating nicotine and other

chemicals into a vapour that is inhaled.21

Three main types:22

Disposable products (non-rechargeable)

Electronic cigarette kit – rechargeable

with replaceable pre-filled cartridges

An electronic cigarette that is rechargeable and has a tank or

reservoir filled with liquid nicotine

E-cigarettes: what are they?

E-cigarettes

Estimated 2.1 million e-cigarette users nationally15

Currently unregulated and unlicensed, so safety and efficacy remains

undetermined

Research regarding clinical effectiveness as a stop smoking aid is

currently limited

WHO recommendation16

‘Until such time as a given electronic nicotine delivery system is

deemed safe and effective and of acceptable quality by a competent

national regulatory body, consumers should be strongly advised not to

use any of these products, including electronic cigarettes’

E-cigarettes and young people

Some e-cigarette devices replicate smoking.

Marketing strategies focused to appeal to youth

audience17,18:

Wide range of flavours

Brightly coloured designs

Customisation of devices

Celebrity endorsement

2013 Trading standards survey with 3,471 young

people aged 14-17 years across Lancashire County:

1 in 4 (27%) bought or tried e-cigarettes

Of these, 39.9% were non-smokers

Government intend to introduce legislation to ban

sales to under 18s within Children and Families Act in

201519

Part of a harm reduction strategy23

Could be a less hazardous way to maintain nicotine

addiction24

E-cigarettes: friend?

A potential gateway to smoking and renormalisation

Long term safety not known

Nicotine addiction remains

Causes confusion and undermines compliance with

smokefree legislation

E-cigarette companies owned by Tobacco Industry –

produce a product that kills 1 in 2 lifelong users

E-cigarettes: foe?

E-cigarettes: any questions?

References 1. London Health Observatory (2011). Local Tobacco Control Profiles for England – Public Health Observatories in England Nov 2011.

http://www.lho.org.uk/Download/Public/17712/1/Tartan%20Rug_FINAL_Nov2011%20v2.pdf

2. The Information Centre for Health and Social Care (2012). Statistics on Smoking: England, 2012 and Census 2011 all population aged 35 and over.

3. Wanless D. (2004) Securing good health for the whole population. London: TSO

4. Marmot M et al (2010) Fair Society, Healthy Lives: strategic review of health inequalities in England post 2010. Marmot Review Secretariat London.

5. Office for National Statistics (2014) Integrated household survey, self-reported smoking prevalence, persons, aged 18+, 2011-12.

6. Singleton N et al (1998) Psychaitric morbidity among prisoners in England and Wales: the report of a survey carried out in 1997 by Social Survey Division of the

Office of National Statistics on behalf of the Department of Health.London: The Stationary Office.

7. McManus S, Meltzer H & Campion J (2010) Cigarette Smoking and Mental Health in England: Data from the Adult Psychiatric Morbidity Survey 2007. National

Centre for Social Research. www.natcen.ac.uk/study/cigarette-smoking--mental-health

8. Jochelson K & Majrowski W. (2006) Clearing the Air: Debating Smoke-Free Policies in Psychiatric Units. London: King’s Fund.

9. NHS Information Centre for Health and Social Care (2014). Statistics on women’s smoking status at time of delivery: England. http://www.ic.nhs.uk/statistics-and-

data-collections/health-and-lifestyles/smoking

10. The Information Centre for Health and Social Care (2012) Smoking, drinking and drug use among young people in England in 2011.

11. Trading Standards (2013). Young Persons Alcohol and Tobacco Survey 2013, North West Results. TSNW, June 2013.

12. The Information Centre for Health and Social Care (2012). http://www.ic.nhs.uk/news-and-events/news/about-1260-hospital-admissions-a-day-due-to-smoking-

new-figures-show

13. Callum C, Boyle S, Sandford A (2010). Estimating the cost of smoking to the NHS in England and the impact of declining prevalence. Health Economics Policy &

Law 2010 doi:10.1017/S1744133110000241.

14. Health Economics Research Group, Brunel University; Queen's Medical Centre, University of Nottingham & London Health Observatory (2012) Building the

economic case for tobacco control: A toolkit to estimate economic impact of tobacco. http://www.brunel.ac.uk/herg/research-programme/building-the-economic-

case-for-tobacco-control

15. Public Health England. (2014) Public Health England, tobacco harm reduction and e-cigarettes: a discussion paper. Public Health England, May 2014.

16. World Health Organisation (2013). Questions and answers on electronic cigarettes or electronic nicotine delivery systems.

http://www.who.int/tobacco/communications/statements/electronic_cigarettes/en/

17. De Andrade M, Hastings G, Angus K (2013) Promotion of electronic cigarettes: tobacco marketing reinvented? BMJ 347:f7473.

18. Hardcastle K et al (2014) “Most people I know have got one”: young people’s perceptions and experiences of e-cigarettes. Liverpool: Centre for Public Health,

Liverpool John Moores University.

19. BBC (2014) E-cigarettes to be stubbed out for under-18s. http://www.bbc.co.uk/news/uk-25900542

20. https://www.rcplondon.ac.uk/commentary/what-you-need-know-about-electronic-cigarettes

21. Bauld L, Angus K , de Andrade M (2014) E-cigarette uptake and marketing. A report commissioned by Public Health England

22. ASH. (2014) Electronic cigarettes http://www.ash.org.uk/files/documents/ASH_715.pdf

23. Statement from specialists in nicotine science and public health policy. (2014) http://nicotinepolicy.net/documents/letters/MargaretChan.pdf

24. Britton J, Bogdanovica I, (2014) Electronic cigarettes A report commissioned by Public Health England