Session 2: Nicotine, policy and regulation Seminars

Globally, tobacco control researchers, policy makers, advocates etc are passionate and often united in working towards ending the smoking epidemic,  though we choose to take different paths to achieve this ambition. The UK has taken a compassionate approach to vaping, including for groups for whom there is a very high smoking prevalence, such as people who experience mental health problems, misuse substances and those who experience homelessness. However this approach is also evidence based as e-cigarettes have been shown to be beneficial at an overall population level, particularly if youth uptake is constrained. This presentation will discuss why it has been appropriate for England to take a population level approach, as well as a focus on high risk groups at an individual level, to reducing smoking and hence to vaping regulation. It will also give a more personal reflection on responses to nicotine use in society.

The tobacco marketplace has changed with the introduction of new nicotine delivery devices. While the public health community has been addressing the dramatic increase of e-cigarette use among youth, FDA recently conducted qualitative research with adult smokers to ascertain their current attitudes and beliefs about cigarettes and other tobacco products. Focus group findings underscore that quitting cigarettes remains difficult. Smokers are often navigating multiple barriers to quitting, including stressors, perceived benefits of smoking, and persistent misperceptions about nicotine and addiction. Findings also revealed an increase in the belief that reducing use is an effective strategy for cessation, and there is low motivation among smokers to abstain from nicotine. While large-scale mass media campaigns and public health cigarette education efforts have contributed to reductions in prevalence rates, an opportunity remains to further educate and address these misperceptions to support long-term cessation. 

Stigmatizing smoking has been at the heart of tobacco control efforts for decades, which may drive more people to quit but at the same time potentially create new difficulties for smokers, including self-isolation, creation of social groups that might become ‘hardened’ to changing smoking behaviors, and perceptions by the user and society that complete abstinence is the only option.  The stigma associated with a wide variety of behaviors has impeded progress toward improving population health in some cases, such as the reticence in making products and services available that could reduce the risk of communicable disease (eg needle exchanges), as well as harm reduction products that could benefit users and society when an individual addicted to a substance is not able to or chooses not to become completely abstinent (eg NRT, ENDS, smokeless tobacco).  This presentation will explore some of the conflicting aspects of stigma in tobacco control, explore similarities and differences regarding the stigma of using of different addicting substances, and consider some research, practice and policy directions.

The recent commentary ‘It is Time to Act with Integrity and End the Internecine Warfare Over E-Cigarettes’ addresses the need to achieve a lifesaving rapprochement between the tobacco control mainstream and the tobacco harm reduction community. Failure to end the warfare and reinstate fealty to good science risks millions of additional premature, smoking-related deaths that could otherwise have been prevented. Numerous instances of the undermining of science, and the scientists behind the science, threaten to impede the objective of furthering the development and dissemination of credible evidence and bringing together the major stakeholders for reconciliation and to join in common cause in this vital endeavour. Protecting youth and supporting adults can and must be achieved simultaneously. We must also listen to the pleas of consumers, many from marginalized communities, who have lived experience as smokers who have transitioned off lethal smoked products with the aid of alternative nicotine-containing products and whose voices have been wrongly ignored, distrusted, rejected, and too often dismissed as serving the interests of the “tobacco industry.”

As the debate unfolds on how best to prevent adolescents from using electronic cigarettes, we have lost sight of their potential for harm reduction in adult smokers. Despite decades of availability of evidence-based smoking cessation medications, many adults continue to smoke. In some populations, such as people with COPD, mental health diagnoses or HIV infection, rates of smoking remain 2-3 times that of the general population. I will discuss what we know about using electronic cigarettes for harm reduction in specific populations, as well as where we need additional information.

How do we end the toxic culture that has emerged?