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** 12 October 2021
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** UK
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** Combination therapies are the most effective smoking cessation medicines, review finds (#1)
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** Sunak 'planning £2bn in cuts and the UK's highest peacetime tax rate' (#2)
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** Smoking to be banned within 20 metres of all schools in Milton Keynes (#3)
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** Norfolk: MiQuit launches to help expectant parents quit smoking (#4)
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** International
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** Harmful chemicals found in popular Australian e-liquids (#5)
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** Hearth site in Utah desert reveals human tobacco use 12,300 years ago (#6)
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** Parliamentary Activity
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** Parliamentary questions (#7)
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** UK
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**
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** The largest ever review into the effectiveness and safety of e-cigarettes and medicinal quitting aids for smoking has found that combination therapies, particularly varenicline and nicotine replacement therapy (NRT) combined, are the most effective tobacco cessation pharmacotherapies.

The study was led by the University of Bristol and published in the journal Addiction, funded by the National Institute of Health Research (NIHR). Researchers identified and analysed 363 trials for the effectiveness of combination therapies and e-cigarettes and 355 trials for the safety.

They found that most single and combination therapies were more effective than placebo at helping people to stop smoking, with varenicline alone and varenicline plus NRT combined being the most effective. Bupropion was also shown to be effective but was associated with increased risks of having a serious adverse effect. The research found that e-cigarettes showed promise but require more research to establish their long-term effectiveness and safety.

The findings could have implications on the licensing of smoking cessation treatments and recommended treatments, as e-cigarettes and combination therapies are currently unlicensed. NICE will shortly release its new guidance for "Tobacco: preventing uptake, promoting quitting and treating dependence", which will include data from this study.
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**
Source: News Medical, 11 October 2021

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** See also: Addiction - Comparative clinical effectiveness and safety of tobacco cessation pharmacotherapies and electronic cigarettes: a systematic review and network meta-analysis of randomized controlled trials ([link removed])
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** The leading independent thinktank for public finances, the Institute for Fiscal Studies (IFS), says that the chancellor Rishi Sunak is expected to announce cuts worth £2bn for Government departments tasked with meeting the Conservatives’ levelling up agenda. The cuts come as Sunak is also poised to lift the UK’s tax burden to its highest sustained level in peacetime with a package of tax increases at the budget and spending review this month (October 2021).

The expected tax increases would help fund what would be the highest levels of Government spending since 1985. In its “green budget” assessment of the public finances, issued with economic forecasts from the investment bank Citi, the IFS said that overall government spending was likely to settle at 42% of national income, about 2% higher than before the pandemic. Despite this, the IFS says that areas such as local government, further education, prisons, and courts could still have their budgets cut by more than £2bn next year (2022).

The IFS said that pressures from an ageing population meant that a growing share of spending was going towards health. Without a substantial shift in direction, it said Sunak was on track to raise spending on public services other than health, defence, schools, and overseas aid by less than was planned before the spread of the coronavirus last year. This comes despite the IFS noting that Sunak was likely to see a £50bn boost to the public finances this year compared with official forecasts from March, which predicted that almost £240bn of borrowing would be needed to meet the deficit. Analysis from Citi estimated that the UK economy would be between 2% and 3% smaller in 2024-25 than before the pandemic, but Citi cited Brexit as a more important factor in this reduction than Covid.

Source: Guardian, 12 October 2021
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** Milton Keynes council’s ruling Labour and Liberal Democrat Progressive Alliance have agreed to vote together to pass a motion encouraging schools to introduce signage asking parents and carers not to smoke within 20 metres of the school gates or other exits and entrances. Liberal Democrat councillor and Cabinet member Paul Trendall will move the motion this week which is being seconded by Labour councillor Zoe Nolan, Cabinet member for children and families.

The motion will ask the council to use its influence to try to persuade academies to place the signage outside their gates. Trendall said: “Placing these signs outside schools is a simple task, but one that has a strong message; we care about the health of our children and young people, and they shouldn’t have to be placed at risk just because some adults chose to smoke.”
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Source: Milton Kenyes Citizen, 11 October 2021
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** A new service named MiQuit is launching in Norfolk to help pregnant women to quit smoking and to improve the health of their baby. The MiQuit service, developed by experts at the University of East Anglia and University of Cambridge and commissioned by Norfolk County Council, provides free text message support for users, sending information and advice directly to their phone.

Users sign up for the MiQuit service from their mobile phone. A series of text messages are sent asking questions about their smoking, with answers used to tailor the support provided to the individual. Healthcare professionals in Norfolk including midwives, assistant midwives, and health visitors, will be provided with information about MiQuit by Norfolk’s Healthy Lifestyles team.

Councillor Bill Borrett, Norfolk County Council’s Cabinet Member for Public Health, said: “Smoking during pregnancy can have a major impact on a baby: it’s no exaggeration to say that quitting smoking will improve your child’s health not just at birth, but throughout their life. This new service aims to get tailored advice straight into the phones of people who need support in quitting, and the results of this pilot being run in Norfolk may help the service be taken up across the country.”

Source: Norfolk County Council, 11 October 2021
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** International
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A new study, published in the Medical Journal of Australia today (12 October 2021), has identified toxic and harmful chemicals in several dozen e-cigarette liquids readily available in Australia. The researchers examined the ingredients of more than 60 of Australia’s most popular over-the-counter "nicotine-free" liquids used for electronic cigarettes and found that the majority of them contained substances known to cause respiratory issues and lung damage when inhaled.

The research, funded by the Minderoo Foundation, Lung Foundation Australia and Cancer Council of WA, was co-led by Associate Professor Alexander Larcombe of Curtin University and the Wal-yan Respiratory Research Centre. The researchers also found nicotine present in 9% of the liquids tested, despite being marketed as nicotine free. They found that 42 of the 65 e-liquids studied contained benzyl alcohol, a solvent and flavour enhancer that has been linked to severe skin and allergic reactions. None of the e-liquids tested were labelled with a comprehensive ingredient list, meaning users could not know what chemicals they were inhaling.

Source: Medical Xpress, 11 October

Editorial note:
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*
** Products on sale in Australia are not required to meet UK standards. In the UK, caffeine and other stimulants are banned in e-liquid, as are vitamins, colourings, and any additives that, in unburnt form, meet the criteria for classification as a carcinogen, mutagen, or reprotoxin. See regulation 15 in the Tobacco and Related Products Regulations 2016. ([link removed])
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** Scientists have discovered the earliest-known use of tobacco, in the remnants of a hearth built by early inhabitants of North America’s interior about 12,300 years ago in Utah’s Great Salt Lake Desert in the US. Researchers discovered four charred seeds of a wild tobacco plant within the hearth contents along with stone tools and duck bones left over from meals.

Before the discovery, the earliest documented use of tobacco had been the nicotine residue found inside a smoking pipe from Alabama dating to 3,300 years ago. The researchers believe that the nomadic hunter-gatherers at the Utah site may have smoked the tobacco or sucked wads of tobacco plant fibre for the stimulant qualities offered by the nicotine it contained.

Some scholars have argued that tobacco may have been the first plant domesticated in North America - and for sociocultural rather than food purposes. Tobacco domestication as we know it occurred thousands of years later elsewhere on the continent, in the Southwestern and Southeastern United States and in Mexico, spreading worldwide following the arrival of Europeans in the New World more than five centuries ago.

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** Source: Reuters, 11 October 2021
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** Parliamentary Activity
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** PQ1: Health Education

Asked by Mark Pawsey, Rugby

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** To ask the Secretary of State and Health and Social Care, with reference to the Government's data on vaping published on 4 March 2020 and 23 February 2021 which show that the number of people vaping in England has plateaued, whether he plans to increase communications to smokers on ways to quit tobacco, including the use of less harmful alternatives to smoking.

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** Answered by Maggie Throup, The Parliamentary Under-Secretary for Health and Social Care
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Public Health England's smoking cessation marketing activity, including the current ‘Stoptober' campaign, signposts to a range of quitting support such as replacing tobacco with electronic cigarettes. The updated National Health Service Quit Smoking app launched in advance of Stoptober will continue beyond the campaign with ongoing development planned.
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** In 2022, the Office for Health Improvement and Disparities will publish an independent review of the up-to-date evidence on the safety of e-cigarettes. The review will include information about the relative harm of smoking and vaping. New guidance from the National Institute for Health and Care Excellence, to be published in November 2021, will advise the public and health professionals on the most effective ways of stopping smoking and reducing its burden of death and disease.
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** Source: Hansard, 12 October 2021 ([link removed])
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**
PQ2: Smoking
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**
Asked by David Jones, Clwyd West
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To ask the Secretary of State for Health and Social Care, pursuant to the answer of 27 July 2021 to Question 36588 on Tobacco, if he will publish his planned timetable for publication of the Tobacco Control Plan for England.

Answered by Maggie Throup, The Parliamentary Under-Secretary for Health and Social Care
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** The Department is currently in the process of drafting the new Tobacco Control Plan working closely with Public Health England and other Government departments. We expect the final Tobacco Control Plan to be published by the end of the year.

Source: Hansard, 12 October 2021 ([link removed])
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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