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** 29 October 2019
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** UK
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** Vaping and lung disease in the US: PHE’s advice (#1)
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** International
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** USA: Juul to cut jobs as e-cigarette firm restructures (#2)
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** Canada: Research finds that women have more difficulty quitting smoking (#3)
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** Why vaping causes harm in the US but not the UK (#4)
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** Parliamentary Activity
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** Parliamentary Question (#5)
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** UK
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**

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** PHE has published advice on smoking and e-cigarettes today. The advice reaffirms that the problems being reported in the US are not linked to long-term use of regulated nicotine vaping products: “if [they] were, we would expect to see a very different demographic profile affected, more typical of long term vapers.”

“PHE has not changed its advice on nicotine containing e-cigarettes: Smokers should consider switching completely and vapers should stop smoking. We are as certain as ever that e-cigarettes are far less harmful than smoking, which kills almost 220 people in England every day.”

“The evidence still shows that vaping carries a small fraction of the risk of smoking. Using a nicotine-containing e-cigarette makes it much more likely someone will quit successfully than relying on willpower alone. But it’s important to use regulated e-liquids and never risk vaping home-made or illicit e-liquids or adding substances.”

“Vaping devices that do not include nicotine come under a different set of regulations, the General Product Safety Regulations. These are generally less stringent than the regulations covering nicotine containing e-cigarettes.”

PHE advice on smoking and e-cigarettes
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** For smokers: You should stop smoking completely. Getting expert support combined with using an e-cigarette doubles your chances of quitting successfully. For the best way to quit read our advice
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** For people who vape nicotine: if you are still smoking, you should stop and switch completely to vaping, then come off nicotine when you are confident you won’t relapse to smoking.
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** If you have never smoked: Don’t vape.
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** For people who vape CBD: although CBD is less tightly regulated, if you experience symptoms or are concerned you should stop.
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** For people who vape THC: if you are vaping THC (or an unknown liquid which could contain THC) it can be hazardous. These are the products most implicated in the US outbreak. If you feel unwell or have any difficulty breathing after vaping THC, go to A&E and tell them precisely what the product was you were using.
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Read Advice in Full ([link removed])


** International
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**

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** On Monday 28 October, e-cigarette maker Juul Labs announced that it would cut jobs as part of a restructuring plan. The San Francisco-based company was growing rapidly before a spate of vaping-related lung injuries in the US. Juul was reported to finish last year with about 1,500 employees, and said it hired an average of 300 people a month this year.

"To right-size the business, the workforce will be reduced between now and the end of the year," Juul said in response to an AFP inquiry. It would not disclose how many jobs it expected to cut, but a Wall Street Journal report indicated the company planned to eliminate around 500 positions.

Layoffs would be spread across departments, but hiring would continue for certain positions, according to Juul. Government affairs, clinical, and corporate responsibility teams will be consolidated and focus on "earning trust with regulators, policymakers and government officials worldwide". Juul technical teams including hardware, software and design will be combined in a product team.

Source: Mail on Sunday, 29 October 2019
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** Women are half as likely to quit smoking as men, according to research presented at the 2019 Canadian Cardiovascular Congress (CCC) last week (24 – 27 October). Affordability of smoking cessation medications was identified as another barrier to success. The study examined the predictors of success in quitting or reducing smoking in patients attending a smoking cessation clinic at St. Michael's Hospital in Toronto.

The retrospective analysis included 233 patients who attended the clinic at least twice between 2008 and 2018. Participants received individual medical counselling, and according to the patient's preferences, prescription of stop-smoking medications and nicotine replacement therapies. After six months, 25% of participants had quit smoking and 29% had reduced the daily number of cigarettes by more than 50%. Factors including total number of visits, varenicline use, gender, and medication affordability, were independently associated with quitting or reducing smoking by more than 50%.

"In our study, women had a higher prevalence of anxiety or depression than men (41% versus 21%, respectively), which potentially disturbed the smoking cessation process," said study author Dr Carolina Gonzaga Carvalho. "Hormonal or social factors might also play a role. Our observational study cannot answer why but it speaks to the need for gender analysis and treatment specific to sex."

"Female sex and medication affordability were independent predictors of inability to quit or significantly reduce tobacco smoking. Previous research has shown that a policy to cover the financial costs of smoking cessation medications improves quit rates […] The number of clinic visits was the strongest predictor of successfully quitting or reducing smoking […] This highlights the importance of these appointments, when counselling was provided, and medication was reviewed and adjusted as needed."

Previous studies have shown that varenicline use is associated with greater success in quitting smoking when compared to placebo and other medications, and the current study agrees with these findings. "Varenicline decreases withdrawal symptoms and may have reduced craving for nicotine among our patients, potentially reducing relapse," said Dr. Gonzaga Carvalho.

She concluded: "Our study emphasises the need for sex-specific interventions and financial coverage of smoking cessation medications. Our message to smokers is that smoking cessation is achievable with help. Get assistance and connect to a smoking cessation program, where individual needs will be assessed, and a plan to quit smoking will be developed. The sooner, the better."

Source: Medical XPress, 28 October 2019
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** In an opinion piece for the Wall Street Journal on attitudes towards e-cigarettes, Matt Ridley concludes that “a century after the American experiment with Prohibition, neither the US nor the UK has fully absorbed the lesson of its failure: that public health and safety are best served when governments treat our harmful habits as problems to regulate, not evils to ban.”

“Some countries argue that vaping is an effective means of reducing smoking, while others want to see it stamped out altogether, fearing that it could give a new lease on life to the tobacco industry. As with drugs and prostitution, this debate pits prohibition against “harm reduction”: the idea that it is better to regulate harmful habits to make them safer than to ban them in the hope of enforcing abstinence […]”

“In both the UK and the US, the rapid growth in vaping has coincided with rapid reductions in smoking rates, especially among young people. Yet there is a stark contrast between the two countries in how vaping has been treated by public health authorities and, as a result, in its safety for users.”

“In Britain, vaping is all about nicotine, not drugs. It is socially acceptable and is confined almost entirely to people who have smoked, even among the young. Less than 1% of vapers are people who have never smoked, and there is little sign of young people taking it up faster than they would have taken up smoking.”

Source: The Wall Street Journal, 24 October 2019

See also: [link removed]
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** Parliamentary Activity
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**

Asked by Mr Ranil Jayawardena MP, North East Hampshire:
To ask the Secretary of State for Health and Social Care, how many times ambulance services have been called to (a) a school and (b) other locations for an incident in relation to vaping fluid laced with (i) cannabis and (ii) Spice in the last 12 months.

Answered by Edward Argar, Minister of State (Department of Health and Social Care):
This information is not collected centrally.

Source: Hansard, HC Deb, 28 October 2019

Link: [link removed]
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For more information call 020 7404 0242, email [email protected] (mailto:[email protected]) or visit www.ash.org.uk

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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