Hazel Cheeseman & Ian Gray presentation from E-Cigarette Summit 2014

1. Hazel Cheeseman
Director of Policy
Action on Smoking and Health
Ian Gray, CFCIEH, MBE
Chief Policy Officer, Chartered Institute of Environmental Health

2. Permitting or prohibiting vaping – ingredients for developing a policy
Ian Gray
Principal Policy Office
Chartered Institute of Environmental Health
Hazel Cheeseman
Director of Policy
Action on Smoking and Health

3. The project
•Support small number of councils through policy development process
•Learn from their experiences to share ideas about a good process with others
•To date worked with seven councils, three now have formal policies, rest in development
•Next year we’ll publish conclusions
•This presentation is based on lesson’s we’ve learnt working with these councils and others around the UK.
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4. Why do organisations find this difficult issue to address?
•Complexities
•Confusion
•Conflicting beliefs
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5. Complexities: There are no easy answers
“Are they safe to use?”
“Will they lead to more children smoking?”
“Will they undermine smokefree legislation?”
“Will banning them have a negative effect on people trying to quit?”
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“They’re safer than smoking”
“There’s no evidence of this yet…”
“They haven’t yet, we don’t think they will…”
“We don’t know, it’s possible…”

6. Complexities: competing ‘rights’
Number of different and conflicting rights
•Non-smokers and non-vapers to clean air
•Smokers to have alternatives available to them
•Vapers to use a product which does not harm others
•Non-smokers right to ‘smoke’ breaks
•Those trying to quit to use product of choice
•Those trying to quit not to have to stand with smokers
•Those trying to quit who don’t want to see products that look like a cigarette
•Etc etc
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7. Complexities: a balance of responsibilities
Number of different and conflicting responsibilities
•Promote public health
•Duty of care to staff
•Duty of care to clients and public
•Support smokers to quit or reduce harm
•Protect corporate image
•Minimise workplace conflict
•Maximise the choice of vulnerable service users
•Locus Parentis
•Etc etc
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8. Confusion: failure to distinguish between smoke and vapour
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0%
5%
10%
15%
20%
25%
30%
35%
40%
A LOT MORE
harmful
MORE
harmful
JUST AS
harmful
LESS harmful
A LOT LESS
harmful
Completely
harmless
Don’t know
Do you think electronic cigarettes are more, less or as harmful as regular cigarettes?

9. Confusion: poor knowledge of nicotine
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0%
5%
10%
15%
20%
25%
None or very
small
Some but
well under
half the risk
Around half
the risk
Much more
than half the
risk
Nearly all
the risk
Don’t know
According to what you know or believe, what portion of the health risks of smoking comes from nicotine in cigarettes?

10. Conflicting beliefs: addiction
“harm reduction will leave people addicted to nicotine forever..”
“Its wrong not to support people on low incomes to overcome their addictions…”
“Smokers don’t need nicotine, they should just go cold turkey…”
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“I’ve got a right to my addiction if it doesn’t bother anyone else”
“What’s the difference between your coffee addiction and my electronic cigarette addiction?”
“People are more likely to quit and stay quit with support and access to nicotine”

11. Conflicting beliefs: tobacco industry
“If the tobacco industry is involved then it must be for the wrong reasons – we must have nothing to do with this agenda”
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“Our policies on nicotine containing products should be developed in the interests of the public’s health regardless of who develops or markets them.”

12. Why do organisations find this difficult issue to address?
•Complexities – people (and corporate policies) struggle to manage complexity
•Confusion – without a shared understanding of some basic evidence development of good policy is a challenge
•Conflicting beliefs – slow and difficult to find consensus on questions of belief
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13. The spectrum of permissiveness
Complete prohibition
Qualified use
Complete freedom
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14. Ingredients needed for policy development
1.Identify key principles and policy objectives
•Vaping and smoking are not the same
•NICE guidance directs us to reduce harm from tobacco use
•Policies should aim to maximise public health gain
2.The right stakeholders engaged
3.The best evidence considered
4.Using appropriate language
5.Review fit with existing policies and strategies
6.Clear process for implementation and review
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