2025 Fri 5th December Seminars

The Tobacco and Vapes Bill was introduced in the House of Commons on 5 November 2024 and is currently progressing through the House of Lords. The Bill fulfils the Government's manifesto commitment to ensure that the next generation will never legally be sold tobacco products and that vapes will be banned from being branded and advertised to appeal to children. Martin Dockrell, on behalf of DHSC, will briefly outline the provisions that will be included on the face of the Bill and regulation-making powers requiring subsequent secondary legislation and further consultation. He will also update on the upcoming DHSC call for evidence which covers issues such as vape ingredients, devices, nicotine limits, licensing and registration.

In this year's opening keynote, Professor Lion Shahab will highlight the importance of harm reduction in tobacco control and trace how international approaches to e-cigarettes—particularly in the UK and US—have diverged historically. This divergence has fuelled increasingly polarised debates, shaped by abolitionist and libertarian agendas, that often overshadow balanced evaluation of evidence. The talk will examine how findings on e-cigarette harms and benefits are frequently misrepresented, either understated or overstated, and argue for a rigorous, evidence-led approach to public health policy. In this context, it will also consider the intended and unintended consequences of current proposals in the UK Tobacco and Vapes Bill. The talk will conclude by identifying critical gaps in the literature and setting priorities for future research to understand vaping’s population impact better and support proportionate, effective regulation.

The 21st century rise of noncombustible nicotine products has complicated efforts to determine tobacco and nicotine policies’ health impacts, as cross-product effects can aggravate or mitigate health costs depending on the products’ relative harms. Research on electronic cigarette policies has attempted to address this by assessing effects on combustible tobacco use as well as vaping, but less consideration has been given to potential heterogeneity in effects between groups that are more versus less likely to smoke. In particular, if e-cigarette policies’ effects on smoking and vaping vary by socioeconomic status, such regulations could narrow or amplify disparities in tobacco-related disease. To consider this, Prof. Friedman will present preliminary results from a natural experiment leveraging US e-cigarette policy variation to assess potential implications for socioeconomic disparities in smoking and vaping.

Effective communication of health risks is central to public health, yet the discourse around e-cigarettes has become increasingly muddled. This presentation explores how misinformation has led many smokers to believe that vaping is more harmful than smoking, despite evidence to the contrary. It will examine the principles of risk communication and the importance of tailoring messages to different audiences — promoting vaping as a harm reduction tool for smokers while clearly communicating the potential risks for non-smokers.
A key focus needs to be on the role of trust in public health messaging. In an era marked by declining confidence in science and institutions — particularly since the COVID-19 pandemic — rebuilding trust is essential to ensure that evidence-based messages are heard, understood, and acted upon. Through this lens, we’ll consider how public health can better support informed decision-making and reduce health inequities.

Synopsis for my presentation: In Scandinavia, bio-ceramic tobacco-free nicotine pouches have become the very latest supplement to the nicotine market. However, over the past century, various nicotine products have had successive time-limited periods of market dominance. Plug tobacco for chewing at the start of the century was replaced by pipe smoking from the 1930s, which in turn was replaced by rolling tobacco as the dominant method of use from the 1960s. From the 1980s followed some decades where varieties of manufactured cigarettes (plain, filter, light) dominated the market, only to be replaced by varieties of tobacco-based snus (loose, portions) for oral use from 2015. More recently, tobacco-free cellulose-based nicotine pouches (white snus) have started to outcompete the traditional types of (brown) snus. In addition, non-combustible inhalation products (vapes & heated tobacco) have gained some market share without achieving dominance in the Nordics. This historic product substitutability illustrates the correctness of Professor Michael Russell’s statement in 1971 “One nicotine product has never left the market without being replaced by another”. Neither corporal, economic and social punishment of the users, nor the wide range of supply- and demand regulations (including prohibition) have succeeded in eliminating the appetite for recreational use of nicotine. Starting with a brief historical analysis of the historic development of the nicotine market, we will subsequently narrow our focus on nicotine pouches; the current market situation, the inconsistent international regulations, the assumed harm potential, usage patterns and.…all the knowledge gaps.

The term ‘addiction’ has multiple meanings relating to an acquired ‘need’ for something. In some cases, it refers to a clinical syndrome characterised by a set of signs and symptoms including subjective, behavioural and physical phenomena. In other cases, it refers to a dimension of need that people can experience to varying degrees. The term ‘dependence’ is sometimes used synonymously with ‘addiction’ and sometimes differentiated from it, with addiction referring to a psychological need and dependence referring to a physiological need. These meanings serve different purposes and it is vital to be clear about which meaning one is referring to and to match that meaning to the purpose in hand.
When it comes to nicotine and tobacco addiction, the most important use is to understand and predict the success of quit attempts. Here, the evidence indicates that construing addiction as a dimension of psychological need is the most successful approach, assessed by measures such as the Fagerstrom Test for Cigarette Dependence (FTCD) and the Strength of Urges to Smoke Scale (SUSS). The physiological clinical syndrome approach, as assessed for example by DSM-V tobacco dependence criteria, performs poorly when predicting success of quit attempts. Evidence also indicates that it is crucial to distinguish between different nicotine and tobacco products and the context in terms of societal and population characteristics. It follows from this that the broad concept of ‘nicotine addiction’ as a clinical syndrome lacks empirical validity. Instead we should be focusing on dimensions of psychological need for specific nicotine and tobacco products in specific populations and contexts.

• How can we ensure that vaping and nicotine policies do not widen inequalities?
• What actions are needed to correct misinformation on smoking and vaping?
• Is societal nicotine use inevitable?
• Will nicotine pouches be less controversial than vape products?

The Department of Business and Trade, representing the Office for Product Safety and Standards, is the UK's regulator for Waste, Electrical and Electronic Equipment (WEEE) and Waste Portable Battery regulations, overseeing “WEEE & Battery take back Schemes”. As Senior Compliance Lead, Bubbly Sandhu will introduce the roles of the DBT and OPSS and their focus on promoting responsible product stewardship. The session will clarify the key regulations, highlight the environmental impact of vape waste, and examine compliance challenges specific to this rapidly changing sector. Bubbly will define good compliance, share enforcement insights, and outline future priorities to help develop a more sustainable vaping industry.

During this session, David Hunt will emphasise the importance and scope of collaboration with all relevant agencies in establishing a compliant and legitimate industry. He will focus on his joint work with the MHRA on the Vape Expert Panel scheme, which refers new and novel products for examination and testing. This process helps prevent many poor-quality devices, including child-friendly products and packaging, from entering the legal supply chain. David will discuss common issues he observes and how compliance has evolved since its introduction, noting that increasingly, businesses are voluntarily self-referring before submission, which supports the legitimate industry in making changes and achieving compliance more swiftly.

In this presentation, Kate Pike from Trading Standards will discuss how criminals have entered the UK vaping space and the size and scale of the challenge they present. These criminal groups are solely motivated by making as much money as possible from this commodity. They have no concern for public health, safety, compliance, the environment, or good business practices. Kate will examine what regulators and law enforcement can do to address this issue and what the industry can do to support these efforts.

Product standards are basic quality requirements that may apply to all products within a product class. This could include, for example, a maximum nicotine concentration, that the product be sold in a child-resistant container, or that the product not contain specified ingredients (e.g. diacetyl or vitamin E acetate). Certain basic assumptions are required to have an evidence-based discussion of product standards that might benefit public health. The standard should be enforceable. All e-cig product standards should recognize that e-cigs are just one type of nicotine product, and that all nicotine products exist along a continuum of risk, with cigarettes at the high end and nicotine patches at the low end with e-cigarettes somewhere in the middle. It will not improve public health to pass rigid new standards for lower-risk products (e.g., e-cigarettes) while failing to pass equally or more stringent standards for higher-risk products (e.g., cigarettes). A framework for considering nicotine product standards should also recognize that nicotine products compete with and can substitute for other nicotine products. It should also acknowledge the limited success that governments around the world have had in simply banning popular classes of drug-delivery products, or of persuading everyone to abstain from substances that people find reinforcing or addictive voluntarily. Product standards that are appropriate for public health are those that help consumers to transition away from the most harmful products and towards much less harmful alternative products, and ideally quit harmful products before their harms are realized. A key component of the success of this type of regulation is that governments and public health and scientific organizations provide accurate information to the public about the relative risks of products they have access to, along with evidence-based guidance on how to switch or quit.

The UK Vaping Duty will raise the price of e-liquids, with the main aim of discouraging e-cigarette use among non-smokers, particularly young people. However, there is still a lot we don’t know: How responsive will young people be to price increases? To what extent will higher prices discourage adults who smoke from switching to vaping? What are the implications of the duty for health inequalities? Could the vaping duty increase misperceptions about the harms of vaping? Could the vape duty be configured differently to reduce unintended consequences? This talk will explore what we do, and what we don’t know, about the likely impact of the vaping duty, setting an agenda for future research.

Since their arrival in 2019, nicotine pouches have become an increasingly visible part of the nicotine market in Great Britain, promoted through billboards, social media, and sponsorships of motorsports and music festivals. Their rise in popularity has taken place in a regulatory vacuum, with no limits on age-of-sale or nicotine strength and minimal restrictions on advertising. The public health impact will depend on who is using them and for what purpose: are they more often a tool for cessation and harm reduction among people who smoke, or a new route into nicotine for those who might otherwise never have used it? This presentation will draw on new population data to address these questions and consider what the UK’s forthcoming Tobacco and Vapes Bill could mean for their future.

• How important are consumer product preferences when designing regulatory legislation?
• Does prohibition make enforcement easier?
• What are the critical considerations when choosing between different regulatory approaches?
• What regulatory opportunities have we missed?

Dr Toll’s presentation will focus on the rise of e-cigarettes as the dominant form of tobacco use in the United States (US) and the need for the development of treatments focusing on e-cigarette reduction and cessation. The supremacy of e-cigarette use by US youths will be briefly discussed, along with data showing that the majority of young adults who use nicotine in the US use e-cigarettes. Preliminary data on nicotine pouch use in US-based youths and adults who use cigarettes, e-cigarettes, and smokeless tobacco will be presented. The US perspective on e-cigarette use will be presented, including views and behaviors regarding adolescent, young adult, and adult use. The relatively cautious stance of the US FDA will be discussed. Data will be presented from multiple pilot studies regarding treatment of adult e-cigarette mono-users and e-cigarette and combusted cigarette dual users, including treatment with varenicline tartrate (for mono-users) and nicotine replacement therapy (for dual users). Very preliminary data on the biological impacts of vaping cessation will be presented.

NENCB ICB has funded an innovative project, the ‘HIVE’ team, to support patients with multiple and complex needs in having equitable access to, experience, and outcomes on our clinical pathways. The team has found a high prevalence of tobacco dependency in the cohort and will share the details underpinning high levels of engagement and positive outcomes with case studies and live outcome data.

The HIVE Programme brings together local clinical knowledge with insight from people with lived experience and the expertise of local authority and community services. The aim is simple yet ambitious: to improve access, experience, and outcomes for those who are often overlooked by traditional services. The work has initially focused on people with respiratory conditions referred through urgent cancer pathways. More than half of those supported are living in our most deprived communities or are in unstable housing, suffer with poor mental health or learning disabilities/ neurodivergence, or are living with addiction or substance dependence.

The Tobacco and Vapes Bill is about to reshape tobacco and vaping policy in the UK, alongside new investment in stop smoking services aimed at reaching ‘priority groups.’ But what does this mean for people with the most challenging lives, such as those with mental health conditions, people who use other substances, and individuals in prison? Tobacco dependence treatment and policy is rarely designed with their needs at the centre and THR is often positioned as what is offered when quitting is judged impossible, rather than as a valid and proactive route to reducing harm. Policies and treatment are frequently misaligned with lived realities, for example, in mental health services where smoke-free policies focus on compliance, in substance use settings where tobacco use has rarely been addressed, or in prisons where vaping is shaped by security and control rather than reducing harm. The needs of people in such services are misperceived, they are often seen as lacking motivation to quit tobacco, or services only treat ‘one addiction at a time.’ What is missing is care designed for the people most affected by smoking. This session will consider how current policy may affect ‘priority’ groups, and whether harm reduction will continue to be sidelined as second best, or recognised as central to reducing inequalities.

In this talk Professor Notley will present evidence of predictors of postpartum relapse using data from a recent RCT recruiting pregnant people who quit smoking for pregnancy and will discuss the impact of misunderstandings, misinformation and misalignment of public health goals. The role of vaping in supporting sustained abstinence will be considered, prioritising the voices, views and experiences of those who used vaping as part of their smoking quit journey. There is evidence of continued misunderstanding of vaping as a harm reduction approach from influential health care professionals, leading to dissemination of misinformation. This suggests a potentially concerning situation where people in the early postpartum may be vulnerable to tobacco smoking relapse due to a perceived need to quit vaping or using other nicotine products, that are portrayed as akin to tobacco smoking. The presentation asks for a focus on clarity in public health goals, that may help address the confusing advice and (mis)information that parents have to negotiate.

Over the past five years, youth vaping has risen significantly, prompting both government and local authorities to respond. In many areas, swift action has led to the roll-out of local anti-vaping initiatives aimed at discouraging young people from taking up vaping. Yet, rapid implementation can sometimes result in ineffective measures and unintended consequences. In this session, Dr Khouja will present findings from a survey of local authorities, showcasing the resources currently in place to tackle youth vaping. She will highlight elements of the initiatives that are more likely to be effective and offer recommendations for improving them. Following this, Louise Ross will explore the potential unintended consequences of local initiatives that overlook adult smokers and vapers, particularly how such approaches may undermine the switch from smoking to vaping among adults.

• Will long-term nicotine use increase health inequalities?
• How can the needs of people who currently smoke be better served in health policy discussions?
• Can discussions on vaping cessation be beneficial to smoking cessation, or is it a distraction?
• Has vaping stigma replaced smoking stigma?

Building on insights from the WHO COP FCTC and recent European regulatory proposals, Tim Phillips from ECigIntelligence will analyse the changing landscape of nicotine products, global regulations, and the rise in enforcement worldwide. Tim will highlight where product development is occurring and consider what this could mean for the adoption of new nicotine products over the next decade.

Nicotine use in England is evolving rapidly. Among younger adults, daily cigarette smoking has fallen sharply, with vaping now more common than smoking. In contrast, older adults continue to follow more traditional smoking patterns and are more uncertain about the relative harms of e-cigarettes – despite evidence that these products work just as well for them in supporting smoking cessation. Drawing on the latest evidence, this talk will explore age-specific trends in nicotine use over the past decade, highlight the unique barriers facing older adults, and consider the policy challenges of striking the right balance: ensuring that people who smoke can access less harmful alternatives while limiting uptake among those who would otherwise remain nicotine-free.

The evidence is clear that switching from smoking to vaping reduces health risks and can save lives. Though more preliminary, evidence on oral nicotine pouches suggests the same. But as evidence grows in this space, public opinion continues to move in the opposite direction, with valuable opportunities to reduce the burden of tobacco use missed due to misinformation and misunderstandings. These preventable deaths warrant swift action and well thought through policies, but with science – and public health – under threat in some areas of the world, how do we move forward? This presentation will cover the latest Cochrane evidence on vaping and pouches, and recent research into policy-making challenges in this space.

Aotearoa New Zealand was one of the first countries to run clinical trials of e-cigarettes, evaluate relative risk, and endorse their use to stop smoking. An early commitment to objective, evidence-based approaches made New Zealand an early adopter of vaping for harm reduction. Easy access, low prices and support from the government for stopping smoking saw significant uptake of vapes, correlating with record declines in smoking, especially for Māori women, for whom smoking rates halved from 32% to 14.8% in only 4 years. Access to much less harmful nicotine alternatives was even a factor in enabling New Zealand’s abandoned tobacco denicotinization laws.

However, concerns about youth vaping uptake, misinformation about nicotine, and stigma about addiction have seen tobacco harm reduction increasingly labelled as a public health crisis rather than a success. Not to mention international pressure to downplay the role of vaping. This talk will reflect on why increased hostility to tobacco harm reduction is drowning out the story of New Zealand’s success. Are the lessons from New Zealand under threat from public opinion, activist science and political gesturing?

In this session, Martin will reflect on his 20 years in tobacco control and the 20 preceding years in HIV prevention, drawing lessons for the current challenges in nicotine policy. He will explore the importance of fully utilising the evidence, maintaining public trust, and promoting public health with clear-sighted prioritisation.
Martin will talk about his “pilgrim's progress” on a mission to end HIV transmission and to end smoking, and what he learnt along the way and how those lessons shaped new priorities and values.
Public health is indeed a moral crusade, but not one of conformity. It is a journey alongside people to help them live their healthiest and happiest lives.

• The UK and NZ approach to vaping has been controversial. Is there an alternative model that has worked better?
• What would the role of tobacco control be in a post-smoking era?
• How will we know when — or if — we get things right— what are the measures of success?