Martin Dockrell

E-Cigarettes: Prevalence and Attitudes in Great Britain

Introduction: Electronic cigarettes (e-cigarettes) are a means of recreational nicotine use that can potentially eliminate the need to smoke tobacco. Little is known about the prevalence of use or smokers’ attitudes toward e-cigarettes. This study describes use of and attitudes toward e-cigarettes in Britain. Methods: Respondents from three surveys were recruited from a panel of adults in Britain. Preliminary online and face-to-face qualitative research informed the development of a smokers’ survey (486 smokers who had used e-cigarettes and 894 smokers who had not). Representative samples of adults in Britain were then constructed from the panel for population surveys in 2010 (12,597 adults, including 2,297 smokers) and 2012 (12,432 adults, including 2,093 smokers), generating estimates of the prevalence of e-cigarette use and trial in Great Britain. Results: Awareness, trial, and current use increased between 2010 and 2012; for example, current use more than doubled from 2.7% of smokers in 2010 to 6.7% in 2012. The proportion of ever-users currently using e-cigarettes was around one-third in both years. In 2012, 1.1% of ex-smokers reported current e-cigarette use, and a further 2.7% reported past use. Approximately 0.5% of never-smokers reported having tried e-cigarettes. Conclusions: While we found evidence supporting the view that e-cigarette use may be a bridge to quitting, we found very little evidence of e-cigarette use among adults who had never smoked. British smokers would benefit from information about the effective use, risks, and benefits of e-cigarettes, as this might enable the use of e-cigarettes to improve public health.

Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach

Background: An international expert panel convened by the Independent Scientific Committee on Drugs developed a multi-criteria decision analysis model of the relative importance of different types of harm related to the use of nicotine-containing products. Method: The group defined 12 products and 14 harm criteria. Seven criteria represented harms to the user, and the other seven indicated harms to others. The group scored all the products on each criterion for their average harm worldwide using a scale with 100 defined as the most harmful product on a given criterion, and a score of zero defined as no harm. The group also assessed relative weights for all the criteria to indicate their relative importance. Findings: Weighted averages of the scores provided a single, overall score for each product. Cigarettes (overall weighted score of 100) emerged as the most harmful product, with small cigars in second place (overall weighted score of 64). After a substantial gap to the third-place product, pipes (scoring 21), all remaining products scored 15 points or less. Interpretation: Cigarettes are the nicotine product causing by far the most harm to users and others in the world today. Attempts to switch to non-combusted sources of nicotine should be encouraged as the harms from these products are much lower.

Comprehensive smoke-free legislation in England: how advocacy won the day

Objective: To examine how a government committed to a voluntary approach was forced by an effective advocacy coalition to introduce comprehensive smoke-free legislation. Methods: A diary was kept from the start of the campaign in 2003, backed up by journal and press articles, and information downloaded from the web. Regular public opinion polls were also carried out to supplement government surveys and polls conducted by the media. Results: The 1997 Labour Government was committed to a voluntary approach to deal with the problem of secondhand smoke. By 2003, efforts to persuade government to introduce regulation of workplace secondhand smoke through a health and safety code of practice with exemptions for the hospitality trade, had failed. Despite a lack of support from the government, including the health minister, a new strategy by health advocates focusing on comprehensive workplace legislation was able to succeed. Conclusions: In a democracy it is crucial to develop public knowledge and belief in the extent of the risks of secondhand smoke. Gaining public and media support for the issue can ensure that government has to take action and that the legislation will be enforceable. The interests of the tobacco industry and the hospitality trade differ and this can be used to gain hospitality trade support for comprehensive national legislation in order to ensure a level playing field and protection from litigation.

Prevalence of Waterpipe (Shisha, Narghille, Hookah) Use Among Adults in Great Britain and Factors Associated With Waterpipe Use: Data From Cross-sectional Online Surveys in 2012 and 2013

INTRODUCTION We assessed the prevalence and frequency of waterpipe smoking among adults (aged 18+ years) in Great Britain (GB) and determined demographic factors associated with use. METHODS We used cross-sectional representative population surveys conducted online in 2012 and 2013. A total of 12,436 adults in 2012 and 12,171 in 2013 were recruited from a commercial online survey panel. RESULTS The prevalence of ever use of waterpipe across both survey years combined was 11.6% (95% confidence interval [CI] = 11.0-12.1). Frequent use (at least once or twice a month) was 1.0% (95% CI = 0.8-1.2) and was similar in both 2012 and 2013. There was some suggestion of increased ever but not frequent use among 18-24-year-olds between survey years. After adjustment for covariates, females had lower odds of ever waterpipe use than males (odds ratio [OR] = 0.71, 95% CI = 0.63-0.79), those in the lowest social grade had lower odds of use compared to those in the highest social grade (OR = 0.43, 95% CI = 0.35-0.54), older people were at much lower odds of ever use than younger people, ever having smoked cigarettes increased odds of ever waterpipe use, and being Asian (OR = 1.84, 95% CI = 1.39-2.45) or of mixed ethnicity (OR = 2.36, 95% CI = 1.64-3.40) increased likelihood of ever use compared to White ethnicity. CONCLUSIONS Frequent waterpipe smoking was relatively rare in these representative samples of the GB adult population, and prevalence was similar between 2012 and 2013. Continued monitoring and targeted interventions are appropriate.

Tobacco point-of-sale displays in England: a snapshot survey of current practices

Background Tobacco displays at the point of sale (PoS) are an important means for the tobacco industry to communicate with consumers. With regulations prohibiting PoS displays recently having come into force in Ireland, passed into law in England, Wales and Northern Ireland and some Australian states, and being considered in New Zealand, Finland and Brazil, this is an increasingly important issue. This study explores the nature of displays, the extent to which they are tobacco industry funded, and the relation between the tobacco companies and retailers. Methods Three areas were chosen to gain a snapshot of PoS displays in England. Over 100 retailers were visited, with interviews taking place on site. Information was gathered on the type and size of tobacco display, who was paying for the display, requirements and incentives, and visits by industry representatives. Results The majority of retailers had gantries provided by tobacco companies. A minority of these were fitted with automated dispensers called retail vending machines. Attractive lighting and colour were often used to highlight particular products. Most retailers were being visited by industry representatives who checked displays. Some retailers also reported incentives offered to them for displaying products. Conclusions The results suggest that the tobacco industry presence and control in the retail environment is significant. Tobacco companies overwhelmingly provided tobacco gantries in the shops surveyed and influenced displays through a combination of requirements and incentives. The extensive involvement of tobacco companies in providing and monitoring retail displays suggests the importance of implementing policies to end this form of advertising.

Eye and heart at mortal war: coronaries and controversy in a smoke-free Scotland

Evaluation of: Pell JP, Haw S, Cobbe S et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N. Engl. J. Med. 359, 482–491 (2008). A study is published in one of the world’s most reputable medical journals and is rated a “must read” by the prestigious Faculty of 1000 101, yet described in the BBC News Magazine – even before it is published – as looking like “over-hasty, over confident research” 102 and ranked among “the worst junk stats” of the year by a Pro Vice Chancellor of Oxford University. Amid scenes reminiscent of the AIDS conferences of the 1980s, researchers on their way to hear the initial presentation were forced to cross a line of angry pickets waving “Junk Science” placards. The issue is controversial enough to provoke the ‘First World Congress on Smoking Bans and Lies’ in January 2009, and it is precisely the rapidly growing weight of evidence, rather than the lack of it, that has made it a battleground in an emerging clash between the public health community and those who deny that secondhand smoke kills.

Smoke-free public places and their impact on public health

On July 1 England joined the rest of the UK by going ‘smoke-free’, that is to say, prohibiting by law smoking in virtually all enclosed public places. This has been described as the biggest step forward in public health for 50 years. The first expected benefits will come from fewer people breathing secondhand smoke (SHS), but evidence from other jurisdictions suggests that many smokers will quit entirely and many of those who do not will smoke less. In New York, for example, in the year following comprehensive legislation 7 million fewer cigarettes were sold. The tobacco industry and their affiliates have sought to undermine public confidence in a growing body of scientific evidence. However, some emerging evidence does suggest that the expected drop in smoking prevalence may not be sustained if governments do not maintain a multifacetted tobacco-control program. Even if they do, smoking cessation may continue to benefit higher social groups disproportionately and so aggravate health inequalities.

Concerns about tobacco control

In discussing whether the UK is turning the clock back on public health advances,1 the fact that the coalition government is considering mandatory plain brown packets for cigarettes is encouraging.2 However, this move, which may get held up in the courts, must not delay implementing …