Louise Ross, vice-chair of the New Nicotine Alliance, says she would like to see a better understanding of vaping products among policymakers, healthcare professionals and the general public.
The Government’s tobacco harm reduction strategy includes encouraging smokers to switch to non-tobacco nicotine-containing products. However, according to Public Health England (PHE), there are still widespread misconceptions about the role of nicotine, and increasing numbers of smokers and healthcare professionals believe vaping (the use of e-cigarettes) is more harmful than smoking.
The New Nicotine Alliance (NNA) was founded as a registered charity in 2015 ‘to advance public understanding and awareness of ways to reduce the harms associated with cigarette smoking’.
“It isn’t the nicotine component of cigarettes that kills or leads to ill-health, but the tobacco smoke itself,” NNA vice-chair Louise Ross says. “Anything smoked is dangerous, such as cigarettes, pipes, cigars and shisha, and anything providing nicotine but not smoke (such as vaping) is a viable alternative.
“The NNA campaigns and educates about nicotine, reaching out to various organisations. Community pharmacies see smokers every day and have such a strong role in leading public health initiatives. We would be keen to speak to representatives from community pharmacy about increasing their knowledge of non-smoked nicotine products.”
Ms Ross says that primary healthcare professionals have a particularly important role to play in providing evidence-based advice to smokers, to help PHE move towards its target of a smoke-free society by 2030. “Healthcare professionals, such as GPs and pharmacists, are being asked to encourage all smokers to make an annual quit attempt, so this is a natural part of their year,” she says. “They are also encouraged to say ‘keep trying’ to patients to normalise smoking cessation and explain that many people take several goes to get it right.”
She stresses that all healthcare professionals should consider vaping to be a viable alternative to smoking, as well as to NRT products. “Healthcare professionals shouldn’t assume what is going to work for any particular patient, as smokers may need to try different approaches,” she says. “It is important to encourage customers to look at all possibilities – NHS Stop Smoking Services, digital mobile/tablet apps, prescribed medicines such as Champix, nicotine replacement therapy (NRT), vaping… anything that will help to get them away from tobacco smoke.”
Ms Ross would like to see vaping products sold in more pharmacies. “Vaping offers a way out of smoking for many people, and community pharmacists should be confident that it can help their customers,” she says. “Some people use vaping alongside NRT for a while – for example, with a patch to provide background nicotine and vaping as a top up. Others prefer to switch solely to vaping straight away.”
It isn’t the nicotine component of cigarettes that kills or leads to ill-health, but the tobacco smoke itself
Many smokers choose vaping because they enjoy it more than smoking, and also because they enjoy it more than using NRT products to quit. They can choose between different devices and liquids, and also flavours/tastes. “As a consumer product, vaping is very diverse,” says Ms Ross. “Everyone can buy something that suits them and their own needs, creating a very personalised vaping experience. Some people like the ‘tech side’ of vaping as well, and there is also a strong community spirit among vapers, both on and offline.”
The NNA wants to see wider availability of other nicotine-containing products as alternatives to smoking, such as snus and heat-not-burn products. It has been proactive in calling policymakers to lift the EU-wide ban on snus, and says that in Sweden (where snus is legally sold), the smoking rate is dramatically lower than in all other EU member states. “Snus will appeal to some people more than vaping,” says Ms Ross. “You place these non-tobacco nicotine pouches in your mouth between your cheek and gum to release a steady amount of nicotine. In heat-not-burn tobacco, the tobacco is warmed rather than burned. This is safer than smoking, but not as safe as vaping. Having the widest possible choice of alternatives available will help smokers to find an option that works for them.”
According to PHE, combining stop smoking aids with expert support from local stop smoking services makes people three times as likely to stop smoking successfully. Ms Ross suggests that community pharmacists look at other ways to offer support if face-to-face meetings are no longer viable. “NHS Stop Smoking Services are still running, showing that there are other effective ways to provide smoking cessation messages, such as telephone and digital support using apps,” she says. “In fact, remote consultations may be welcomed by people.”
Ms Ross says that digital support is a growing area and something she is keen to emphasise – she is the business development manager for the Smoke Free app. “Our app is not the official NHS one,” she says. “It uses standard smoking cessation techniques to keep smokers committed, but access to live advisors makes it stand out. The paid version provides access to trained stop smoking advisors 24/7 to help smokers quit – ideal for whenever they get the urge to smoke. Most other apps are automated and lead users through a series of standard questions and answers. We have a team of 20 people who are trained in NCSCT (National Centre for Smoking Cessation and Training) techniques, and most of them also work as stop smoking advisors within the community. They can tailor what they offer to that particular smoker, unlike the bot chats.”
With smoking being one of the main risk factors for more severe Covid symptoms, now may be a good time to encourage further engagement. “Community pharmacists, if they are still continuing with their stop smoking services, could go through their older paperwork to create a list of customers who didn’t come back for the full smoking cessation service initially,” Ms Ross says. “This may have been due to lockdown or for various other reasons. By calling these customers, pharmacists can explain that support is still available and how they can access it.
“They can also approach customers coming in for prescriptions or over-the-counter medicines, highlighting that they offer telephone support. It is important that all healthcare professionals emphasise that smoking-related diseases haven’t gone away and that prevention and treatment continues to be essential.”