The UK mulls new smoking and vaping curbs

The UK prime minister, Sir Keir Starmer, has said that his government is looking at tougher rules on outdoor smoking to reduce the number of preventable deaths linked to tobacco use. To find out more, we put in a call to Linda Bauld who is professor of public health at the University of Edinburgh…

Linda - The government has a piece of legislation called the Tobacco and Vapes Bill. We were hoping it would come to the next stage of parliament in the summer, but it looks like it'll be into September. In the meantime, there's been this period of potential strengthening of the legislation. So some of the big ticket items that we know about, raising the age of sale, the smoke free generation addressing vaping, are still in there. But they seem to have added extra things and one of them is to put more restrictions on smoking in partially enclosed or outdoor areas.

Chris - What's the significance of this?

Linda - I think the significance is we still have about one in eight people in the UK who smoke. It's still the leading preventable cause of death and banning it in outdoor areas actually isn't directly about the health harms because obviously mainstream smoke and sidestream smoke quickly dissipate in the open air. But it's more about the continued de-normalisation of smoking. So some of the areas that are being discussed, I understand, are things like children's play parks, beaches, university campuses, potentially the whole area around hospitals, town centres. So it's really about taking smoking out of normal life and extending those smoke-free laws.

Chris - Is there an evidence base to support these sorts of measures, arguing that they actually work? Because, for instance, I work in a hospital and it, for about the last decade, has been a smoke-free site. And as I walk into work, I see various members of staff lurking having a crafty fag behind the hedgerows.

Linda - So there's a difference between evidence from studies and implementation evidence. So if we deal with the first one, there are some studies, I'm just recalling one from New Zealand for example, and they looked at pub balconies and outdoor areas next to pubs. They put air quality sensors inside and outside and they found that actually the smoke when doors were left open, and maybe better weather than we have in the UK, drifted inside. And so people inside were still exposed to smoke when there was an outdoor seating area and that might have health risks. So there's some evidence to support that. There's also studies that have looked at areas like children's play parks, where it's absolutely the case that if children see lots of adults smoking, it normalises the act of smoking to a greater degree. There's also an environmental argument where cigarette butts and the filters on cigarettes are a major cause of plastic pollution on beaches. On the implementation side, you're absolutely right. Implementing smoking bans in outdoor areas, around hospital buildings, mental health facilities are a particular issue. And on the grounds of hospitals when you don't have staff to enforce it, many hospitals have extensive grounds or some do anyway, is actually really, really tough. So there is evidence behind this, but the implementation of it can be tricky.

Chris - Would this then add up, if you put all of the legislation, all of the things we're doing here, would this make the UK one of the toughest places to be a smoker? In other words, is the deterrent here one of the strongest globally?

Linda - We'd be amongst the strongest countries if they introduced all the things that are in the tobacco and vapes bill, including, they'd be discussing other things like licensing cigarette shops as one of the newer measures.

That was Linda Bauld at the University of Edinburgh. It follows a call from the British Medical Association for the UK government to stop what it called a “growing epidemic of vape use in the UK” by tightening regulations of e-cigarette products and restricting access to them, and targeting particularly those designed to seduce and addict young people. David Strain is the science chair at the British Medical Association board…

David - We are asking the government to include a ban on all the flavours of vapes that are so attractive. We're asking them to limit the advertising, limit the bright shiny packaging and even the naming, the blueberry fizz, gummy bear, candy floss flavours. We want these vapes to be put behind the counter next to the cigarettes. So they are offered for smokers, but they're not offered and freely available in the same way as a bar of chocolate or a bag of crisps is. And finally, we're asking for a ban on single use vapes. These ones that you use once then throw away, which is contributing about 10 tons of lithium waste to landfill every year. That's about the same amount that goes into making 5,000 electric cars just ends up in a landfill.

Chris - Have we got evidence that these seductively coloured and flavoured products are luring in kids and exclusively for those reasons? Or are we at risk of upsetting entrenched smokers who are trying to give up, who actually quite like those flavours and they may actually be deterred and encouraged to smoke more?

David - There's two separate questions there. The first is, do we have evidence that these fruit flavours are attracting people? And actually the evidence for that is very simple. We have seen that with the expansion of fruit flavours, with the more and greater availability of them, we've seen a sixfold increased risk of the number of young people who are being attracted to this as a brand new habit. So these aren't smoking quitters, these are people who've been attracted to it. We're also seeing more than half of 11 to 17 year olds who use vapes are doing so on a regular basis, and that's just about exclusively the fruit flavoured market. So that's the closest to evidence that that is the reason that these are going for them. The second piece of evidence is the advertising. Advertising works. That's the reason that so many millions are pumped into the advertising campaigns. And when we moved cigarettes from being broadly advertised to behind the counter with plain packaging, we saw a reduction in the number of new smokers as a result of it. The second question is a lot more tricky, whether banning fruit flavours will prevent people from quitting smoking. And this is something that is very difficult to know for certain. We know that about half of all adult vapers are ex-smokers. Now many of those have gone for straight tobacco or plain vapes. Some of them do go for fruit flavours and lots of stock services do offer the fruit flavours, but they offer them because they're there. What we don't know for certain is what would be the impact of not offering fruit flavours to potential quitters. Now, the majority of people, if they are offered, will take fruit flavouring. That doesn't mean that they wouldn't rather be on a tobacco flavoured or a plain vape rather than being on a cigarette, remembering that cigarettes themselves are harmful, they're associated with cancer, and they're a lot more expensive than a vape. So when we offer every single smoker a tobacco or a plain flavoured vape on the day that they buy their cigarettes, then potentially we are offering them a life saving and cheaper option going forward.

Chris - Are you not incredulous though, David, that we've ended up in this position at all? It did not take Einstein, let alone a public health specialist and the medical profession, to spot that if you have an unregulated industry and it's linked to an addictive substance and you can sex it up, make it look nice and smell nice, that it's going to seduce young people and it's going to hook a whole legion of new smokers?

David - That's easy to see with hindsight. It is very easy to see that nicotine-containing products are very, very highly addictive. And once you're on them, it's very difficult to stop them. What we're at now is a turning point. If we don't stop this now, we're going to see an entire generation that will no longer be able to smoke due to that tobacco and vaping bill, but instead we'll be hooked on a different drug. And don't get me wrong, vaping is another drug, albeit a legal drug. But it is a drug. What we need to do is now, before we have millions of people addicted to this, put the bans in place to make sure that we don't face another public health crisis in about 15 to 20 years, when we suddenly realise the adverse effect that all of these are happening on the development of the brain, on the whole body as we go through the change.