West Sussex Stop Smoking Service E-Cig Friendly Rebecca Robb and Caroline Staddon, Smokefree West Sussex

POSITIVE COMMS

Frequently Asked Questions Can people who use e- cigarettes only and have stopped smoking tobacco products still use the service? Can a stop smoking provider make a claim for helping someone to quit tobacco products even if they used an unlicensed product such as an e-cigarette to help them quit? Should we recommend an e-cigarette product? Where can e- cigarettes be bought? Can e-cigarettes be used in combination with any other stop smoking medication?

NCSCT and Public Health Publications  Electronic Cigarettes : A briefing for Stop Smoking Services – McEwen, McRobbie H 2016 National Centre for Smoking Cessation and Training (NCSCT) –  E – cigarette guide for stop smoking practitioners – 2014 Tobacco free futures – tobaccofreefutures.org  Electronic cigarettes : A report commissioned by Public Health England – Britton J, Bogdanovica L –  Electronic Cigarettes : A briefing for Stop Smoking Services – McEwen, McRobbie H 2016 National Centre for Smoking Cessation and Training (NCSCT) –  E – cigarette guide for stop smoking practitioners – 2014 Tobacco free futures – tobaccofreefutures.org  Electronic cigarettes : A report commissioned by Public Health England – Britton J, Bogdanovica L –

Clear Information for Partners

Assisting providers to support e cigarette users who wish to quit smoking  This approach brings together the most effective method of quitting (Stop Smoking Services) with the most popular (e cigarettes)  Public Health England recommend that stop smoking services should offer support to smokers using e cigarettes to quit smoking  Clients with Stop Smoking Services who combined behavioural support with e cigarettes had the highest quit rates in  This approach brings together the most effective method of quitting (Stop Smoking Services) with the most popular (e cigarettes)  Public Health England recommend that stop smoking services should offer support to smokers using e cigarettes to quit smoking  Clients with Stop Smoking Services who combined behavioural support with e cigarettes had the highest quit rates in

Prevalence and Epidemiology Awareness  Prevalence and epidemiology awareness of e-cigarettes is high in countries where e- cigarettes are available, especially among current and ex-smokers  In Britain the use of e-cigarettes increased from 2.7% in 2010 to 6.7% in  In 2014 and 2015, 20% of smokers reported using e-cigarettes at some point  Data suggests that use has plateaued at around 21%.  It is currently estimated that there are 2.6 million e-cigarette users in Britain.  Prevalence and epidemiology awareness of e-cigarettes is high in countries where e- cigarettes are available, especially among current and ex-smokers  In Britain the use of e-cigarettes increased from 2.7% in 2010 to 6.7% in  In 2014 and 2015, 20% of smokers reported using e-cigarettes at some point  Data suggests that use has plateaued at around 21%.  It is currently estimated that there are 2.6 million e-cigarette users in Britain.

Inside the e-cigarette

E-cig Terminology o Vapers – e cigarette users o E-liquid - is the flavoured liquid o Tank - where the e-liquid is stored o Atomiser -are what heat the e -liquid and then turns it into a vapour. o Cartomisers - Accessories for flavour and vapour production. o Adjustable air flow – enables the cooling of the coil from the heat generated by the power from the battery o Micoprocessor – controls heater and light. o NCP – Nicotine Containing Products o Vapers – e cigarette users o E-liquid - is the flavoured liquid o Tank - where the e-liquid is stored o Atomiser -are what heat the e -liquid and then turns it into a vapour. o Cartomisers - Accessories for flavour and vapour production. o Adjustable air flow – enables the cooling of the coil from the heat generated by the power from the battery o Micoprocessor – controls heater and light. o NCP – Nicotine Containing Products

E-cigs – 3 generations 1 st Generation o 1 st generation e-cigarettes, sometimes called cigalikes, are designed to look like a cigarette and generally use cartomisers. o When the user takes a puff (or presses a button on some models) a heating coil is activated to vapourise the e- liquid, creating a vapour that can be inhaled. o Many 1 st generation models have a light on the end of the device that also glows when a puff is taken.

E-cigs – 2nd Generation o More experienced e-cigarette users (vapers) prefer to use newer (second and third) generation e-cigarettes. o These are often called personal vaporisers. o These e-cigarettes are typically larger o Have a more powerful battery linked to an atomiser and a ‘tank’. o There are choices of e-liquid which may include flavours and contain nicotine in different concentrations. o These devices can be used with a range of atomisers, cartomisers and tank systems. They typically use larger batteries and may have adjustable power settings

E-cigs – 3 rd Generation o Third generation e-cigarettes are usually larger still with a more powerful battery and adjustable air flow. o They also allow the user to adjust the voltage or wattage applied to the atomiser (often referred to as ‘variable voltage’ or ‘variable wattage’ devices). o Some have ‘puff counters’ or downloadable software that allow users to program their own voltage and wattage level, and to monitor their patterns of use. o Third generation devices are designed to allow modifications and substitution of individual components according to user preference.

Benefits of E-cigarettes  E-cigarettes can support people to quit smoking.  Clients of stop smoking services who combined e-cigarettes with behavioural support had the highest quit-rates in 2014–15  The four-week self-reported quit rates for these two groups, unlicensed NCP alone and NCP in combination with a stop smoking medication, were higher (66% and 63% respectively) than those seen in people who used combination nicotine replacement therapy (NRT) (48%, n=135,719).  There is an opportunity to improve success rates by combining the most popular (e- cigarettes) with the most effective method of quitting (behavioural support from services)hat they were predominantly e-cigarettes.  E-cigarettes can support people to quit smoking.  Clients of stop smoking services who combined e-cigarettes with behavioural support had the highest quit-rates in 2014–15  The four-week self-reported quit rates for these two groups, unlicensed NCP alone and NCP in combination with a stop smoking medication, were higher (66% and 63% respectively) than those seen in people who used combination nicotine replacement therapy (NRT) (48%, n=135,719).  There is an opportunity to improve success rates by combining the most popular (e- cigarettes) with the most effective method of quitting (behavioural support from services)hat they were predominantly e-cigarettes.

8 TOP TIP’s  Don’t be anxious about not being an expert.  It is unlikely that you will know, or be expected to know, everything about e-cigarettes  What you do know is how to help people stop smoking.  Familiarise yourself with e-cigarettes, read the documents.  Talk to experienced vapers  Visit a reputable retailer  Read posts on forums.  Be positive when speaking about e-cigarettes.  Don’t push people to come off their e-cigarette.  Don’t be anxious about not being an expert.  It is unlikely that you will know, or be expected to know, everything about e-cigarettes  What you do know is how to help people stop smoking.  Familiarise yourself with e-cigarettes, read the documents.  Talk to experienced vapers  Visit a reputable retailer  Read posts on forums.  Be positive when speaking about e-cigarettes.  Don’t push people to come off their e-cigarette.

Regulation – 20 May 2016  At present, e-cigarettes are covered by general product safety legislation.  This will change 20 May 2016 with the introduction of new regulations under the revised European Union Tobacco Products Directive (TPD).  Under the TPD e-cigarettes will either be licensed as medicines or, if unlicensed, will be subject to new quality and safety standards.  packaging and labelling requirements to include all ingredients  restrictions on advertising.  Limiting size of tanks, banning additional ingredients  Products must be child proof  At present, e-cigarettes are covered by general product safety legislation.  This will change 20 May 2016 with the introduction of new regulations under the revised European Union Tobacco Products Directive (TPD).  Under the TPD e-cigarettes will either be licensed as medicines or, if unlicensed, will be subject to new quality and safety standards.  packaging and labelling requirements to include all ingredients  restrictions on advertising.  Limiting size of tanks, banning additional ingredients  Products must be child proof

What are the health risks of E-cigs? Limited current research……. o Low levels of toxicants and carcinogens have been detected in e-cigarette liquid and vapour, but these are much lower than those found in cigarette smoke. o The concentration of toxins in exhaled vapour is much lower than that in side-stream and exhaled cigarette smoke.  The US Food and Drug Administration has classified propylene glycol as an additive that is “generally recognized as safe”. It has been used as an excipient - as vehicle in some old and new pulmonary (lung) inhalation devices, as well as in food and cosmetics.  Mild adverse effects (e.g. throat irritation) have been recorded when using e-cigarettes  There is no research showing Young people taking up smoking using e-cigarettes when not already smoking  The other main component of e-liquids is flavourings. These flavourings are considered safe for oral ingestion, but the risks of their inhalation are largely unknown. o Low levels of toxicants and carcinogens have been detected in e-cigarette liquid and vapour, but these are much lower than those found in cigarette smoke. o The concentration of toxins in exhaled vapour is much lower than that in side-stream and exhaled cigarette smoke.  The US Food and Drug Administration has classified propylene glycol as an additive that is “generally recognized as safe”. It has been used as an excipient - as vehicle in some old and new pulmonary (lung) inhalation devices, as well as in food and cosmetics.  Mild adverse effects (e.g. throat irritation) have been recorded when using e-cigarettes  There is no research showing Young people taking up smoking using e-cigarettes when not already smoking  The other main component of e-liquids is flavourings. These flavourings are considered safe for oral ingestion, but the risks of their inhalation are largely unknown.

Medicines and Healthcare Regulatory Agency - MRHA  Some manufactures have applied for licensing of the e cigarettes to be made available on the NHS  First may be available in the near future, however it is likely to be the first generation type of e cigarette  Some manufactures have applied for licensing of the e cigarettes to be made available on the NHS  First may be available in the near future, however it is likely to be the first generation type of e cigarette

We Will…  Continue to work with all smokers who want to quit in West Sussex, including those who are already or who would like to use e- cigarettes as part of the quitting process  Provide the same evidence based, Russell standard service to all smokers in West Sussex who wish to quit, regardless of whether they are using e-cigarettes or not  Answer all queries about E-cigarette usage to the best of our ability and ensure that our partners are kept up to date and receive relevant training on E-cigarettes  Continue to work with all smokers who want to quit in West Sussex, including those who are already or who would like to use e- cigarettes as part of the quitting process  Provide the same evidence based, Russell standard service to all smokers in West Sussex who wish to quit, regardless of whether they are using e-cigarettes or not  Answer all queries about E-cigarette usage to the best of our ability and ensure that our partners are kept up to date and receive relevant training on E-cigarettes

We Will Not…  Prescribe e-cigarettes to people  Recommend any brand of e-cigarettes  Offer the service to people who are using e- cigarettes but who do not smoke tobacco  Prescribe e-cigarettes to people  Recommend any brand of e-cigarettes  Offer the service to people who are using e- cigarettes but who do not smoke tobacco

Rebecca Robb Breathe Project Manager Rebecca Robb Breathe Project Manager

Additional smokeless tobacco products. Snus Snuff Gutkha Hookah/shisha Chewing tobacco

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