Anti-smoking legislation

“We are entering a historic time in tobacco control and the momentum gained in recent months must be maintained to finally address the 1·8 million deaths each year from lung cancer.”

Jan 06, 2025

Your opinion is requested.

The following opinion article appeared in the Lancet today to which I subscribe.

I wonder how many of my readers would approve of this kind of increase in government control over the choices that individual citizens make regarding the use of tobacco and vaping products. Would you recommend that Canada follows the UK lead?

The UK Tobacco and Vapes Bill: a historic opportunity

The Lancet Respiratory Medicine

EDITORIALVolume 13, Issue 1P1January 2025

Publication History:

Published December 18, 2024

DOI: 10.1016/S2213-2600(24)00419-3. Also available on ScienceDirect

ABSTRACT:

On Nov 26, 2024, the UK Tobacco and Vapes Bill passed its second reading in the Houses of Parliament with a vote of 415 in favour and 47 against. The Bill leads the way in global tobacco control legislation aiming to tackle both the lethal effects of smoking while protecting the young, and with the goal of a future smoke-free generation.
The Bill sets out to prohibit the sale of tobacco or herbal smoking products and cigarette papers to all those born on or after Jan 1, 2009. It will also introduce bans on advertising and sponsorship of all vapes and nicotine products, including the increasingly popular nicotine pouches, and has called for regulation of flavours, as well as restrictions on the display and packaging of these products, mirroring efforts that were effectively brought in for the sale of cigarettes. Current indoor smoking bans could also be extended to outside spaces, such as playgrounds, and outside of hospitals and schools, with details to be confirmed in secondary legislation, and with similar discussions ongoing in the EU. This positive news follows an earlier announcement to ban all disposable vapes from June, 2025, in England, Wales, and Scotland. Uptake of these disposables has been substantial, especially among children. Despite the age limit for purchase being 18 years of age, Prof Caitlin Notley (Norwich, UK) reported ASH Smokefree GB Youth survey data at the BTS meeting showing an increase in vaping among 11–17 year olds from 3·2% in 2021 to 7·2% in 2024, driven by use of disposables, which were only introduced in 2021. There is also a substantial environmental impact from disposables with an estimated 5 million thrown away every week, an equivalent of eight per second, with many ending up in landfills.
Any ban will need to be enforced alongside a crackdown on the illegal vapes market. But the UK Government should be applauded for its ambition, especially as recent cross-sectional data in England showed vaping has increased rapidly from 2021 to 2024 in those who were never regular smokers, again driven by use in the younger age groups. However, there are still 6 million smokers in the UK, and 400 000 associated hospital admissions in England in 2022-23; with one in six admissions for respiratory diseases. Therefore, alongside protecting children and future generations, continued efforts must be made to help people quit smoking tobacco. Nicotine analogues, varenicline and cytisine, are available (which work by breaking the addiction to nicotine) and on Nov 12, 2024, the NHS announced that varenicline, a daily oral treatment, will be available in England for thousands of smokers alongside behavioural support through their Stop Smoking Services. Cytisine, which has more contraindications and age restrictions, is also being assessed by NICE. Another speaker at BTS, Prof Matthew Evison (Manchester, UK), advocated for their increased use after disappointing uptake rates were noted for varenicline in previous BTS audits. He called for tobacco dependency to be considered as a disease to prompt automatic treatment with the most effective medications available; cytisine, varenicline, and e-cigarettes. However, unlike the analogues, e-cigarette use does not break the cycle of nicotine addiction mechanistically, but replaces the nicotine from cigarettes and there are scarce long-term data on potential harms. Advocacy of e-cigarettes for cessation is therefore more controversial. Nevertheless, both Notley and Evison were broadly in favour of e-cigarette use as a harm reduction strategy, especially in long-term smokers who have had multiple quit attempts. However, prolonged dual use with tobacco in some users has resulted in continued concerns regarding their promotion as a cessation tool. A recent systematic review highlights why such caution is needed; about a fifth of dual users remained at the same status after 16–24 months, with 8% remaining dual users at 24–48 months, and thus potentially exposed to higher nicotine levels.
Other discussions at BTS called for integration of cessation programmes at every opportunity where patients touch the health system. Lung cancer screening programmes provide one such timepoint and Dr Mahdi Sheikh (Lyon, France) reported a 33% decreased risk of death for those that quit after a lung cancer diagnosis, but he noted that only 35% of oncologists in Europe provide or refer patients for cessation support. Evison discussed how hospital admissions were also an opportunity for people to quit as they are entering a smoke-free environment and in a recent BTS Clinical Statement he proposed a framework consisting of six building blocks for effective cessation efforts.
We are entering a historic time in tobacco control and the momentum gained in recent months must be maintained to finally address the 1·8 million deaths each year from lung cancer.