The introduction of smokefree workplaces in England has delivered exceptional public health progress: workers in enclosed public places are now protected from secondhand smoke, and an estimated 400,000 smokers quit within the first year. This could prevent 40,000 deaths over the next 10 years. Not surprisingly, research from the Department of Health has found high levels of public support and compliance. This is an outstanding achievement and shows that the conviction displayed by all of those MPs who supported this landmark change was both justified and crucial.
Smokefree workplaces, however, should not be seen as the final piece of the jigsaw. There are still challenges to be met. Around 9.6 million adults smoke cigarettes in Great Britain and prevalence rates are highest amongst low income groups and young people. Every year, around 96,000 people in the UK die from diseases caused by smoking. Smoking accounts for over one-third of respiratory deaths, over one-quarter of cancer deaths, and about one-seventh of cardiovascular disease deaths (ASH, June 2016). It also has an impact on the social care system. A study conducted for ASH in 2014 showed that current smokers, and to a lesser extent former smokers, are more likely than people who have never smoked to need domiciliary care as they age, which in many cases will have to be paid for from Council funds. The study estimated that the cost to English local authorities would be between £560 and £660 million per year in terms of increased spending on domiciliary care.
Since the publication of the last government’s tobacco control plan ‘Smoking Kills’ in 1998 the prohibition of most forms of tobacco advertising, the creation of the NHS stop smoking services and the enactment of smokefree legislation represent outstanding progress and have delivered important public health benefits over recent years. However, smoking continues to kill far too many people. The Smokefree Action Coalition, a group of organisations dedicated to improving public health, including the CIEH, believes that if we are to stop tobacco taking more lives we must maintain the momentum and build on the success of smokefree workplaces. In 2008 we published our vision for what needs to be done.
In March 2011 the Coalition Government published its tobacco control strategy, Healthy lives, healthy people: a tobacco control plan for England.
The CIEH has fully endorsed the Local Government Declaration on Tobacco Control and encourages councils across the country to join those who have already signed up to it.
The Declaration commits local authorities to taking concerted action to protect their communities from the harm tobacco causes.
Electronic Cigarettes or Nicotine Vapour Inhalers
Electronic cigarettes are different from conventional cigarettes. Many, but not all, are in the form of thin white tubes that look like cigarettes. Some contain nicotine, some do not. Some produce a white vapour which may have an odour, others produce no vapour at all. They do not burn tobacco and do not create smoke (products of combustion). A number of questions have been asked about their use. For example, are there any health or safety risks associated with using them, should they be allowed to be used in the workplace and is there a risk they may encourage people to take up smoking cigarettes who would not have otherwise done so?
It has been clearly shown that using an electronic cigarette is far safer than smoking a cigarette. However, until further research is conducted it is not possible to guarantee the absolute safety of such products. Most, but not all electronic cigarettes contain nicotine. A report on electronic cigarettes published by Public Health England in May 2014 (and updated in 2015) concluded that the doses of nicotine delivered by electronic cigarettes are extremely unlikely to cause significant short or long-term adverse events. Electronic cigarettes do not burn tobacco, so any toxins in vapour arise either from constituents or contaminants of the nicotine solution. Levels of these substances are much lower than those in conventional cigarettes, says the report. Although regular exposure over many years is likely to present some degree of health hazard, the magnitude of this effect is difficult to estimate.
There have been several reports in the press of accidents involving electronic cigarettes. Trading standards departments around the UK are currently investigating whether electronic cigarette safety information is sufficient and widely available enough to consumers. In the meantime the Government has published some advice for consumers on how to avoid accidents such as fires, for example by not leaving electronic cigarettes to charge for long periods of time. Electronic cigarettes and refills containing nicotine should be kept well away from children.
Electronic cigarettes at work
Despite its name an electronic cigarette is not a ‘cigarette’ and using one is not ‘smoking’. Therefore the UK smokefree legislation does not apply to them. It is for employers to decide whether or not to allow electronic cigarettes in the workplace. To assist them in making their decision, the CIEH and ASH have produced two guidance notes:
Will you permit or prohibit electronic cigarette use on your premises? Five questions to ask before you decide October 2015
Developing an organisational approach to the use of electronic cigarettes on your premises August 2014
Advertising of electronic cigarettes
Fears that the advertising of electronic cigarettes might lead to their usage being glamorised and that people might be encouraged to try smoking ordinary cigarettes seem to be unfounded. Researchers from the University of Stirling who were commissioned by Public Health England to review the marketing and uptake of electronic cigarettes found that they could not identify any evidence to suggest that non smoking children who tried electronic cigarettes were more likely to then go on and try tobacco. The current UK industry codes of practice for advertising say that the marketing communications and advertisements for electronic cigarettes must contain nothing which promotes the use of a tobacco product or shows the use of a tobacco product in a positive light. Further controls will be enacted in 2016 as a result of an EU Tobacco Products Directive.
Benefits of using electronic cigarettes
The CIEH believes that the benefits of using electronic cigarettes outweigh any potential risks. Every year, over 100,000 smokers in the UK die from smoking related causes. Smoking accounts for over one-third of respiratory deaths, over one-quarter of cancer deaths, and about one-seventh of cardiovascular disease deaths. (ASH, Nov 2015). Electronic cigarettes are a popular and safe alternative to smoking.
Research shows that the vast majority of those using them are current or former smokers and that they appeal to many smokers who might not be willing to use other more traditional smoking cessation aids. As long as there are appropriate regulations in place to ensure product safety and common sense is exercised when using them, the CIEH believes electronic cigarettes have a useful role to play in helping people to give up smoking and thus improve their health.
Further information on the above issues and other aspects of electronic cigarette use can be found in the ASH briefing notes, including ASH Fact Sheet Use of electronic cigarettes (vapourisers) among adults in Great Britain, May 2015.