Q&A about stopping smoking with Linda Bauld and ASH (Action on Smoking and Health) - ANSWERS BACK

[LucilleMumsnet]

We're running a Q&A over the coming week about stopping smoking with Linda Bauld, Professor of Health Policy at the University of Stirling who is working alongside the organisation ASH (Action on Smoking and Health).

Linda Bauld has conducted studies on drug and alcohol use, inequalities in health and, most notably, on tobacco control and smoking cessation. She is a former scientific adviser on tobacco control to the UK government and currently chairs a number of public health advisory and funding committees for NICE, Cancer Research UK and the Scottish government.

Action on Smoking and Health (ASH) was established in 1971 by the Royal College of Physicians. It is a campaigning public health charity that works to eliminate the harm caused by tobacco. ASH say "We do not attack smokers or condemn smoking and while we aim to be innovative and agenda setting in our work, our policies are always evidence based and follow a dual approach, involving:
• Information and networking: To develop opinion and awareness about the 'tobacco epidemic'
• Advocacy and campaigning: To press for policy measures that will reduce the burden of addiction, disease and premature death attributable to tobacco.

Information on our activities as well as a wide range of information and resources on smoking can be found on our website"

Post your questions to Linda before midday on Wednesday 11 June and we'll post up her answers the following week on 18 June.

[Lesuffolkandnorfolk]

Hello Linda-

I just wanted to share my experience of coping with quitting (ten years ago) and wondered if you'd seen anybody else use this method.

It was quite simple. Every time I wanted a cigarette I picked up my GameBoy and played Tetris. It proved impossible for the brain to concentrate on a task and sustain a craving and after a few moments, the craving had passed. The reward centres of the brain are activated in a similar fashion by some of these games and whilst you aren't actually changing your base reward responses, you are making healthier choices and gaining pleasure and a bit of an adrenalin surge when you win!

Do you ever encourage people to use gaming technology as a distraction and have you ever researched it as a tool?

[Greenrememberedhills]

That doesn't surprise me. I gave up after years last summer, finally. It seemed to me to be a psychological issue in the main- when I thought about facing one I stopped myself thinking about it, and after a day or two I got quite good at "brushing away" the thought if it when it occurred.

[Scousadelic]

I wondered what are ASH's views on e-cigarettes?
It seems to me that a lot of people view using them as not smoking even though they are still inhaling (often nicotine) and still have the hand to mouth habit.
Is there anything being done about the concern that the tobacco giants are using them as a way to get a new generation addicted to smoking and/or nicotine?

[Shonajay]

Scousadelic there have been surveys done saying its not encouraging people to,start smoking - as someone who has smoked for thirty years and now been smoke free for three months, I think vaping is an excellent alternative and you can taper down the level of nicotine. The problem with cigarettes is the hundreds of other nasty chemicals, nicotine is actually found in lots of,fruits and vegetable, occurring naturally.

The amount of people giving up using this method is on the rise, and studies so far show it's working brilliantly. I'm cynical about the governments reactions to it, after all they're going to lose billions in taxes.

[Allergictoironing]

Scousadelic the latest ASH report on e-cigarettes was very much in favour of them. They aren't smoking because there is no smoke involved, which is a by-product of combustion (burning) which doesn't take place.

Nicotine in less than massive (and I mean massive) quantities is not harmful to health, a hand to mouth habit is a habit same as fiddling with hair or biting nails - so I don't see why people have a problem with them.

The tobacco giants came very late to the table, with most of them only now developing their own products and those already here (like BAT's Vype) originally developed by independent companies that the big tobacco companies have bought out. E-cigarettes have been driven by consumer demand rather than "pushing" by manufacturers.

[PlentyOfPubeGardens]

Wow thank you so much for arranging this MNHQ, it feels like our little stop smoking section has 'arrived'

I have so many potential questions for Linda, I had better go away and narrow them down before posting. Are we allowed to ask more than one question or is it one question each like the webchats?

^^ please don't let that be the only question I am allowed

[PlentyOfPubeGardens]

Thank you Linda for taking the time for this Q&A and thank you so so much for being a signatory on the letter to the WHO about tobacco harm reduction. Lots of us who use this section of Mumsnet have successfully quit smoking by using an ecig (some of us by accident!) and none of us want to end up back on the fags so the support of organisations like ASH means a lot to us.

It has been heartening in recent months to see vapers finally included in the debate around e cigarettes. My question is this:

What have you learnt from talking to vapers and has anything surprised you?

A second question (if I'm allowed) - What are your views on the best way to regulate ecigs in order to maximise their potential while minimising any possible harms?

[PlentyOfPubeGardens]

Third question (and last, probably ) -

What do you think about the Chief Medical Officer, Dame Sally Davies' comment made at the recent PHE symposium - that smokers and vapers should just 'grow a backbone and quit'?

[FunnysInLaJardin]

I don't have any questions but would just like to say I have smoked for over 30 years having tried just the 'odd one' from the age of 13 progressing almost immediately into a full blown smoker.

Last September I tried my first ecig and haven't smoked a normal cigarette since. This is unheard of for me and although I was a light smoker I just couldn't get rid of the habit. I am so much happier and feel so much healthier vaping (I now have all the kit) and would be very sorry indeed to see any regulations tightened or any attempt made to deter vaping.

I still have nightmares that I have started smoking again btw such is the horror of going back to it!

[ineedausername]

As a new vaper (and an ex 20 a day, 15 year smoker!) i would just like to say that vaping has absolutely helped me stop.
I tried will power, gum, that spray mist (awful), lozenges and patches. Nothing worked!

Is the best way to help smokers quit to over-regulate and effectively exercise an unrealistic amount of control over ecigs?

The cynic in me says this will give the government an opportunity to apply unnecessary tax to these items, thus driving the cost of e-cigs, liquids, all parts etc up.

Also, if costs of these items are to rise, surely people will resort to buying from, lets say, less regulated markets? Leading to buying cheap/fake liquids and parts?

hope that all makes sense :)

[Allergictoironing]

Not absolutely sure whether Linda would be able to have a view on this or not, but here goes...

There's much said about how vaping may be a "gateway" into cigarette smoking for young people, and that many young people have taken it up. Has there been any research done on the number of young people who vape but WOULD have taken up smoking before e-cigs were widely available and accepted? I know of at least 2 teens who made the decision to vape rather than smoke - their mates either smoked or vaped and they were going to end up doing one or the other.

[Cantabile]

I used to get through 40-50 fags a day, heavy heavy smoker. I got an ecig out of curiosity and a love of gadgets. I didn't expect anything from it at all. The day I started using it I found I had only smoked 12 cigarettes. I hadn't even wanted to give up or cut down as I knew I would fail, get bad tempered, eat more, and generally feel miserable (yes, I had tried a few times in 30 odd years). Over 6 months on, I'm still not trying, but I'm down to less than 5 fags a day, do not eat more (if anything, I eat less), am not bad tempered. I have a progressive debilitating condition, which will require certain operations and treatments over the coming years, a my cardiologist is happy, my gp is happy, I am fitter than I have been for years, my heart and lungs are improving, and my muscles are too.

Linda Bauld, I want first to say thank you for supporting us vapers. It seems that many people do not, or cannot, separate smoking from vaping; we need to separate nicotine from tobacco in the public's perception. There is evidence on this thread already that people need a pariah to focus on and as they think that hand to mouth movements and inhaling equals smoking and is therefore baaaad and must be stopped, I am wondering how this problem of misperception could best be handled.

I am really worried that ecigs will follow in the way of snus in the EU and thousands of people will be subject to unnecessary and messy (and expensive to the NHS) deaths as a result.

[ICanSeeTheSun]

Why doesn't there seem to be much information on the negatives of giving up smoking.

Giving up makes you feel crap.

Common problems seems to be headaches, bad chest, flu like symptoms, lack of concentration, sore throat and mood swings.

Luckily I am attending a group and know these are common problems, but I think these should be highlighted

[PlentyOfPubeGardens]

Don't forget bleeding gums, spots and greasy hair!

I have another question - as smoking rates have fallen, it has become increasingly apparent how much smoking is a social class issue and a mental health issue - i.e. poorer people and those with a MH diagnosis are much much more likely to be smokers than other groups. What new strategies are needed to help these groups of people to quit?

[FuckitAndStartAgain]

Reading all your thoughts on vaping is very encouraging. I have one in my bag, and cigarettes by my side. Maybe I will have another go at using the cig this eve.

[Allergictoironing]

FuckitAndStartAgain there's a whole topic on stopping smoking including tons & tons of info about vaping here. No question too silly .

[Allergictoironing]

Oh and swap over so the cigarettes are in your bag out of sight, and the e-cig is the one next to you .

[PlentyOfPubeGardens]

I know it says CLOSED at the top and I'm not sure this will post but anyway ...

I just wanted to say a massive thank you to ASH for being completely sensible in their latest briefing on e cigs

Lit tobacco could be obsolete within a decade if we don't fuck it up.

[Jux]

Excellent report from ASH. Thanks for posting that link, Plenty.

[PlentyOfPubeGardens]

Any answers yet?

[LucilleMumsnet]

We now have the answers back from Linda and will be posting them up on the thread shortly. Thanks to everyone who took part in the Q&A!

[LindaBauld]

@Lesuffolkandnorfolk

Hello Linda-

I just wanted to share my experience of coping with quitting (ten years ago) and wondered if you'd seen anybody else use this method.

It was quite simple. Every time I wanted a cigarette I picked up my GameBoy and played Tetris. It proved impossible for the brain to concentrate on a task and sustain a craving and after a few moments, the craving had passed. The reward centres of the brain are activated in a similar fashion by some of these games and whilst you aren't actually changing your base reward responses, you are making healthier choices and gaining pleasure and a bit of an adrenalin surge when you win!

Do you ever encourage people to use gaming technology as a distraction and have you ever researched it as a tool?

First of all, congratulations on quitting. Stopping smoking is probably the single most important change you could ever make to improve your health.

And you are absolutely right that distraction is an important part of many successful quit attempts. What you describe is a classic example of this sort of technique. When someone stops smoking they need to find something to occupy themselves, ideally something with their hands.

The researcher Robert West talks about why distraction techniques work in his excellent new book, the Smokefree Formula. Robert is a research psychologist with 30 years of experience in this field. He leads a team at UCL looking at how to help smokers quit. In the book, he describes how nicotine fools your brain into thinking it is doing something constructive, even when you are not. Your 'animal brain' cannot tell the difference between the satisfaction from nicotine and the reward from a job well done (or game won). Robert has even included a distraction game as part of the stop smoking app SF28 that he designed. Distraction with any simple activity (a puzzle, sorting DVDs, household chores) works just as well. Different distractions suit different people. And exactly as you describe, you can trick your brain to feel satisfied while quitting even though it does not get a nicotine hit.

[LindaBauld]

@Scousadelic

I wondered what are ASH's views on e-cigarettes?
It seems to me that a lot of people view using them as not smoking even though they are still inhaling (often nicotine) and still have the hand to mouth habit.
Is there anything being done about the concern that the tobacco giants are using them as a way to get a new generation addicted to smoking and/or nicotine?

You've hit upon the topic of the moment in tobacco control. In short, ASH would always recommend that quitting all forms of nicotine use is the best option for smokers. But nicotine itself (the main ingredient in electronic cigarettes) is actually not harmful, other than for being addictive. Electronic cigarettes do not contain the tar and smoke in traditional cigarettes that cause cancer and heart disease. Traditional cigarettes will kill one in two of their users, unless they quit. Even if we don't have research on the long-term effects of using electronic cigarettes, they are definitely a safer alternative to smoking tobacco.

So for those who remain addicted to nicotine, my view and the ASH position is that there is a role for electronic cigarettes either in helping people to quit tobacco or to cut down. But this is the short answer! It is worth explaining this position in more detail.

Electronic cigarettes are actually not cigarettes at all: they don't contain tobacco and they don't produce smoke (as nothing is burnt). They are electronic devices that turn liquid nicotine into an aerosol breathed in by the user. Many users call themselves vapers to make the distinction with traditional smoking.

But you are right that we should worry about the effect of electronic cigarettes on social norms and rates of smoking. As you say, vaping can look like traditional smoking and the products themselves often look like cigarettes. But this close resemblance partly explains why the products have been so popular with existing smokers. There is no evidence that electronic cigarettes have increased rates of smoking. More than 99% of electronic cigarette users are either ex-smokers or current smokers. And we know that electronic cigarettes are as effective as the nicotine replacement therapy (used by NHS Stop Smoking Services) in helping people quit.

As you point out, the increasing involvement of the tobacco industry in electronic cigarette markets is a worry. The best way to deal with this is to create the best regulatory environment, most importantly with proper advertising standards. While advertising has a role to promote the products to people aiming to quit or cut down, we do not want the Tobacco Industry to use advertising to recruit children, especially if the adverts are also covertly encouraging traditional smoking. This is a knotty issue, requiring sensible policy based on evidence.

[LindaBauld]

@PlentyOfPubeGardens

Thank you Linda for taking the time for this Q&A and thank you so so much for being a signatory on the letter to the WHO about tobacco harm reduction. Lots of us who use this section of Mumsnet have successfully quit smoking by using an ecig (some of us by accident!) and none of us want to end up back on the fags so the support of organisations like ASH means a lot to us.

It has been heartening in recent months to see vapers finally included in the debate around e cigarettes. My question is this:

What have you learnt from talking to vapers and has anything surprised you?

A second question (if I'm allowed) - What are your views on the best way to regulate ecigs in order to maximise their potential while minimising any possible harms?

To make sure that we get it right when developing national policy on electronic cigarettes, it is critical that we talk to all stakeholders, particularly vapers. As chair of the NICE (the National Institute for Clinical Excellence) Development Group on Tobacco Harm Reduction, I am very moved by the inspiring stories we hear from vapers telling how electronic cigarettes have helped them stop smoking, some after many decades trying to quit. These experiences are valuable and we must learn from them. I am also pleased to report that Public Health England (PHE - the NHS organisation responsible for improving and protecting the nation's health and wellbeing) has been listening to the views of vapers and invited users to contribute to their recent symposium on electronic cigarettes.

The ASH view and my own position on regulation is similar, in that we must maximise the opportunities and minimise the risks of electronic cigarettes. Without going into too much detail, the revised EU Tobacco Products Directive will take effect in 2016, meaning that electronic cigarettes will have to be regulated as a tobacco product (therefore no television, internet or other cross-border advertising). But it would still be possible for the UK to offer an additional medicines regulation route for companies that choose to opt into it. This would allow companies who want to make health claims about their products to apply to the MHRA (Medicines and Healthcare products Regulatory Agency) for their products to be regulated as medicines. Although this sounds like more red tape, the real advantage of the medicines route would be lower VAT rates of 5%, with advertising allowed as long as it promotes the products as aids to quit tobacco. It would also ensure that consumers are getting safe and reliable products, proven to help people quit. ASH and I support this dual approach as we believe it will ensure that smokers trying to quit have maximum access to high quality products.

[LindaBauld]

@PlentyOfPubeGardens

Third question (and last, probably ) -

What do you think about the Chief Medical Officer, Dame Sally Davies' comment made at the recent PHE symposium - that smokers and vapers should just 'grow a backbone and quit'?

I’ve spent more than 15 years doing research on smoking and have identified that for many people stopping is actually very difficult. It is common for people to quit several times and relapse before finally stopping smoking for good. In fact, evidence shows that the more you try to quit, the more likely you are to be successful in the longer term.

We also know that using nicotine containing products, like those available from NHS Stop Smoking Services, really increases your chance of quitting. People who get help from NHS Stop Smoking Services are up to four times more likely to quit successfully than trying to do it on their own.

So my view is: quitting can be tough but there is a lot of help out there. Keep trying. The health and financial benefits of stopping smoking are enormous. More information on the free NHS support available to help you quit is available here.