Scotland aims to be smoke-free by 2034 but what about e-cigs?

Scotland strategy paving the way. Ale'streets, CC BY

Given just how well established anti-smoking campaigns in Britain now are, many of today’s smokers, and younger smokers in particular, have taken up the habit with at least some awareness of the damaging consequences of smoking on their long-term health. And despite these campaigns, the number of people smoking is still too high – particularly in Scotland, where, according to the Scottish Health Survey, one in four adults continues to smoke every day compared with around one in five in England and Wales.

In comparison to some of the more complex messages that public health campaigns need to get across, such as how many minutes a week we should all be active or how many units of alcohol we should be drinking, the message about tobacco harm is simple. So there is clearly more work to be done and the reasons behind smoking uptake still need to be fully understood.

The big picture

Each year, tobacco use is associated with around a quarter of all deaths in Scotland. It accounts for 56,000 hospital admissions, and costs NHS Scotland £400m in treating smoking-related illnesses. It’s an issue that bears consequences not only on those who smoke, but for Scottish society and its economy.

Since the Scottish Health Survey began in 1995, smoking among adults has declined by nearly 10%. The number of cigarettes being smoked has fallen too, from an average of 15-a-day to just over 12. Almost a third (29%) of those who smoke every day are between 25 and 44, making them the largest proportion of smokers.

Vast inequalities exist though. Those living in the country’s most deprived areas are more than three times as likely as those living in areas of least deprivation to smoke.

In March 2013, the Scottish government published Creating a Tobacco-Free Generation, an ambitious new tobacco control strategy that aims to create a smoke-free Scotland by 2034. The strategy puts Scotland right up there as a world leader on tobacco control. The standardisation of packaging of tobacco products, prohibition of tobacco vending machines, and a restriction on the display of all tobacco and smoking-related products as laid out in the strategy will also all serve to help undermine the marketing efforts of tobacco companies.

The first of the strategy’s milestones is to reduce prevalence to 17% by 2016. We therefore have a few more years to wait before we get a sense of just how ambitious the aim for a smoke-free generation is. It should be taken as read that the tobacco industry are watching on with great interest.

E-cigarette bans

The increased profile and availability of e-cigarettes has thrown a bit of a spanner in the works. Are they a stepping stone to tobacco use or if properly regulated could they act as a useful alternative to cigarettes? The long-term effects of e-cigarettes are not yet known. They may in time prove to be a useful quitting aid but as yet there is little evidence to support this. In the meantime, sales of e-cigarettes have increased by 340% in the past year while in the same period sales of licensed nicotine replacement products has slowed.

The danger lies in e-cigarettes use, or “vaping”, becoming a way of simply replacing one habit, proven to be damaging to health, with an alternative habit, about which little is currently known. Until we know more about their long-term health effects then perhaps the focus should be on discouraging habitual nicotine use more generally. It’s encouraging to see that Glasgow’s Commonwealth Games is the latest event to have banned the use of e-cigarettes from its venues in the same way tobacco smoking has been banned. This follows on from initiatives by other organisations including ScotRail, Starbucks and Wetherspoons pubs, none of whom allow “vaping”.

We’ve also changed the Scottish Health Survey in 2014 to include questions on e-cigarette use for the first time. This means we will soon have robust data on the prevalence of e-cigarette use in Scotland, how it varies across different groups in society and how it relates to other health behaviours.

A recent EU Directive will also clarify the status of the e-cigarette as a product. The framework allows products to “opt in” to medicines regulation or, failing that, be subject to a range of new controls which include safety and quality requirements as well as restrictions around advertising. With legislation to ban the sale of e-cigarettes to under 18s already passed in England and Wales, it is likely that Scotland will follow soon.

There are currently also no specific guidelines governing e-cigarette advertising but the Committee of Advertising Practice recently launched a public consultation on the marketing of e-cigarettes after one prime time advert attracted over 1,000 complaints. The consultation ends in April and any new rules arising out of the consultation are expected to be implemented soon after.

Good news

The good news is that, according to a recent survey by Ash Scotland, Smoking among young teenagers is at its lowest level since 1990, an indication, perhaps, that this generation has taken more notice of – or been perhaps been more exposed to – effective anti-smoking campaigning.

We know from the latest Scottish Health Survey that 73% of smokers would like to stop and 41% have tried to quit on at least three occasions, so most smokers clearly want to change their behaviour. The challenge is to help and support these people give up, protecting others from second-hand exposure and fostering an environment where young people in Scotland do not want to take up smoking. In tandem with this is the challenge for the health community to figure out where e-cigarettes fit in with this in regards nicotine addiction and harm reduction.