Towards a smoke-free generation: a tobacco control plan for England

In July 2017, the Department of Health set out plans to reduce smoking rates in its tobacco control plan, ‘Towards a smoke-free generation’.

The plan set out several national ambitions and made key commitments for the end of 2022 on:

• reducing smoking rates among adults, 15-year-olds and pregnant women
• reducing the inequality gap in smoking prevalence between people in routine and manual occupations and the overall population.

The strategies to achieve these aims included: a ‘whole system approach’ to tobacco control; boosting public awareness; improving Stop Smoking Services; and, maintaining taxation of tobacco products. The plan also included the target for a smokefree NHS by 2020, with trusts encouraging people using, visiting and working in the NHS to quit.

The plan also emphasised the need for further evidence on and continued monitoring of:

• how regulations and policy impact smoking rates and use of e-cigarettes
• the relative harmfulness and addictiveness of nicotine, e-cigarettes and tobacco cigarette smoking
• trends in e-cigarette use and experimentation among non-smokers, smokers and ex-smokers, and how trends relate to cigarette smoking rates.

Response

The Royal Society for Public Health (RSPH) welcomed the plan's acknowledgement of health inequalities. However, concerned about the wider context of reductions in local authorities’ public health spending, the RSPH highlighted that the plan’s success was dependent on sufficient government funding.

Evidence review on e-cigarettes

As part of the tobacco control plan, the government requested that Public Health England (PHE) update its 2015 evidence review on e-cigarettes and vaping devices on an annual basis until 2022. This was aimed at informing policy and regulation.

In February 2018, PHE published the first of these annual reviews of the evidence on e-cigarettes. The review considered peer-reviewed literature, surveys and other evidence produced since the 2015 publication.

While emphasising that ‘this does not mean e-cigarettes are safe’ in the 2018 review, PHE reinforced the relative safety of vaping and repeated the conclusion from its 2015 report that vaping was ‘at least 95% less harmful than smoking’. Public health experts had questioned the evidence-base for this finding in 2015. Experts also expressed concern about cuts to NHS smoking cessation services, described in the BMJ as being supported by the 'best evidence for helping people to stop smoking'.

The 2018 review also found that available evidence at the time suggested the following:

• the use of e-cigarettes in Great Britain had plateaued (at around 6% of the adult population) and had not undermined falling rates of cigarette smoking
• use of e-cigarettes had contributed to higher quit success rates
• there was significant public misunderstanding about nicotine (when asked, only 8–9% of british adults accurately identified that most health risks from smoking are not caused by nicotine) and about the harm caused by e-cigarettes in comparison with smoking
• experimentation with e-cigarettes mostly did not result in young ‘never smokers’ becoming regular users of e-cigarettes.