Examination of Witnesses

Tobacco and Vapes Bill – in a Public Bill Committee am 9:34 am ar 30 Ebrill 2024.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Dr Charmaine Griffiths and Sarah Sleet gave evidence.

Photo of George Howarth George Howarth Llafur, Knowsley 10:05, 30 Ebrill 2024

We will now hear oral evidence from Dr Charmaine Griffiths, the chief executive of the British Heart Foundation, and Sarah Sleet, the chief executive officer of Asthma and Lung UK. We have until 10.40 am for this session. Could I ask the witnesses to introduce themselves and give their titles for the record? Then we will move into the questions.

Dr Griffiths:

Good morning. My name is Dr Charmaine Griffiths and it is my privilege to be chief executive of the British Heart Foundation.

Sarah Sleet:

My name is Sarah Sleet and I am the chief executive officer of Asthma and Lung UK.

Photo of Preet Kaur Gill Preet Kaur Gill Shadow Minister (Primary Care and Public Health)

Q You will know that the Government have a clear target to narrow the gap in healthy life expectancy between the highest and lowest areas in the next five years. Do you think that smoking rates are particularly high in certain parts of the country, and are the health benefits following the ban therefore likely to be more prevalent in some places than in others? That is my first question. Secondly, I am concerned about the huge rise in youth vaping in recent years. Are you concerned about the increase in vaping even among groups who have not previously smoked cigarettes?

Photo of George Howarth George Howarth Llafur, Knowsley

We will also take the Minister, and then we can answer both sets of questions together.

Photo of Andrea Leadsom Andrea Leadsom The Parliamentary Under-Secretary for Health and Social Care

I am also interested in the impact of smoking and vaping on children’s hearts and lungs in particular. I would very much appreciate hearing the professional assessment of you both of the particular vulnerability of children’s lungs and hearts, as compared with adults. I know that the Opposition spokesman and I share that grave concern, as do a number of colleagues. My second question is: do you expect the smoke-free generation policy to stop young people starting smoking?

Photo of George Howarth George Howarth Llafur, Knowsley

I do not know which order you want to take the questions in.

Dr Griffiths:

I am happy for us to do a double act between us.

Thank you for such clear questions. In terms of inequality, we know that the burden of smoking falls unevenly. We have a third more smokers in the third most deprived areas, so it affects people’s health unequally. Heart disease is the world’s biggest killer, and there is absolutely no doubt that smoking is one of the major drivers of cardiovascular disease, so the picture is clear and very well established from an inequalities point of view.

In terms of young people, we share your concern at the British Heart Foundation. It scares me to think that, today, 350 young people will start smoking for the first time—and the same tomorrow and the day after, and the day after that. We know that a huge proportion of them go on to become long-term smokers. Tragically, we see the burden and the cost to life and quality of life that that causes, with about 15,000 deaths every year across the UK from heart and circulatory disease associated with tobacco. So, we are deeply worried about people starting, and it is not just us at the British Heart Foundation who are worried. We know that the majority of smokers wish they had never started, but nicotine is an incredibly addictive substance. Once people have started, it is incredibly difficult to stop, so we share your concern.

Just to cover two things on the biology, the way that smoking is so damaging to our hearts and circulatory system is manifold. It damages the lining of our circulatory system, causing our arteries to clog up with fatty deposits, which puts us at an incredibly high risk of heart attacks and strokes. We know that a smoker’s risk of having a heart attack is double that of someone who does not smoke. For stroke, the risk is three times greater, but if someone smokes 20 cigarettes a day, they are six times more likely to have a stroke. So, there is really clear evidence on the biology that smoking is damaging.

We are deeply worried about young people starting, which is where the power of this Bill comes in. What an opportunity to create, for the first time, a smoke-free generation, relieving tens or hundreds of thousands of people from the risk of death and disability from smoking. We, as the BHF, would urge for the Bill to be pushed through in full.

Photo of George Howarth George Howarth Llafur, Knowsley

Sarah, is there anything you wish to add to that?

Sarah Sleet:

Yes, Asthma and Lung UK very much support this bill because the effect of smoking on lung disease is profound; it is deadly. Lung disease is the third biggest killer in the UK. Of the 100,000 people who die every year, 35% of those—more than a third—are, in effect, killed by smoking. Smoking is profoundly damaging to people, their children, and those who live around them. It is not just the person smoking who is profoundly affected; it is also the family living around them.

We know that smoking drives health inequalities and is also a cause of health inequalities. We know that smoking is responsible for half of the gap between those with the best and worst life expectancy. If you really want to tackle health inequalities, you need to tackle smoking as your first port of call. It is the biggest single driver of health inequalities. People with lung disease are most exposed to that health inequality. We really support driving this forward and support everything that the BHF have said.

Photo of George Howarth George Howarth Llafur, Knowsley

Thank you. Can Members of the Committee who want to ask a question indicate so.

Photo of Andrea Leadsom Andrea Leadsom The Parliamentary Under-Secretary for Health and Social Care

Q I asked a specific question about children’s asthma and children’s heart damage. Could I urge our witnesses to respond to that question?

Dr Griffiths:

Thank you, and apologies if we did not cover that as clearly as we could have. Obviously, there is no such thing as a safe cigarette, there is no safe number of cigarettes to smoke, and there is no safe age to start smoking at all. We would emphasise our concern for children starting to smoke, because the damage starts as soon as you start smoking. There is no safe number of cigarettes to smoke. Combined with that, the fact that nicotine is so addictive that it leads to most people—over two thirds of those who start—becoming long-term smokers, worries us enormously. In terms of both the risk and the damage of starting smoking, the number of people who start and the fact that they go on to adopt a lifelong smoking habit caused by nicotine is of deep concern to us.

Sarah Sleet:

It is worth thinking about children’s wider environment. Children who live in households where the adults smoke are four times more likely to smoke themselves, and find it much harder to give up. Children are getting into a cycle of deprivation and damage to their long-term health right from the very beginning. For children, stopping smoking availability is going to be profoundly helpful for their future lives, their ability to contribute to the economy and their overall prospects. This Bill, which tackles the issue from childhood up, will be one of the most profoundly important health interventions that you can make.

Photo of Preet Kaur Gill Preet Kaur Gill Shadow Minister (Primary Care and Public Health)

Q I think the Minister was referring to vapes and the evidence based around the impact on growing lungs and hearts. Is there anything you would like to say about that before we move on?

Dr Griffiths:

As Deborah from ASH said, vapes are a fairly new product, so the research and evidence base, which we have in abundance for tobacco and smoking, is still forming for vaping. However, there are indications that it is not great for health. We are cautious and worried about the long-term implications. What we do know is that vaping can be an important cessation tool for those trying to quit smoking, and that many do want to quit, so we strongly encourage anything that stops smoking, but the people who are turning to vaping as an alternative to smoking for the first time is of deep concern to us. We do not understand the long-term health implications, but the addiction to nicotine deeply concerns us.

Sarah Sleet:

We strongly agree. It is a very delicate balancing act between stopping the harm caused by smoking and looking to the long-term with regard to vaping. Quite clearly, smoking is far more damaging for adults and children. Anything that can steer people away from smoking will be healthier than continuing to smoke in the long run, but we do recognise that more attention and more research need to be put into vaping.

Photo of Rachael Maskell Rachael Maskell Labour/Co-operative, York Central

Q Clearly, smoking is far more harmful than vaping, but research by UCL has shown that there are DNA methylation changes linked to carcinogens from vaping in the oral cavity, which quite probably translates to the lungs as well. Should we be looking at this legislation not with the naiveté with which smoking was looked at in the past, but rather as taking advance steps to ensure that we do not see an inducement of lung disease in the future?

Sheila Duffy:

As I said earlier, it is a delicate balancing act. We need to move people away from smoking, and anything that does that is a good thing, but we need to look at the long-term effects of vaping. The balancing act in the proposals around restricting access to vaping—making sure that nobody under-age gets access to vapes, denormalising them by taking them away behind the counter and so on—all of those are good measures to reduce the number of children moving on to vaping, but they need to be enforced. We need to make sure that we have the right enforcement action in place to make sure that that actually happens.

Dr Griffiths:

You gave a great example of early science that causes us concern, and it perhaps will not surprise you to know that as a body that is based in science and evidence, we at the BHF take statistics incredibly seriously. We are worried that the body of evidence will grow. We would hugely support and welcome a position where vaping was available to people as a cessation tool, but absolutely would discourage anyone else from taking it up as a starting point for nicotine consumption.

Photo of Steve Tuckwell Steve Tuckwell Ceidwadwyr, Uxbridge and South Ruislip

Could you take us through the impact second-hand smoking has on healthQ ?

Dr Griffiths:

It has a huge impact, and thanks to some of the previous legislation there have been some improvements that we can measure and track with great certainty. Second-hand smoke is undoubtedly a cause of cardiovascular disease, and for those people unfortunate enough to be exposed to it, it is a serious issue. Just over 15 years ago, there was a study that looked at coronary heart disease and cardiovascular disease in men. It showed a significant uplift for those exposed to second-hand smoke on a regular basis that was roughly the equivalent in risk of smoking nine cigarettes a day. So there is a very clear basis for saying that second-hand smoke causes heart and circulatory disease.

Sarah Sleet:

I would add the legislation on smoking in closed places—there was of course the legislation back in 2015 about children and smoking in cars—was based on very good evidence and was introduced for very good reasons. It proved to be a popular measure. Second-hand smoke in this context as well is an important additional factor to consider in terms of the harms balanced against the need to restrict these particular products.

Photo of Trudy Harrison Trudy Harrison Ceidwadwyr, Copeland

Thank you. While the harms of vaping are becoming better understood, what do we know about the behaviours around vaping? I ask as an MP who represents the northern constituency of Copeland, where smoking levels are above the national average, where health inequalities are more prevalent, and where deprivation is also a factor. Are we seeing the same kind of mapping of deprivation in areas where people are starting to vape? Are we aware of copycat behaviour—children mimicking their parents or other people in their households—and are we starting to see some patterns in age groups starting to vape? That statistic—350 young people starting to smoke every day—is shocking. What do we know about vapingQ ?

Dr Griffiths:

Not as much as we would like. That is the headline, but I do not think it will surprise any of us to know that people follow cues in their environment. That is partly what happens around them in their social environment, but I would like to draw attention to what happens in shops and convenience stores where people buy vapes. I was looking around my local convenience store, which is not far from a school, and thinking about today. It does not take a lot to look at what is happening behind the counter and see the packaging, the marketing and the highly, brightly coloured products that are clearly labelled, named and flavoured in a way to be attractive to children, whether it be cherry cola vapes or cotton candy vapes. They are things that are deliberately sweet and targeted at children, so it causes us great concern that that will be such a huge influence on so many children. We see that playing out in prevalence. I do not know if there is anything that you would add, Sarah.

Sarah Sleet:

I think you are right that there is no real evidence base around this. That research should be done and we would very much like to look at. Where smoking is very prevalent—as you say, in more deprived areas—people take cues from the people around them in terms of their behaviour. I have no doubt that look to similar cues for vaping. Are people around them smoking? Is it easy to get hold of vapes? Is it completely normalised? I think we would find a very similar pattern, but we need to get that evidence.

Photo of Mary Foy Mary Foy Llafur, City of Durham

We have heardQ that this Bill covers tobacco and vaping, and we have talked quite a bit about the advertising and packaging of vapes. Do you think that we could go further in actually tackling tobacco, which is the biggest killer, around the advertising and packaging of tobacco and flavoured tobacco?

Dr Griffiths:

We would welcome anything that stops people smoking or beginning to vape as a starting point for their addiction to nicotine. Given the scale of the devastation that that has on people personally as well as on our NHS in terms of cost burden and all the other impacts that it has, we fully support the Bill going through in full as it is now. If there are opportunities and support for strengthening it, I am sure that we would welcome that too.

The majority of people across the UK support the Bill and would love to see a smoke-free generation. The fact that you have 51% of retailers supporting it also speaks to how powerful a moment it is. We should do anything that we can to strengthen the Bill and prevent it from being diluted. We know that the tobacco industry will be campaigning in the opposite direction to limit any restrictions that would reduce its success, so we are really mindful of that. We urge the Committee and everyone who can to protect the Bill from dilution. It can save and improve lives. It is potentially a transformative piece of legislation.

Sarah Sleet:

We asked our supporters who was in favour of the Bill. Bearing in mind that many of our supporters may still be smoking or are ex-smokers, 84% supported the Bill and really wanted to see it come through. Daily on our helplines we hear people saying, “I wish I had never taken up smoking.” They are completely addicted and find it almost impossible to get out of smoking, and their health is being slowly degraded over time. They are having to come out of the workforce and retire early and potentially face death as well.

Photo of George Howarth George Howarth Llafur, Knowsley

We have time for another round of questions, if Members want.

Photo of Kirsten Oswald Kirsten Oswald Shadow SNP Spokesperson (Women), Shadow SNP Spokesperson (Equalities)

Q I am grateful to you both for your comments so far. Would you say more about your thoughts on groups of people, particularly young people —this is a thing you will hear around the table—who are taking up vaping but have not previously smoked. Do the measures in the Bill go as far as you want in trying to prevent that from being the direction of travel?

Dr Griffiths:

If the Committee is minded to strengthen anything that would prohibit people from starting vaping in the first instance, where they are not doing so as a cessation tool—I hope it is really clear that we believe that, as a cessation tool, this is a product that has its place that would help thousands of smokers give up and, ideally, prevent them from losing their quality of life or, tragically, their lives; I hope that is explicitly clear—I think that could have incredible impact. What we are worried about is people using vaping as a start and an entry point to nicotine. Nicotine is so highly addictive. You see that in the number of smokers who desperately want to give up. We have spoken to such people in abundance. Anything that helps us get to that point would be welcome.

Sarah Sleet:

Nicotine, we know, is as addictive as heroin and cocaine. It is a terrible addiction. However, in terms of vaping, it is going to be quite tricky to get that balancing act right. We really need to have vaping as a cessation tool. We know it is more effective than just about anything else you can have in terms of cessation. For example, when it comes to flavouring, if you make that too difficult or make it problematic for people to switch, then there is a chance that we may have a real problem in terms of stopping smoking. On the other hand, we really do not want people to be attracted into vaping who have never smoked. I understand that that bit of the legislation is in secondary legislation and can be adapted over time; I think a lot of attention is going to need to be given to how people are actually responding and how they are behaving, and then adjusting that over time.

Photo of Angela Richardson Angela Richardson Deputy Chair, Conservative Party

You have been quite clear that even though we do not yet have the evidence to understand the impacts of vaping, it is a very important cessation tool. Do you see a world in which it could be prescribed as a cessation tool, as opposed to being available as a retail productQ ?

Sarah Sleet:

I believe that is the system in Australia—it is prescribed. I think it is a possibility. It needs to be well researched. Would it still encourage people who need to stop smoking to use it as a tool, or would it put a barrier up to using that tool? Before we move to that system, we would need some really good behavioural evidence that it is not going to be a further barrier for people. If it is not, then that could be a really good option.

Photo of George Howarth George Howarth Llafur, Knowsley

I am going to take the Minister at this point, and then Preet Kaur Gill.

Photo of Andrea Leadsom Andrea Leadsom The Parliamentary Under-Secretary for Health and Social Care

Q Some people say that the smoking generation does not need to be raised a year higher every single year. Can you say for the record what your view is of that? Does it need to keep lifting each year?

Dr Griffiths:

We support the Bill exactly as it is written at the moment. It is really important to recognise that, as proposed, it does not inhibit anybody who is currently a smoker from purchasing tobacco, but it does take us on a really clear and, I believe, a transformative path to a smoke-free generation.

Dr Griffiths:

Because it is a really clear path to make sure that we move to a situation where we have a generation that is prohibited from buying cigarettes, and who are disincentivised from doing so.

Sarah Sleet:

We have heard today the evidence about just how harmful and destructive smoking is, particularly for people in more deprived areas. If we really want to tackle that, we need to remove smoking as a normalised, available, legal option going forward. This seems to me a very measured and thoughtful way of introducing a smoking ban that will take hold. It is very important for our children going forward.

Photo of Preet Kaur Gill Preet Kaur Gill Shadow Minister (Primary Care and Public Health)

Q I want to ask about the information that is given to parents, especially if their children have never smoked but have taken up vaping. We know that a generation of children is becoming addicted to nicotine because products that have been classified as 0% nicotine do actually contain it. One of the parents that I spoke to asked, “Well, how many puffs are there in one vape? If my child has two or three of those in a day, what does that actually mean?” It is about the information on that sort of risk, and how we share that information with parents who are trying to address this issue with their children. Is there anything you want to say about that, and is there any research being done to look at that?

Dr Griffiths:

I would observe that there is so much variation between products and how people are consuming them. I think it is quite difficult to give advice in a standard way, and that it is part of it being an emergent product and market. As we have discussed, there is no doubt that, with nicotine being so deeply addictive, it is an incredible worry that a child has a single puff on a vape, given the potency of nicotine and where we know it leads people, having seen that over generations with smoking.

I should perhaps take a moment to emphasise that we also really support the £70 million investment being allocated to public health campaigning and cessation services, as well as enforcement. You are right that we need to be really clear with the messaging of the Bill to encourage support from parents and others around children in particular. We really applaud the decision to put resourcing behind this as well. We know that effective public campaigning can be an incredibly powerful tool. We were really proud to run the “Give Up Before You Clog Up” fatty cigarette campaign way back 20 years ago, and we know even that campaign led to 14,000 smokers seeking to quit. We know public campaigning works, and it was a great thought to allocate that resource as part of this work—it will be needed.

Sarah Sleet:

The variation in nicotine levels and the method of delivery, which affects the uptake of the nicotine, is undoubtedly very concerning in vapes. I am a mother of three adult children who all vape, and I am very concerned about how often they are doing that and what impact that is having. We must also remember that, from what we know at the moment, it would appear that smoking is far and away the most damaging activity, compared with vaping. There is a little bit of concern that we overemphasise the harms of vaping to the extent that people say, “Well, I might as well smoke then. I’ll do that instead.” We need to be very careful about how we have this conversation.

Photo of Lisa Cameron Lisa Cameron Ceidwadwyr, East Kilbride, Strathaven and Lesmahagow

Q I want to follow up on something that both of you alluded to earlier in the evidence you have given. Is there any research beginning to form that suggests that, while vaping can be helpful for cessation, it might also be a gateway to smoking itself for young people?

Dr Griffiths:

That is an interesting question, and I can see the clear linkage you have described, but I am not able to provide any evidence. I am very happy to go back and provide that as a follow-up.

Sarah Sleet:

I am not aware of any evidence around that either.

Dr Griffiths:

It is a great question.

Photo of George Howarth George Howarth Llafur, Knowsley

I call Dr Caroline Johnson, and this will be the final question.

Photo of Dr Caroline Johnson Dr Caroline Johnson Ceidwadwyr, Sleaford and North Hykeham

Q In the Health Committee, of which I am a member, we heard evidence that some schoolchildren with lung diseases, such as asthma, were not able to visit school toilets during the day because the overwhelming smell of people vaping in there was triggering their asthma. Have you heard anything about that? Do you have any evidence about asthma in children or adults being triggered by vaping?

Sarah Sleet:

We have heard anecdotally that people have had issues with being around vaping, but there is not any robust evidence as to whether it genuinely triggers asthma for some of those people. It is an area we want to look into a bit further, but I would say that here is a clear case of where the law is that children should not be vaping. We need to ensure that enforcement is in place, as far as possible, to prevent that from happening.

Photo of Dr Caroline Johnson Dr Caroline Johnson Ceidwadwyr, Sleaford and North Hykeham

Q Is that an absence of evidence, or does evidence exist but is inconclusive?

Sarah Sleet:

I am not aware of any serious evidence that has been gathered around this at this stage. It probably needs to be looked at.

Photo of George Howarth George Howarth Llafur, Knowsley

I thank the two witnesses for being not only concise, which enabled us to get through all the questions, but informative. I am sure we have benefited from the evidence you have given.