Framing and scientific uncertainty in nicotine vaping product regulation: An examination of competing narratives among health and medical organisations in the UK, Australia and New Zealand

Erku, Daniel Asfaw; Kisely, Steve; Morphett, Kylie; Steadman, Kathryn J.; Gartner, Coral

doi:10.1016/j.drugpo.2020.102699

Cited by 33 publications

(19 citation statements)

References 16 publications

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“…Few Australian health and medical organisations have endorsed them as a cessation aid or harm reduction tool for smokers. Rather, policy briefings, media releases and position statements from notable health bodies focus mainly on the potential dangers associated with NVPs unlike some other western countries . This portrayal of NVPs as dangerous products could have an impact on attitudes held by smokers and the general public towards their safety and what is an appropriate regulatory approach.…”

Section: Discussionmentioning

confidence: 99%

Nicotine vaping product use, harm perception and policy support among pharmacy customers in Brisbane, Australia

Erku

Gartner

Tengphakwaen

et al. 2019

Drug and Alcohol Review

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Introduction and Aims Despite regulatory barriers for accessing nicotine liquid, use of nicotine vaping products (NVPs) has increased rapidly in Australia. Legal use of NVPs to aid smoking cessation requires a prescription, and pharmacies report receiving enquiries about the use of and access to NVPs. In this study, we assessed vaping product use, harm perception and policy support among community pharmacy customers. Design and Methods A cross‐sectional survey was conducted among customers (n = 470) from a large community pharmacy chain in Brisbane, Australia. Multivariable logistic regression was used to examine perception of NVPs as less harmful than combustible cigarettes and regulatory recommendations in relation to demographics, smoking status and NVP use. Results Almost one‐third of the sample (31%) had either tried NVPs in the past (16%) or were current vapers (15%), the majority of them being current smokers (67%) who are trying to quit (31%) or substitute smoking (41%). Vapers primarily depended on family/friends as a source of information (76%). Current smokers and vapers were more likely to perceive NVPs as less harmful than cigarettes than non‐smokers and non‐vapers. Perceiving NVPs as safer than cigarettes was correlated with a recommendation to regulate as a tobacco product. Discussion and Conclusions There was widespread misperception about relative risk of nicotine‐containing products, with 37% of respondents perceiving nicotine‐containing NVPs to be as harmful as combustible cigarettes. Community pharmacies represent an ideal setting for educating smokers about smoking and vaping. Thus, pharmacy staff needs educational support to ensure that they are equipped to provide current evidence‐based information to customers.

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Section: Discussionmentioning

confidence: 99%

Nicotine vaping product use, harm perception and policy support among pharmacy customers in Brisbane, Australia

Erku

Gartner

Tengphakwaen

et al. 2019

Drug and Alcohol Review

Self Cite

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“…We purposively selected four different influential jurisdictions, considered important for setting the agenda on policy recommendation for e-cigarettes policy: WHO, UK (Scotland, England, Wales, and Northern Ireland), Australia, and USA. These jurisdictions were selected to reflect the different approaches towards e-cigarette regulation [ 17 ]. The UK has adopted a ‘harm reduction’ approach towards e-cigarettes, proposing that smokers should be encouraged to switch to e-cigarettes [ 16 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

Examining the sources of evidence in e-cigarette policy recommendations: A citation network analysis of international public health recommendations

et al. 2021

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Background Public health policies and recommendations aim to be informed by the best available evidence. Evidence underpinning e-cigarettes policy recommendations has been necessarily limited due to the novelty of the technology and the lack of long-term epidemiological studies and trials. Some public health bodies have actively encouraged e-cigarette use whilst others have raised concerns over introducing new health risks and renormalising tobacco smoking. Using citation network analysis we investigated the author conflicts of interest and study funding statements within sources of evidence used by public health bodies when making recommendations about e-cigarette policy. Methods We conducted citation network analysis of public health recommendation documents across four purposively selected diverse jurisdictions: WHO, UK, Australia, and USA. We extracted all citations from 15 public health recommendation documents, with more detailed data collected for influential citations (used in 3+ recommendation documents). We analysed the relationships between the sources of evidence used across jurisdictions using block modelling to determine if similar groups of documents were used across different jurisdictions. We assessed the frequency and nature of conflicts of interest. Results 1700 unique citations were included across the 15 public health recommendation documents, with zero to 923 citations per document (median = 63, IQR = 7.5–132). The evidence base underpinning public health recommendations did not systematically differ across jurisdictions. Of the 1700 citations included, the majority were journal articles (n = 1179). Across 1081 journal articles published between 1998–2018, 200 declared a conflict of interest, 288 contained no mention of conflicts of interest, and 593 declared none. Conflicts of interest were reported with tobacco (3%; n = 37 journal articles of 1081), e-cigarette (7%; n = 72), and pharmaceutical companies (12%; n = 127), with such conflicts present even in the most recent years. There were 53 influential citations, the most common study type was basic science research without human subjects (e.g. examination of aerosols and e-liquids) (n = 18) followed by systematic review (n = 10); with randomised control trial being least common (n = 4). Network analysis identified clusters of highly-cited articles with a higher prevalence of conflicts of interest. Conclusion Public health bodies across different jurisdictions drew upon similar sources of evidence, despite articulating different policy approaches to e-cigarettes. The evidence drawn upon, including the most influential evidence, contained substantial conflicts of interest (including relationships with e-cigarette and tobacco industries). Processes to explicitly manage conflicts of interest arising from the underlying evidence base may be required when developing public health recommendations.

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“…First, there are a relatively limited number of human studies on the health effects of ENDS, contributing to the uncertainty of their clinical impact [27,34,35]. Second, decisions by clinicians and policy makers are often based on beliefs that are not supported by the available studies [36][37][38]. Research evidence on the health risks of ENDS is a priority for decision making because ENDS could represent an excellent tobacco harm reduction opportunity [34] if their long-term risk reduction when compared with smoking would be demonstrated.…”

Section: Overviewmentioning

confidence: 99%

Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews

et al. 2021

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Background Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. Objective We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. Methods These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. Results The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. Conclusions The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. Trial Registration PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 International Registered Report Identifier (IRRID) DERR1-10.2196/29084

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Framing and scientific uncertainty in nicotine vaping product regulation: An examination of competing narratives among health and medical organisations in the UK, Australia and New Zealand

Cited by 33 publications

References 16 publications

Nicotine vaping product use, harm perception and policy support among pharmacy customers in Brisbane, Australia

Nicotine vaping product use, harm perception and policy support among pharmacy customers in Brisbane, Australia

Examining the sources of evidence in e-cigarette policy recommendations: A citation network analysis of international public health recommendations

Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews

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