Tobacco and Vapes Bill (Fourth sitting)

Kirsten Oswald Excerpts

Committee stage
Wednesday 1st May 2024 Public Bill Committees

[Dame Andrea Leadsom]

Q Could I ask you both to agree that it is therefore not a matter of free choice? This is an addiction that removes people’s choice; would you both be willing to agree with that?

Professor Agrawal: I think it is a lethal addiction.

Tim Mitchell: Undoubtedly, I would agree with that.

[Kirsten Oswald (East Renfrewshire) (SNP)]

Q I know that the Royal College of Physicians has called for regulation to protect young people from vaping. I thought that what Professor Agrawal said about the importance of helping people to stop smoking was very interesting. At the same time, that balance is really important.

I am interested, however, in the harms of vaping to those who have never smoked, particularly young people, and the challenges we have heard about with them being advertised to in various ways, including on sports kits and in online spaces. What are your thoughts on how we best deal with that?

Professor Agrawal: I agree that it is awful and that we need to restrict it. The tobacco industry has a playbook on how it attracts young people to smoking, and it is not dissimilar to vaping. Billboards, influencers on social media, brightly coloured, garish packaging and the names of flavours are all used to appeal to young people. The provisions in the Bill will provide the powers to restrict that. That is really important and is exactly what we should be doing.

There is also the influence of social media, and we should not forget that. Whether this Bill will deal with that or whether it will be some secondary legislation that does that, that is fine, but we certainly need to curb the impact of social media and other influences on young people starting to take up vaping.

[Kirsten Oswald]

Q Do you have anything to add?

Tim Mitchell: Just that the scientific evidence in relation to surgery and vaping is very limited. Clearly, as I have said, we see vaping as being much less of a risk to people than smoking, and from that perspective, it is very good. But otherwise, I would defer to Professor Agrawal and what he said.

[Nickie Aiken (Cities of London and Westminster) (Con)]

Q I absolutely accept what you both have said about wanting to get the Bill through as quickly as possible with no amendments. However, is there anything in the Bill that you think we have missed and that you would like, if this was possible—I am not saying it is—to add in? What have we missed, if anything?

Professor Agrawal: I thought it was such a well-balanced Bill, with all the objectives, whether that is making sure they are available to help people quit, or really focusing on preventing young people from being attracted to vaping. The Bill is not in isolation, as I have alluded to. The ban on disposables is undergoing consultation, and there is the excise tax. All of those measures form a whole. Yesterday, we heard about the potential for track and tracing, for example, to be used with vapes, which would therefore mean that things like retail licensing are probably not needed because a good track and tracing system will actually do the job. I think the Bill has been well thought through, not by accident, and I cannot think of anything that will not get picked up in the consultation. I suppose the one thing that is not in there is interference from the tobacco industry, front groups and lobbyists with any part of tobacco regulation, and making sure that that does not occur.

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[Dame Andrea Leadsom]

Very specifically the increase in children vaping, which is nicotine as well. It is the same addiction.

Mark Rowland: The causes of the deterioration of young people’s mental health are really complex. There are a number of different factors, and it is difficult to disaggregate them all. There is social media and what we call the social evaluative threat, which emerges from being in a context where you are able to see how you are doing in life against everyone else in the world. It is the first time we have had that in human history, so no doubt we need greater protections in the use of social media for young people.

In terms of the evidence of vaping and young people’s mental health, we have not seen a causal relationship between vaping and poorer mental health. We know that all addiction is bad for all of us, especially young people. We did a Delphi study a couple of years ago looking at the most important protective factors for people’s mental health, and No. 1 was, “Don’t become addicted to drugs.” That had the most deleterious impact. It is not going to help if more young people are addicted to nicotine, for absolute sure. It comes back to the original point that we need to equip our young people with skills to be able to manage difficult emotions and not look for the quick dopamine hit that nicotine provides. So it is not helping, but is it the major driver of children’s mental ill health? We do not have the evidence to be able to point to that right now.

[Kirsten Oswald]

Q I am interested in the exchange that has just taken place. You have said that all addiction is bad for us, which makes sense to me. We heard evidence yesterday about the impact of young people vaping in schools. Some of that impact is the disruption to education and the challenge for young people if they a need to go out of the classroom to vape because the pull of the addiction is so strong. I wonder what your thoughts are on the mental health impact of the addiction in the education setting. I would also welcome your thoughts on the connections with sports; I am particularly interested in sports organisations advertising vapes, which I think is a poor choice. I think sport should have a positive impact on the mental health of young people, but I am not sure that connects properly when these vapes are being advertised.

Mark Rowland: I really support the Bill’s efforts to regulate and protect young people from ever engaging in vaping. As you say, it is about the unintended consequences. We are not quite clear on the mental health consequences of vaping for young people. We know that young people who have lower levels of mental wellbeing are more likely to vape. We know that the targeting of young people drives them into addictive behaviour, so we need to protect young people from that. We need a regulatory environment that does not allow young people to be exposed to advertising that is particularly targeted at them. I would support such a measure.

I think the unintended consequence of children missing out on education due to vaping cannot be underestimated. We also have an issue around the mental health of young people who are not attending school—the school rejectors. We need to bring them into an education environment in which we can see what that young person needs and what the consequences for their mental health have been from not being in school. I would rather kids were in school and that that educational setting was protected for them.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)]

Q When I worked in mental health services, we often found that there was an association between people who were smoking cigarettes and also cannabis and having aggravated psychotic symptoms. Do you think that the measures in the Bill will help people to avoid smoking in general and therefore be less likely to move on to smoking cannabis as well and aggravating those psychotic episodes?

Mark Rowland: The evidence around cannabis use and the increased risk around psychosis is really clear and strong. I have personal experience of the absolutely devastating experience of friends who have experimented casually with cannabis and the consequences for their mental health.

It is a fair supposition to make for you as legislators that a Bill that makes such a symbolic and strong stand against young people getting addicted to smoking, reducing the rates and preventing young people from getting addicted to vaping will set a fantastic context for preventing addiction to other substances. Would it not be great if we also saw some delay in the first experience of young people drinking? We could be on the cusp of doing something really fantastic for young people if we look at the range of addictive or self-soothing products, and cannabis would be one of them. If you break the chain and teach people how to manage their mental health and distress in a positive way, you will reduce the risk of people choosing addictive and damaging products to do that for them.

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[Trudy Harrison]

Q I am the very proud mum of four daughters, aged between 21 and 25. When I think back to them as teenagers, I do not think they would have found a unicorn, a cartoon character or a bubble gum flavour particularly trendy—when they were four or five, yes—so I do not buy the idea that teenagers are attracted to such things. I worry that whatever we manage to do to avoid cartoon characters or bubble gum flavours being prevalent just will not work. For example, cigarettes are still attracting many young people, which is why the Bill is needed. I think they taste absolutely revolting, but that is not putting children off. What are your thoughts on what needs to be done to prevent teenagers from finding vapes attractive?

Mr Lawson: I am not sure we can ever prevent any youth getting access to vapes—that is an impossibility. Youth are known to engage in risky behaviours, so they will drink alcohol under age and engage in risk-taking behaviour. What we can do is limit the drivers that bring youth to using vape products, such as flavours that are appealing or cartoons they are familiar with. These are small factors that play into the overall picture as to why somebody may pick up a vape when they did not previously smoke. That needs to be balanced with the question of adults quitting smoking. If you restrict flavours to only tobacco flavour, as we see in the US pretty much at the moment, adults are then limited to flavours that remind them of smoking, and that is probably less likely to reduce the smoking prevalence in the population.

[Kirsten Oswald]

Q To extend that conversation a bit, the issue of youth vaping is particularly concerning to me and obviously to many others around the table. You spoke to the Committee about how easy it is to buy products that are illegal but that may look to the unexpert eye as if they are legal products—even to the shopkeepers, one presumes. That must be much more difficult for children and young people—even people who are at the lower age of legally buying vapes—so I wonder what your thoughts are on how that might be acted upon. I also wonder whether you think that vape manufacturing is likely to be impacted by the measures in the Bill.

Mr Lawson: I can answer that anecdotally for you. Of my friends and peer groups who vape, despite what I do for a living, they do not listen to me that the products they are using are illegal, so I think the only way to prevent those products being used is to enforce action against them being on the market to begin with. I think there is a complete lack of awareness and knowledge of the current regulations among shopkeepers, and among the population. Many people may choose to buy an illegal product despite it being illegal, but many people might not have made that decision had they known otherwise.

What we are seeing more recently in that category of illegal products is that the safety of those products is less well known than for products that have gone through the MHRA’s notification process. We have done research into their metals content, for example, and we see elevated levels that you would not normally see in a product that has been notified to the MHRA. There are a few layers of this, but I think that if consumers are not aware of the safety of the products they are using—which they are not—that is a bigger concern. Whether youth use them or not is a separate thing to that.

[Dr Johnson]

Q Mr Lawson, you talked about how many of these products exceed the level, and those figures you presented were quite shocking, but how do people tell? You might think that if you went to a reputable major supermarket, the products there would be the right thing to buy, but we know that in February last year, Elf Bars were removed from Tesco, Morrisons and Sainsbury’s because their products—the Elf Bar 600s, I believe—were found to contain over 50% more than the legal limit of nicotine liquid.

I have three questions: how can a consumer tell if they are buying a legal product? How can a shop, particularly a smaller shop with fewer resources, tell that they are buying a legal product—as we have already heard, the MHRA does not actually test them? And are the penalties for getting this wrong enough?

Mr Lawson: With respect to Elf Bar, the industry itself has tried to take some level of leadership. Distributors are now doing testing on products before they go to the shops, before they stock them or sell them on. My company is registered for testing with UKAS—the United Kingdom Accreditation Service. We work with trading standards, and we work with the industry in testing products like these, so I think this Elf Bar issue has been a bit of a wake-up for industry to take more action.

With respect to smaller stores, I mentioned post offices earlier, because you would assume that going into a post office, you would be able to purchase a legal and reputable product, but I think there is a lack of awareness among the people purchasing these products in stores about what is and is not illegal. I would assume that you should not be able to buy an illegal product; if I owned a store and I was able to buy these products somewhere, I would assume that the only things I could buy were legal. You do not go into a store and buy alcohol, for example, that is illegal, so I guess there is an assumption that products should be legal.

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[Dame Andrea Leadsom]

Q Professor Ford, do you want to add anything on what we should be looking out for?

Professor Ford: I think Professor Gilmore is the expert on tobacco industry strategies.

Professor Gilmore: I am happy to speak on that if it helps. The model that we developed to understand how the industry argues about policy is called the policy dystopia model, because the industry will argue for a whole host of dystopian outcomes: “The regulation will not work”; “There is no evidence”; weirdly, “It will increase youth smoking”; “It will increase illicit”, as Dr Branston has said.

The other key thing the industry will always claim is that it will be bad for business, but it will never admit that it will be bad for its own business, which is obviously its key concern. It is always trying to claim that the negative impacts will be on others, such as retailers. We are seeing those arguments now: “It is impractical”; “It is untested”; “It will be impossible to enforce”—that is the other favourite argument; “It reduces freedoms”.

Those are the typical industry arguments. It might present them quietly itself, but it acts directly less and less—increasingly, it acts through the third parties I flagged. I would be careful of all those arguments, and of approaches from people who might seem credible but, very often, have industry links behind them or are meeting with industry and simply believing those arguments without question. Generally, the arguments have some plausibility, but they have never materialised with any previous policy. They simply have not come true.

On illicit cigarettes, it is worth remembering that the tobacco industry has a very long history of orchestrating the smuggling of its own products on a vast scale, which is well documented through its own documents, which it had to release through litigation. That may sound counter-intuitive, but the more expensive the product, the less is sold; the cheaper the product, the more is sold. If the product is illicit and the excise duties on it are not paid, it sells more cheaply and more is sold. That also enables the industry to make the illicit argument: if there are illicit products on the market, it makes the illicit argument stronger.

It is also worth noting that the last time we looked at rates of illicit and published on that, the biggest share of the illicit cigarette market in the UK was the tobacco industry’s own products. At best, that means that it is failing to control its supply chain. It makes a big song and dance about counterfeit and illicit whites, but there remains a problem with the tobacco industry’s own products ending up in the illicit market. That is really important to bear in mind.

[Kirsten Oswald]

Q I have a question for Professor Ford. Can you describe for us how the packaging of vapes attracts young people to purchase them, and how the visuals advertising vaping that young people might see on social media or sports kits, for instance, might attract them and influence their desire to purchase them?

Professor Ford: Packaging in the UK just now is doing two things: first, it is communicating a message to young people, and secondly it is having a huge impact in the retail setting. I will deal with those separately.

First, we recently conducted a pack analysis of a representative sample of vape packaging that was legally available for purchase in the UK. We found that 85% of those packs are really brightly coloured. A proportion of them have a childish cartoon font on the pack, and the language and terminology on a proportion of the packs utilised youth language and slang, so it is tapping into something that young people could be receptive to.

There is also an issue with how the nicotine content is displayed on the front of the pack. There is no consistency. Some of the packs say that the nicotine content is 2%. We know from our qualitative work that young people misinterpret that as a low percentage, but it is actually the maximum legally allowable amount in the UK. All of that together is communicating to young people that this product is for them; in our qualitative work, that is what they have told us that they believe. We have also spoken to adult smokers, and they also believe that a lot of this colourful packaging is targeting young people. At the moment, there is a mismatch between what we would ideally like vape packaging to do—we want it to speak to adult smokers—and what it is doing. It is not speaking to adult smokers; it is communicating to young people.

The second part is the impact of the packs in the retail setting. I am sure you have noticed that in the retail setting—within the store, but also in the shop front—the display made up of brightly coloured packs is vast. We did a youth tobacco policy survey in 2020 and followed that up with the youth e-cigarettes policy survey last year, in July 2023. We are finding an increased awareness of vape displays in shops among 11 to 16-year-olds across the UK, from 40% up to 68%. That is a substantial increase.

We asked those 11 to 16-year-olds last year what they think about these displays in the retail setting. Some 58% think they are colourful, 36% think they are attractive, 36% think they are eye-catching and nearly a quarter think they are attractive. That shows not only how the display feeds into the appeal but, perhaps even more importantly, how it feeds into the social norm around this product and this behaviour. To give you just a couple of other statistics, nearly a third of our sample reported that displays make them think it is okay to vape, and 64% reported that vape displays make them think that a lot of people vape, so they are really feeding into this social norm. Thankfully, the Bill covers those aspects of promotion.

There has also been an increase in young people reporting seeing vapes and vaping imagery on social media: 25% of 11 to 16-year-olds reported that in 2020, and 41% reported it last year. On your final point about sponsorships, we are seeing quite a lot of sports-associated imagery with nicotine pouches. I know that nicotine pouches should be included in the Bill, because that is another nicotine product. We are starting to see the terminology, awareness and imagery of nicotine pouches take off among young people. This is concerning, and it is one to watch. The imagery is of it being a hit or a boost that helps you to focus. There is a big association with professional footballers; we definitely saw a gender difference in terms of the males picking up on that. For nicotine pouches, there is also sponsorship on Formula 1.

[Nickie Aiken]

Q Are they the ones that you put on your gums?

Professor Ford: Yes, it is a little white pouch. You put it underneath your lip and leave it there for up to an hour. For some of these products on the market, their displays are becoming more elaborate. The packaging is very childlike and the number of those childish packs is increasing.

The products can be incredibly strong. We have seen some for sale that contain up to 150 mg of nicotine. In terms of future-proofing the Bill and having the powers to regulate a range of products, the market is so innovative and developing so quickly that it is important to stay on top of that kind of thing.