Caroline Johnson Portrait Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
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I am an NHS consultant paediatrician, and a member of the Royal College of Paediatrics and Child Health.

Lisa Cameron Portrait Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)
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I am a practising psychologist, and I also chair the all-party parliamentary health group.

Mary Glindon Portrait Mary Glindon (North Tyneside) (Lab)
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Sir George, do we have to declare our memberships of any groups? I am a member of the all-party parliamentary group for responsible vaping.

None Portrait The Chair
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Well, whether it was required or not, you have now done it.

Lisa Cameron Portrait Dr Cameron
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I am, too.

None Portrait The Chair
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We will now hear oral evidence from Michelle Mitchell, the chief executive of Cancer Research UK, Deborah Arnott, the chief executive of Action on Smoking and Health, and Sheila Duffy, the chief executive of ASH Scotland. To begin with, I will call on Michelle Mitchell.

Michelle Mitchell: First, thank you for your openness and transparency, Sir George. It is also important to declare whether anybody giving evidence has associations with the tobacco industry; I have none. The principle of accountability and transparency is also important for the people who are giving evidence.

Smoking is the biggest cause of death, ill health and disability. It is the biggest cause of cancer in the UK. It has a huge impact on preventable deaths, the economy, productivity and of course families and loved ones. Cancer Research UK supports the legislation to create the first ever smoke-free generation and to stop young people developing addictions, risk, ill health and, of course, cancer. We believe that the rights and entitlements of current smokers are reasonably unaffected. We urge you through your considerations in Parliament to pass the legislation, as does the public, 73% of whom support the legislation.

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Preet Kaur Gill Portrait Preet Kaur Gill
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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.

Lisa Cameron Portrait Dr Cameron
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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.

None Portrait The Chair
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I call Dr Caroline Johnson, and this will be the final question.

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Kirsten Oswald Portrait Kirsten Oswald
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Q I wonder if you can develop some of the points you have made, which have been very useful. I am hearing anecdotally about issues in schools where the addiction of children to these vapes is itself causing a problem, because the children are unable to sit in the classroom and have to go out to vape, with whatever excuse is made, so that they then feel able to come back to the classroom, such is the level of their addiction to these products. If I may go beyond that slightly, what are your views on the way these things are promoted—for instance, on our particular concern about vape companies advertising on sports strips and in sports stadiums, and the impact on the same young people who are so addicted?

Matthew Shanks: I completely agree. The way in which vapes are marketed—the colours, flavours and so on—and the places where they are marketed suggest to people that they are safe. The fact that they are put forward as a “safe” alternative to cigarettes, the fact that parents use them and the fact that there are lots of colourful vape shops open in high streets: all those aspects promote the idea that vaping is okay.

At the same time, getting into a child’s mindset—we have all been there, as children—we like to break the rules and feel like we are pushing at boundaries. We know that it is not okay, but it is made okay. I would suggest that more children engage in vaping than in cigarette smoking, because they are not sure what the harmful effects are. That is the danger in it. I do think it leads on, because the younger children vape, but by the time they are 16 or 17, vaping might not be cool any more, so they go on to cigarettes or other things.

Anecdotally, we have heard of schools down in the south-west where people are putting cannabis into the vapes, so the addiction grows from that point of view as well. It leads to children coming out of lessons agitated. If I did not have three coffees in the morning, my agitation would be quite high. If children are not getting nicotine, as well as going through all the other things they are going through, they really do present as confrontational to staff, which makes it difficult to deal with them in classrooms and engage them in their learning. At the same time, to repeat a point I made earlier, you have parents at home who are saying, “Well, it’s okay to do.” I absolutely concur about the way it is marketed and so on.

Patrick Roach: To add to that, because those are important points: vape producers and manufacturers, and indeed those supplying vapes, are advertising freely in ways that make their products increasingly attractive to children and young people, with the way vapes are advertised and the marketing descriptors used for them. All the evidence we have, and certainly what our members tell us—our survey was of 4,000 teachers, so this is not anecdotal; it has an impact right across the system— suggests that the way those products are marketed and described deliberately seeks to entice young people to make use of them.

We believe that this is a strong Bill that very clearly sets out the societal expectations in this space, but as with any legislation, there is always scope for loopholes. If there are areas in the Bill where there is potential to further strengthen the legislation, I think the enticing way products are described, before an individual understands what they are getting themselves into, is something that needs to be considered and addressed.

From our point of view, it is about advertising, but it is also about access to these products. With the best will in the world, and no matter how they are advertised, if the products are easily available at the point of sale it makes things incredibly difficult. I remember that when I was bringing up my own children I worried about going to the supermarket with them, because they would be surrounded by candy and sweet products at the checkouts. You could not navigate your way through the checkouts. Thankfully, things have moved on: that has changed, and many parents are benefiting from those changes.

Young people are very much interacting with many of these products at the point of sale. They are in the shops that are in the vicinity of or on the route to and from school. They are being marketed in places that young people will frequent, whether that be a local café, the hairdressers or the barbers. They are in places where young people will be. They are also immediately available. The more we can do to stop the immediacy of marketing of these products and that easy availability, no matter how they are described, the better.

Lisa Cameron Portrait Dr Cameron
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Q I have been hearing from parents and schools in my constituency that they are very concerned that children are going out at lunchtime and spending their lunch money on vapes, so they are not having anything nutritious during the day. Is there any evidence that indicates that there might be a pattern developing in that respect that will have an impact on children’s physical health and wellbeing?

Matthew Shanks: Absolutely: children will find any which way they can to do what they want to do. At the moment, while this is not illegal, they will gather more people to follow the crowd and go out. In my experience, the majority of children want to do as they are instructed—probably about 85%, anecdotally, over the years—but they will follow the herd. At the moment, there is a greater herd growing because of all the things we have talked about, with the marketing and colour of vapes. I can absolutely see children going out at lunchtime and spending their money on that, instead of on food. There is peer pressure to do that as well—it is taking more people with them. As Patrick said, you can see these products in the barbers, in the shops and so on.

Patrick Roach: To add to that, there are also bullying behaviours that manifest themselves. Whether a pupil is making the choice to go out at lunchtime to acquire vapes or is feeling coerced to do so, there is an issue either way. The availability of those products in the proximity of schools needs to be considered. That is a point that we would make.

Increasingly, schools have introduced systems to seek to ensure that children are being fed at lunch times, for example. We should not lose sight of that, but in some instances these products—particularly disposable vapes —are cheap as chips. I know that that is an issue of concern to the Government, and it is of concern to us and our members.

It is really important that we look at how we can ban the sale of disposable vapes entirely, because frankly no one knows what is in them, and they are incredibly cheap to acquire. Even if your parent can see what you had on Tuesday lunchtime because it comes up on their phone, how will they know if you have spent 10 minutes popping out to the local shop to acquire some vapes, particularly if they are of the disposable variety? More can be done not only to limit appeal, but to reduce the availability and accessibility of those products to young people. The more that can be done on that, the better.

None Portrait The Chair
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Four more people want to get in—actually, it has just gone up to five—and we have about 12 or 13 minutes left. It is unlikely that I will be able to get everybody in, but if Members put their questions as briefly as possible and witnesses respond as concisely as possible, I will try.

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None Portrait The Chair
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I will attempt one final question from Dr Lisa Cameron. I simply make the point that the briefer the question, the more possibility there is that she will get an answer.

Lisa Cameron Portrait Dr Cameron
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Q Thank you; I will be very brief. Do you think it is fair to describe older adults as having made a choice, when perhaps it was not an informed choice, given the misinformation and lack of evidence at the time that they made the choice to start smoking?

Paul Farmer: I think a lot of people made a choice without having the information in front of them. I suppose my parting thought to this Committee is that the consequences of failing to intervene in previous generations are now seen by the older people of today. If this legislation is implemented, the first generation of people will not reach 65 until 2074, but I can tell you that that generation of 65-year-olds will look back and recognise the contribution that the Government have made to changing and impacting on their long-term health in the same way that this generation looks back on the contribution of other Governments in other health initiatives.

None Portrait The Chair
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I thank the witness for his answers to the questions from Members, which were really helpful. They gave us not only the perspective of those who his organisation represents, but the intergenerational nature of their role in the world. That brings us to the end of this morning’s sitting. The Committee will meet again at 2 pm here in the Boothroyd room to continue taking oral evidence.

Ordered, That further consideration be now adjourned. —(Aaron Bell.)