BTS Position Statement Tobacco And Vaping 2024

1. Introduction / context
This document states the Society’s views on tobacco and vaping and demonstrates how we apply these principles across the Society.

The key audiences are all healthcare professions, all BTS members, and industry. Everyone who engages with us needs to adhere to our position on tobacco and vaping. We monitor this policy via our annual Declaration of Interest (DoI) forms, and through our Approved Exhibitor process.

This is not a review of the evidence. The harms and costs of smoking are well documented. Smoking is the leading cause of death and disease in the UK and tobacco addiction is the most common and most deadly comorbidity. In the UK there were 506,100 hospital admissions due to smoking in 2019/20, and in 2019 there were 74,800 deaths attributed to smoking among adults aged 35 and over.(https://commonslibrary.parliament.uk/research-briefings/cbp-7648/) .Recent data indicates that the rates of vaping are increasing in both adults and under 18s, including among never smokers. (Refs: Use of e-cigarettes (vapes) among adults in Great Britain ASH: https://ash.org.uk/uploads/Use-of-e-cigarettes-among-adults-in-Great-Britain-2023.pdf and Use of ecigarettes (vapes) among young people in Great Britain ASH:  https://ash.org.uk/uploads/Use-of-vapesamong-young-people-GB-2023-v2.pdf)

2. Summary of our position
BTS believes that only clean air should be in the lungs.

BTS supports legislation to achieve a smoke-free and vape-free society to eradicate smoking-relateddiseases.

Vapes are not risk-free and we support the use of regulated vapes* only for very specific purposes.
Summary of key messages:
- BTS will not countenance the involvement of the tobacco or vaping industry in any of itsactivities.
- People who smoke need help and support with their tobacco addiction.
- BTS acknowledges the role that regulated vapes can play to help people who smoke to stop smoking completely, particularly when used alongside behaviour change support from a tobacco dependency advisor.
- People who smoke and use regulated vapes as a tool to quit smoking should be supported with their nicotine addiction so they can end their use of vapes completely.
- People who have never smoked should not vape.
- Vapes should not be used by any individual under the age of 18 years.

BTS POSITION STATEMENT ON TOBACCO AND VAPING October 2024
The Society does not condone cannabis/water pipe/shisha/opioid smoking – but this is not covered in detail in this statement as this is not related specifically to tobacco. BTS does not condone the use of smokeless tobacco.

3. Tobacco and vaping in children Tobacco and/or vapes should not be used by anyone under the age of 18. BTS supports the need for legislation to protect under 18s from targeted advertising of vaping products.
BTS supports recommendations set out by NICE, the Royal College of Physicians of London, the British Paediatric Respiratory Society and others to reduce the impact and uptake of tobacco in children including smoke free legislation, limiting exposure to images depicting smoking and vaping on all forms of media and protecting children from passive smoking. A recent report from the World Health Organisation highlighted concerns around the aggressive marketing of vapes to young people, including via social media and influencers. (Ref: https://www.who.int/news-room/questions-andanswers/item/tobacco-e-cigarettes.

Pernicious effects of smoking on unborn children are well documented. BTS supports increased information and support for women who smoke.

4. The tobacco and vaping industry

The tobacco industry must have no opportunity to influence, profit from or be involved in the delivery of UK healthcare. BTS openly opposes any healthcare organisation with funding or formal/informal ties to the tobacco industry.

Through a variety of overt and covert means the tobacco industry continues to influence uptake, continuation and intensity of smoking in both the developed and the developing world.

BTS will respond strongly, as a Society and with other organisations, to condemn the involvement of the tobacco industry in academic and research organisations.
BTS is concerned about the role of tobacco companies in vaping.
BTS acknowledges the global nature of tobacco and vaping challenges and promotes collaboration with international partners. This aims to share best practices, align policies, and combat issues like cross-border marketing tactics and misinformation from the tobacco and vaping industries.

5. How this statement will be applied by the Society
Engagement with the Society
Members:
Membership of the Society is not open to persons who are or have been full, or part-time, employees of, or paid consultants to, the tobacco or vaping industry, at any time during the ten years prior to their application for membership. This includes any involvement in the marketing of vapes.

All members of BTS Committees and groups are required to complete an annual Declaration of Interest (DoI) form at least annually, with updates expected as required.

If evidence reveals a relationship with the tobacco or vaping industry either before or after joining BTS, we reserve the right to cancel an individual’s membership with immediate effect. BTS accepts that our members may have an indirect association with vaping companies, and we will not sanction members who:
- Include regulated vapes as a component part of their evidence-based tobacco dependency treatment service.
- Engage in research/audit/quality improvement projects that contribute to the evidence-base around:
* the effectiveness of regulated vapes to treat tobacco dependence.
* the effect of vaping on respiratory health.

Industry:
Companies who are either owned by, or have an association* with, the tobacco or vaping industry:
- Are not permitted to attend or exhibit at events organised by the Society.
- Will not be approached to support any of the limited number of specific activities that require external funding (e.g. conference awards).
- Cannot fund publication (wholly or in part) of papers published in the Society’s journals. Thorax and BMJ Open Respiratory Research have specific policies which prohibit tobacco company sponsored research publications.
- Will not be able to register as stakeholders to receive newsletters from BTS. The Society notes that there may be instances of an organisation being linked to a tobacco company without intent through a prior third party arrangement. Where this occurs, senior members of BTS Board and Head Office will assess each case on an individual basis.
* "Association” refers to any formal or informal relationship between the company concerned and the tobacco industry to be decided at the discretion of the BTS Board and Head Office. Treating tobacco dependence and the role of regulated vapes

BTS supports:
• Equality of access to tobacco dependency services irrespective of postcode, and to those that are homeless, in temporary accommodation, or asylum seekers. Providing more support with tobacco addiction to those with the highest prevalence of smoking.
• Efforts to reduce the burden of smoking in people with mental health disorders. The BTS Clinical Statement on the medical management of tobacco dependency for hospital clinicians summarises the relevant evidence and good practice (ref: https://www.brit-thoracic.org.uk/qualityimprovement/clinical-statements/medical-management-of-inpatients-with-tobacco-dependency/ ).

BTS supports the view that many smokers:
- may not be able to stop smoking in one step.
- may want to reduce the amount they smoke.
- may want to stop using tobacco but continue to use nicotine.

Vaping is not harmless, but the Society acknowledges the role that regulated vapes can play in the following specific circumstances:
• to treat tobacco dependency when there is a clear focus on helping individuals to stop smoking completely.
• when combined with support from an expert trained to help with tobacco dependence. Smokers who use regulated vapes as a tool to quit smoking should be supported to end their use of vapes at the appropriate time and ultimately to stop vaping.
We also support the recommendations in the NICE Guidance document (NG2009). For those working in primary care, the Primary Care Respiratory Society has published a position statement on the use of e-cigarettes as a smoking cessation aid. (Ref: https://www.pcrsuk.org/resource/current/pcrs-position-statement-e-cigarettes)

BTS is concerned about the significant rise in vaping in recent years. Vaping is not risk free, and people who do not smoke should not vape.
BTS is concerned at the rise in vaping in people who do not smoke and those who are under the age of 18. We believe more high-quality, independent research is needed to examine the effects of vaping on the respiratory system. BTS supports continued research into the health effects of vaping, particularly on respiratory health, to inform evidence-based policies and clinical practices. This includes advocating for independent research that is free from industry influence, ensuring transparency and credibility in findings related to vaping and tobacco use.

Government legislation
BTS will:
- Support legislation to create a smoke-free and vape-free society.
- Support legislation in relation to preventing the selling and marketing of vapes to under 18s.
- Support legislation to ban single-use vapes.
- Support legislation to prevent the sale and marketing of vapes to adult non/never smokers.

Combating misinformation
BTS will support:
• Strong individual and BTS responses to counter misleading research or media articles, particularly those that undermine tobacco control efforts.
• Strong individual and BTS responses to inform the discussion about the use of regulated vapes in the context of treating tobacco dependence.
• The provision of accurate information for members of the public about smoking and vaping risks, especially targeting youth and vulnerable groups, to prevent smoking and vaping initiation among non-smokers and adolescents.
• Strong individual and BTS responses to make clear that tobacco industry funding of academic institutions is unacceptable.
• Disassociation from institutions accepting tobacco industry funding and companies promoting vaping.

• Working with colleagues in Europe and internationally to continue to combat misinformation about and active promotion of tobacco products and vapes in emerging markets.
*Regulated vapes are those regulated under the Tobacco and Related Product Regulations 2016,
amended by the Tobacco Products and Nicotine Inhaling Products (Amendment Etc.) (EU Exit) Regulations 2019 and 2020 to enable tobacco and e-cigarette regulation to continue to function following the UK’s withdrawal from the EU.