Quiz - e-cigarettes and harm reduction
A quiz with no winners, no prizes and no easy answers
Prepared by Clive Bates
1. If you had a close relative who was a 20-day smoker, what advice would you give them about e-cigarettes?
The only safe thing to do is to quit all tobacco/nicotine completely - these are a distraction
They are unproven and we don't know what's in them - don't try them until they are approved
Try everything officially licensed as a medicine first - if that doesn't work then try ecigs
Try them if you want - they seem to work for a lot of people and it can't be worse than smoking
Great idea - I've bought you an e-cig starter kit for Christmas, let's get started
2. If you could choose between two theoretical outcomes for your community by 2020 what would you prefer:
Would you prefer a world with half the smoking but twice the nicotine use?
a) 20% adults smoking and no vaping?
b) 10% adults smoking and 30% vaping?
3. If you could halve the level of smoking from 20% to 10% how much vaping (% adults) would be worth accepting as a consequence?
80% or more
I would never prefer 20% smoking to 10% no matter how many adults are vaping
4. What are the arguments for and against a Marlboro branded e-cigarette - how should the issue be approached?
Select no more than two
Over my dead body - there are no benefits only problems
People will think e-cigs and cigs are the same and we should stress the difference
On balance it would be bad because it brings Marlboro back to life - but I can see it might help some smokers to switch
Could be useful to attract committed smokers, but needs same marketing restrictions as Marlboro cigarettes
Could be the biggest health product of the decade - as long as people know about it
5. How would you know when e-cigarettes were acting as a gateway to smoking for young people?
Select correct statements
If you see a rapid rise in e-cig use amongst teenagers - for example doubling in a year
If you see e-cig use rising and smoking rising too
If you can trace people starting with e-cigs and moving on to smoking
If you can see people starting to use e-cigs, moving to smoking and believe they wouldn't otherwise have smoked
You can't really tell because you don't know what would have happened without ecigs
It is theoretically possible for smoking to start before vaping, but vaping still be a gateway to becoming an adult smoker
6. Who should determine where people can use e-cigarettes using what criteria?
The law should decide and it should be banned everywhere that smoking is
The law should decide but it should be less restrictive than for smoking - e.g. to protect children
Property owners should decide and be required by law to clearly designate areas where it is allowed or not allowed
It's down to etiquette, and the assumption should be no vaping unless permission granted explicitly or by asking if it is okay
It's down to etiquette, but the assumption should be vaping is allowed unless explicitly banned or the owner asks you not to
There's no reason to restrict it anywhere - we don't stop people wearing perfume or using air freshner
7. Should e-cigarettes be made more addictive?
Absolutely not, this is just about hooking the next generation of smokers - they should be made non-addictive or banned
No, addiction is a disease and a curse, regulators should be aiming to reduce e-cigarette addictiveness
No, we should set design criteria that limit the addictiveness - it's not an area where I want to see any innovation
Yes, they should try to get closer to the smoking experience but I'd drawn a line at additives that increase addictiveness
Yes, we need products that compete with cigarettes - if that means additives that boost the satisfaction, then I'm in favour
If we really want smokers to come over, we should actually favour products that are MORE satisfying, and hence potentially more addictive, than cigarettes - just as long as they are much less harmful
8. Big Tobacco is moving in to e-cigarettes - it is probably inevitable but is it good or bad for public health?
Select the one that most closely reflects your view
Bad - they just see e-cigs just as way to keep people smoking
Bad - they make their money from addiction and they don't care what you are hooked on
Bad - they will try to capture the e-cig market and crush it
Who cares? As long as the market is competitive they will need to get people to switch before their competitors do
Good - they've got deep pockets and lots of know-how - they know how to get this to scale
Good - if this gradually changes their business model they might become the biggest players in the endgame for smoking
Absolutely essential - unless they find a new way to way to make money, they will block this every inch of the way
9. Your mother is 85 and gave up smoking 30 years ago, but says she enjoyed it and still misses it. She tells you she's thinking of trying an e-cigarette. How do you react?
Oh grow up!
Have a glass of sherry instead
You'll be putting yourself at needless risk from products we don't fully understand
If it she wants to try it and it makes her feel better, then why not? She's 85 for goodness sake!
I wouldn't wait for her to suggest it - I'd like to surprise her with something from the modern world she might actually like
Here is an advert for an e-cigarette brand
10. Do you approve of this sort of advertising?
Select the one that most closely reflects your view
This is basically a covert ad for smoking - it should be banned
This aims to glamorise vaping and draw in new users - it should be banned
I don't mind ads aimed at promoting smoking cessation with e-cigs, but this goes too far
The company is irresponsible - while I respect their right to do it, I don't think they should
So what if a few non-smokers or kids are attracted what matters for health is getting smokers to switch
I love the chic and retro feel - this will appeal to smokers and entice more to switch
This is tame - we should let the ad creatives loose on e-cigarettes to do whatever it takes to get smokers to switch
11. The European Union ban on oral tobacco (snus)...
should stay because it would be a backward step for public health to relax a ban on an existing category of tobacco
is justified because snus is not safe and may cause cancer and heart disease
is justified by the precautionary principle
should be lifted in theory, but it just isn't worth the trouble
is no longer justified based on what we know about the products and experience from Sweden and Norway
is a lethal 21-year error that should never have happened and should be reversed immediately
is partly my fault and I would like to apologise for everyone who has died as result
12. If I was in charge...
E-cigarettes would be banned - they are a harmful distraction
E-cigarettes would be regulated as just another form of NRT
E-cigarettes would be controlled with tough product standards and strict marketing controls to protect non-smokers and kids
I'd stand back and let this disruptive technology out-compete cigarettes through consumer choice, innovation and market forces (using only safeguards of existing law)
I'd shape policy and markets to make e-cigarettes and non-combustible tobacco a major part of my endgame for smoking
13. Compared to smoking cigarettes, would you say that electronic cigarettes are…
This reproduces a HINTS survey question
Much less harmful
Just as harmful
Much more harmful
I've never heard of e-cigarettes
I don't know enough about these products
14. If giving people truthful non-misleading information about relative risks was found to increase smokeless tobacco use and leave all other tobacco use unchanged...
If people believe products are more risky than they are, then truthful information may increase use
That information should be withheld - we are here to reduce tobacco use
That information should be disclosed - we are here to support informed choice
15. Suppose a new low-risk nicotine product has the effect of reducing adult smoking by 10 persons in a representative group. I would be opposed to its introduction if it:
Increased teenage smoking by 1 person
Increased teenage smoking by 5 persons
Increased teenage smoking by 10 persons
Increased teenage smoking by more than 10 persons
I wouldn't be opposed: by the time the teenagers are old enough to get ill, these products will be there to help them quit
I wouldn't be opposed: it doesn't matter what effect it has on other people, everyone has the right lower risk products
16. If you were pressed to give a quantification of the comparative risk of vaping and smoking, would you say...
The is no reason to believe vaping is any less risky
About 20% less risky
About 70% less risky
About 95% less risky
LIkely to be at least 95% less risky and probably substantially lower than that
About 99% less risky
There is no reason to believe vaping causes any serious risks
17. In terms of drug (not smoking) harms, if caffeine is 1 and alcohol 5, where do you place nicotine?
Much worse than alcohol
18. What is the most appropriate 'endgame' objective?
Please reflect on possible trade offs between objectives
To reduce tobacco-related disease and premature death as far as possible
To reduce smoking as far as possible
To reduce tobacco use as far as possible
To reduce nicotine use as far as possible
To reduce nicotine addiction as far as possible
To destroy the tobacco industry
To make sure anyone using nicotine can control their health risks if they want to
19. If nicotine could be taken without most of the health risk, the personal cost would go down and demand would go up.
I would be concerned about this and want policies to stop any rise
If people can use it without much harm, I'm not worried who does use it - there are more serious problems to focus on
20. What do you think of "heat-not-burn" heated tobacco products?
Products are likely to create toxic exposure at least 90% lower than smoking but higher than vaping.
The tobacco industry trying to survive by keeping people hooked on tobacco
An unnecessary distraction - vaping is a cleaner and better alternative - no reason to settle for second best
A niche (like pipes) - few people will want it, it doesn't really matter
Will help to attract more smokers to non-combustible products, but once they've shifted most will move on to vaping
Could reach far into the smoker population because it is a much closer simulation of smoking
Is integral to the endgame and worth any extra risks compared to vaping because it is a lot less risky than smoking
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