Agenda item

To provide an overview on nicotine addiction and vaping in Brent, including both national and local contexts and available data.

The Chair opened the item by reminding members of the Committee that this particular item had been brought to the Committee by Brent Youth Parliament (BYP), and therefore he would be inviting them to contribute to the discussion. He then asked officers to introduce the report.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the report, which she advised covered nicotine addiction and vaping in Brent and touched on national policy and legislation as well as providing the local context. She advised members that it was important to recognise that, whilst smoking was the focus for the vast majority of national policy and effort, locally in Brent there were a variety of ways nicotine and tobacco was used, including shisha smoking and chewing tobacco, which the paper drew out. The report also spoke about the health risks, which for smoking were relatively well understood in the community, but for shisha smoking and chewing tobacco, despite the strong evidence base, were generally not well understood by communities. For vaping, research was in its early stages, and whilst it was clear there were some health impacts, the long-term impacts were not yet known. There was also a gap in knowledge specifically related to the long-term effects of vaping on young people, and research had now been commissioned to address that. She advised the Committee that the data in the report on levels of smoking came from 2 sources – the national survey, which she added was robust at a borough level but not granular enough to see ward level data or different groups, and data from WSIC (Whole Integrated Care System) which used local NHS data derived from GP surgeries, allowing public health to look at subgroups of people in the population, but which could not be taken as the whole truth due to the variance across GPs in terms of timeliness of recording and reporting data. The report then detailed the service response and what was planned moving forward, and the Council had been fortunate in bidding for additional funds for tackling nicotine addiction, some of which had been used to recruit a Smoking and Nicotine Addiction Team who would help people using nicotine to overcome that addiction.

Dr John Licorish (Public Health Consultant) added that there was upcoming legislation relating to smoking and smoking age coming through parliament, with the proposal that no-one born after 2009 would be allowed to smoke. Whilst that legislation was being brought through the parliamentary process, in the short term there was funding to increase the scope, attention and evidence base around smoking and vaping.

Councillor Neil Nerva (as Lead Cabinet Member for Adult Social Care, Public Health and Leisure) thanked Brent Youth Parliament for bringing the item in front of Scrutiny and looked forward to a discussion on how the work could be taken forward in Brent.

The Chair thanked presenters for their introduction and before inviting comments and questions from the Committee he asked Brent Youth Parliament to introduce their anti-vaping campaign. BYP explained that, in 2024, over 2,000 young people in Brent took part in the Make Your Mark Ballot. Crime and safety in Brent had been voted as the top priority, and from that, there had been discussions in BYP about the specific issues affecting young people in the borough. The main concerns were underage vaping, the selling of vapes with illegal substances in them and the accessibility of vapes for young people. Following discussions, BYP had agreed that the issue should be raised with the Community and Wellbeing Scrutiny Committee. BYP had also met with the police on several occasions to see how they could support the campaign, and held a public safety neighbourhood meeting with headteachers, community leaders and the police to raise further awareness of the campaign.

The Chair then invited comments and questions, with the following issues raised:

The Chair invited Brent Youth Parliament to lead the discussion as the proposers of the item. Brent Youth Parliament (BYP) representatives began by highlighting the details in the report regarding an expansion of support for young people in relation to smoking, vaping and nicotine addiction and asked for further information about that and whether parental consent would be required for young people to participate, acknowledging that some young people would not want their parents to know that they had been using nicotine. Dr Melanie Smith advised BYP that the plan was to locate the new service within a wider young people’s service called Elev8, which already provided a range of health and wellbeing services to young people. She advised members that young people were very much a part of the decision-making process within Elev8 and had named the service. The reason the new smoking, vaping and nicotine addiction service for young people was being located within Elev8 was because they were the experts in working with young people and were well versed in dealing with issues of confidentiality and consent.

BYP highlighted that, from the data, it was clear that adults smoked and vaped more than young people, but the report referenced a reduction of harm to adults from vaping as opposed to smoking, whilst for young people there was a potential for vaping to be harmful for a developing brain. As such, BYP asked that if there was more potential for vaping to harm young people whether there should be a greater focus on young people and further research on the effects of vaping on young people specifically. Dr Melanie Smith agreed, highlighting that national legislation was long overdue on this in terms of the protection it could offer to young people. She felt there had been a missed opportunity when vaping first emerged to help people understand the importance of preventing the acquisition of addictions at a time when they may not be fully aware of the consequences, as many health professionals had seen vaping as a good thing as switching from cigarettes to vaping was much better for health. Professionals had not anticipated how clever industry marketing would be in targeting young people and making their product incredibly attractive to young people, which had subsequently allowed young people in small numbers to develop a nicotine addiction not through cigarettes but through vaping. She saw legislation as the solution to tackling this.

The Committee were pleased to see that the Council was committed to tackling smoking and smoke-free tobacco and nicotine, but felt there was a lack of detail in the report on any engagement or active work being done relating specifically to under 18 year olds. John Licorish felt that it was important to target young people when tackling smoking, vaping and smoke-free nicotine use, and the legislation would support that. He advised that the specific issue relating to young people currently was vaping, and whilst it was true that it was better for a person’s health to vape rather than smoke, there was an emerging category of people who had never smoked but now vaped, which was an area of national concern. Due to the emergence of vaping amongst young people who had never smoked, Elev8 had been asked to further develop a young person’s smoking and vaping service. Elev8 did already see young people who smoked and vaped, but that work would be expanded. In relation to work in schools, Dr Melanie Smith highlighted that there had been some work in schools although not as much as she would like, and Public Health was open to working more with schools. She highlighted that lecturing children and young people that smoking and vaping was bad for you did not resonate with young people, so a holistic approach was taken, looking at risk taking behaviours with a third sector organisation running assemblies about making choices and risk taking in a broader approach, avoiding ‘wagging fingers’. She added that smoking and vaping were not areas schools were asking for interventions in and they had a lot of other pressures they were addressing, particularly around children and young people’s mental health. Despite the different priorities of schools, Public Health did have good links with headteachers and was currently working with the Harlesden school cluster around a range of messages and had found that offering a menu of options did increase a headteachers willingness to give that time in the busy school day.

Continuing to discuss the approach to young people and smoking / vaping, the Committee asked how effective the Council was at speaking to and listening to young people, and whether they were being spoken to in a language they understood. They heard that the Council’s third sector organisations were much better at relating to young people and speaking their language, and Elev8 worked specifically with young people to design messages, so it came from young people for young people. Dr Melanie Smith added that it was clear that the messaging and approach needed to be different from that for established smokers, which was why the Council had commissioned and recruited to the new service.

In relation to the accessibility of vapes for young people, BYP representatives highlighted that young people in uniforms had been able to buy vapes in corner shops, and asked whether there was anything the Council was doing or could do to reduce or prevent that. Dr Melanie Smith highlighted that the report was focused on the Public Health element of smoking, vaping and nicotine use from a community health and wellbeing point of view, so had not addressed enforcement, but confirmed that there was a considerable amount of activity happening around enforcement, including mystery shopping where young people went into shops and test purchased. One factor that was influencing the accessibility of vapes was that the financial penalty of selling to underage buyers was disproportionate to the profit. That would change with the introduction of the new legislation.

Highlighting that the majority of young people engaged in campaigning against smoking and vaping were those who were not smoking and vaping or those who saw the negativities of smoking and vaping, BYP representatives asked how the Council planned to engage young people who saw it as a positive or did not see the negatives of vaping. Dr Melanie Smith agreed that those most willing to have the conversation were those who were probably not vaping or were vaping but wanted to stop, and it was much harder to get through to someone who did not see the negatives or who was vaping. She advised that when Elev8 spoke to young people about vaping it was done with messaging through other activities that young people enjoyed such as drama club, so that they were being engaged about issues Public Health wanted them to be aware of whilst undertaking activities they were interested in, making them more likely to engage in those messages.

BYP noted the government scheme to undertake a 10-year research programme looking at the effects of smoking and vaping, but, considering the increase in vaping from 2022 to now, highlighted that vaping in young people looked set to increase. They asked what data or solutions could be sought in the meantime. Dr Melanie Smith advised BYP that Public Health was hoping to undertake a survey in secondary schools, which other boroughs had done with varying degrees of success. She advised that the success of the survey was dependent on how the school approached the survey and how much faith young people had that their answers would be confidential. The boroughs who had seen a more successful return of the survey had utilised digital technologies to do so. As such, if Public Health could get a critical body of headteachers on board, the group could then look to talk to BYP about what would make the survey effective and what would enable young people to be honest in their answers.

In response to how Public Health planned to collaborate in future with headteachers to create the same standards across schools with regards to tolerance on vaping, BYP heard that it was a challenge to work with headteachers as they all had their own approaches, policies and priorities. If some of the health issues associated with smoking and vaping could be linked to the priorities of headteachers, such as to educational attainment and students’ life chances, then there was a better chance of getting headteachers on board.

The Committee asked whether work was being done with the various community leaders in Brent to speak to the community about prevention. John Licorish confirmed that this formed part of the wider work Public Health and Brent Health Matters (BHM) undertook in different areas with faith groups and community organisations. Some focused work on specific issues in the borough was also done working with third sector organisations, such as tackling chewing tobacco and the use of shisha. BHM helped develop materials for the community and messages that helped to deliver that work.

The Committee acknowledged that the focus nationally was on smoking and vaping, but in relation to chewing tobacco there were other parts of the country with similar use to Brent such as Tower Hamlets, Leicester and Birmingham who had used various initiatives to tackle chewing tobacco with varying success. As such, members asked whether Brent had connected with those boroughs to share learning and, if not, whether Brent would commit to doing so. Dr Melanie Smith highlighted Brent’s networks in London were very strong. Brent was part of the London Tobacco Alliance and learned from colleagues in London. However, it was acknowledged that this was London-centric and there was an opportunity to look further afield to see what other areas were doing in that space. Councillor Nerva highlighted that there was also high prevalence of chewing tobacco within the NWL ICB footprint including Ealing and Harrow, and hoped to see a NWL-wide focus on reducing that use.

Further detailing the work Brent did to reduce the use of chewing tobacco, John Licorish advised members that colleagues across health and social care and London North West University Healthcare NHS Trust had been checking for risk factors of chewing tobacco, due to the increased risk of head and neck cancers associated with chewing tobacco. This work had utilised the oral health bus and had taken place in Alperton, with an aim to do more of that, testing members of the community and referring them to an onward pathway. There was a focus on the risks of tobacco chewing to the chewer, with 1-1 interventions seeing the most impact. By inviting people to see a dentist for an oral health check through the oral health bus, which had proved popular, this gave the opportunity for some 1-1 counselling about chewing tobacco, with a professional explaining and showing graphic images of the risk of head and neck cancers proving effective.

The Committee asked whether an effort was made to communicate with tobacco chewers in the places where they gathered and in their language to discourage use. John Licorish assured members this was the case, with a factory workstream BHM and Public Health delivered covering a number of health issues. The workstream looking at chewing tobacco had started with one of the larger employers in Park Royal where there was found to be a high prevalence of chewing and smoking. The Council wanted to do more of that work and was looking at doing more work with medium sized employers now that the wider smoking team had been recruited, particularly in factories where the Council knew the levels of smoking and chewing were high. In relation to languages, it was confirmed that wherever possible the Council would speak to individuals in their own language. Across Public Health and BHM, over 50 languages were spoken, so there were a number of people from various communities who helped to tailor resources and communications in that way and work with natural speakers in the community.

In relation to the data in the report, the Committee asked whether the figures for smoking prevalence in Brent included all forms of nicotine use. It was confirmed that the figures were from the national survey which solely measured cigarette smoking. In terms of whether there had ever been an official study looking at what age people started smoking, officers confirmed that 4 out of 5 smokers started before they turned 18. When the Committee queried the figure of between 8-18 years old, officers confirmed that there were people known of locally who were primary school aged and smoking or vaping.

The Committee highlighted that some young people who smoked also smoked drugs, and asked whether those figures were included in the figures around smoking. They also asked whether there was a joined-up approach between the workstreams tackling smoking nicotine and smoking other drugs. Dr Melanie Smith agreed that often risky behaviours coalesced, but the report deliberately focused on only nicotine use, with the figures included only reflecting the smoking or vaping of nicotine or other nicotine use and not other drugs. She added that the Elev8 Service that would deliver the young persons’ anti-vaping and anti-smoking service had two strands, one dealing with substance misuse and the other a more general wellbeing service. The anti-vaping and anti-smoking service would be located in the general wellbeing service, which was seen to be more approachable and accessible, but there was expertise within the service with the other strand for substance misuse so that if a young person came forward for vaping but it was found they were using other substances then the service would be well equipped to explore and address that with the young person.

The Chair drew the item to a close and expressed gratitude to Brent Youth Parliament for bringing the issue to the Community and Wellbeing Scrutiny Committee. He then invited members to make recommendations with the following RESOLVED:

i)               To ensure parents are included in the approach to tackling vaping, smoking and non-smoking tobacco use

ii)              To share information and learning with other local authorities with similar issues, such as Leicester, in relation to non-smoking tobacco use

iii)             To further engage those whose first language is not English and other communities who the Council and partners may not be reaching.

iv)             To ensure targets are set to reduce vaping, smoking and non-smoking tobacco use.

v)              To meet with young people regarding their experience and views towards vaping and smoking to further understand their lived experience and needs.

A specific recommendation was then received from Brent Youth Parliament representatives, recorded as follows:

i)               To lobby for or undertake more research relating to young people vaping and smoking, and to incorporate data into future reports.

The Committee also made an information request, recorded as follows:

i)               To be provided with data on smoking and vaping prevalence by age, with a focus on 8-18 year olds.