Sairah Salim-Sartoni has 16 years’ experience as a stop smoking advisor in the UK; first for the National Health Service and then for local authority stop smoking clinics. She went on to work for Juul Labs on scientific engagement, and now consults with both the public and private sector on smoking cessation and tobacco harm reduction
When did you first encounter vaping as a stop smoking specialist?
I think it was 2011 when the first patient showed up at a group session with an e-cig; I remember there was a blue light at the end of it. My first reaction was, “what is this? What is this? What have you brought into my clinic? You know, we deal with licensed medicines, and here you are with this device. God only knows what this is and how it works or if it’s safe to use!”.
But then slowly, I started to realize what was happening. We had started another clinic in 2012 at Southmead Hospital where there were hundreds of workers - builders, contractors, carpenters, plumbers, electricians - on site. So we did a “White Van Man week” where we would introduce NRT and support them with a quit attempt.
At the time, manual workers had a high smoking rate of around 30% so it was a vital part of our service remit. Lots of the people we came across had already started to use vapes, and we found that the best success rate from came from combining patches and vapes. At that point I realised that my clients were becoming more and more successful and that had to be a good thing.
Between 2012-14 researchers were starting to look more into the science of e-cigarettes, but we still had no confirmation on safety and we still weren’t giving them out, but people were voting with their feet at that point. From there I decided that we needed to get on board with this and become an inclusive, e-cigarette friendly service.
And then in the August I think of 2015, we had that wonderful report from Public Health England which confirmed that vaping was far less harmful than smoking. The relief was immense. Our clients could now feel reassured in using something that they enjoyed and that kept them away from smoking; and just like any stop smoking specialist I just wanted success for my clients. I knew this was the way forward because our quit rates had significantly increased from around 45% to around 60-70%.
The UK has seen an increase in youth use recently. What’s driving that?
The thing is, it’s often the same factors that help adults use vapes to reduce or stop smoking. Disposables are so much more accessible and easy to use, but those factors and the addition of bright colours and attractive flavours and their descriptors also attract kids, and kids will experiment. If you look at the data coming out of the US, the peak for youth use was five years ago, and thankfully we’ve seen a significant decrease since then. My guess is that this will happen in the UK too over the next couple of years.
I do worry that the policy reaction to this may result in disastrous consequences for smokers and vapers alike. As a clinician you want the best tool to unlock a smoke free life for your client and I fear that the most successful tool I have seen is now coming under threat in one way or another.
A potential flavour ban could cause huge issues for those who vape flavours to remain smokefree. It simply won’t have the same appeal for smokers and could be the reason they go a back to smoking or worse use illicit products which will not be as harm reduced as regulated products.
Youth access and youth prevention will be at the heart of future policy making and irresponsible marketing practices like cartoons, bright colours need to be addressed. But protecting effective and easy to use vaping products for adult smokers and vapers must also be paramount for future policy making.
But in terms of stop smoking services, vaping is now essentially approved by UK clinical guidelines, right?
Yes, it was approved by the National Institute for Care and Health Excellence in 2021. But only 40% of services were providing e-cigarettes in 2021 and it then rose to 52% in 2022. In part that may have happened to a greater extent due to shifting public health from the NHS to local government in 2013-4. Decision making now had another layer to and was not public health’s alone to take. An example of this is highlighted in a recent ASH and CRUK report, New Paths and Pathways:
“In spite of the Khan review, PHE and NICE guidance, there is a reluctance at senior leadership level to directly fund any vaping provision as a quit aid due to what is felt to be a lack of evidence about the long-term impact of vaping, concerns about people continuing to smoke while they vape and vaping in the long-term and also concerns about young people then seeing it as harmless and it potentially being a gateway to smoking in the future.”
Other reported justifications from councils included the gateway hypothesis, harm to youth and conflicting evidence.
You moved into industry when your stop smoking service was shut down and staff were offered voluntary redundancy. We hear a lot about how people who have made that career choice are often stigmatized by former colleagues. Has that happened to you?
You can’t be all things to all people. You have to be true to yourself.
With all my clinical experience I had seen that vapes gave my clients an effective tool to take back control of their health, and when it became clear that my service was closing down I started to look further into THR and industry to explore other ways to support tobacco consumers to quit smoking using vapes. In 2017 I had been asked to become a trustee of the New Nicotine Alliance which furthered my interest in THR and in 2018 I attended the Global Forum of Nicotine and was introduced to industry stakeholders which led me to apply for a role at Juul Labs UK.
People are entitled to their own opinions, but I am proud of my choices. I have learned so much and that gives me a unique perspective.
You’ve recently got back into the clinic after all these years! How has it been to be back seeing patients?
I’m back as a tobacco dependency advisor at one of the hospitals in Bristol, so working to help smokers quit in their most vulnerable moments. I did that for five months earlier this year, and I'm on their books to provide cover whenever they need it. It is a privilege to do this work, there is nothing quite like the job satisfaction.
You see some patients may have had a had a heart attack, come in with COPD exacerbation, or they've got cancer or they've had amputations and you get to support them through such a stressful moment helping them to make informed decisions on how to stop smoking and thanks to the Swap to Stop scheme that now also involves providing them with vape starter kits.
It can be incredibly difficult for some patients. They can come in for one health condition and get diagnosed with something else. And so the challenge is, they may not want to necessarily think about stopping smoking due to their stressful situation. They can be so stressed that smoking is their only way to help them deal with their hospital stay and the situation that they're in. So it's not always easy to have that conversation.
But I really enjoy going in and sitting with them, listening to them and then gently, gently you can start to approach the subject.
Any particularly memorable patients?
I think the most memorable experiences I have had would be supporting those patients who are very anxious about stopping. Some will even refuse NRT. In those cases what really helps is letting them know that they don’t need to think about stopping smoking right now and that they can just focus on looking after their cravings while they are in the hospital. It’s all about supporting them to make that first step.
We then go into how nicotine addiction works, that they smoke for the nicotine but are harmed by burning tobacco. And that they do not need to give up the nicotine that they smoke for we just need to separate the harm from the nicotine and then they can still use it in other forms like NRT (which still has a vital role to play) and vaping. Many are so relieved to hear that and for me to be able to reassure them and give them enough facts around vaping that they feel they can give it a go means the absolute world to me.
Generally, we make follow calls to see how they are doing and, in some cases, it’s been amazing to hear from quite a few that they went out to buy vape products (before swap to stop was initiated), had either reduced or stopped smoking and sometimes their partner also joined them on their quit attempt. They are feeling better, recovering well and saving money… in some cases hundreds of pounds in just a few weeks... and that’s the magic right there… that’s why I love clinical work.
