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Marewa Glover: Good morning, everybody. Hope you're feeling fine. Hi, Colin. Lovely to see you. So we'll get it underway, but please come in and join us. We haven't started yet. You're not late. We're starting now. So I'm Marewa Glover. I'm from New Zealand. I've been doing tobacco control for 31 years. Got to keep adding them, which is a good thing, really, then, because I'm still alive. So, this is a workshop in the real sense of a workshop. We're going to put you to work. We're not going to sit here and talk to you. We're just going to introduce ourselves and then I'll explain what these groups are and that you may move to a group that is of more interest to you. So, what else about me? Behavioural scientist, I am an indigenous person of New Zealand, but I also have Irish and English backgrounds, so, you know, I acknowledge all those different sides. And I will introduce my co-facilitators. So as co-facilitators, they're going to just help. We're going to come around and make sure that you're all progressing with the task and not talking about what you did last night. And I think that Sura's also going to come and help us because we have quite a lot of groups here. I'd like to introduce Karen from my team back in New Zealand. She'll be also popping around to make sure you have everything you need. What happened to my husband? Is he lost again? All right. And Steve, my partner in business and life, is also here to help everything run smoothly. So can you introduce yourself?
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Tomás O'Gorman: Yeah, I'm Tomás O'Gorman from ProApea Mexico, and a consumer. And I am very honored to be here with you and participating in this workshop.
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Judy Gibson: Hi, I'm Judy Gibson from INNCO, which is a consumer organization, a global international one, which I think you probably all know. So that's probably enough for me except to say welcome, and I'm so pleased you're all here. Thank you.
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Marewa Glover: Okay, so I hope that you have looked at my global, my GFN 5ers, little five-minute videos. So in 21, we did one on the barriers to quitting or switching that we found among, we have a longitudinal study, very in-depth, there you are, Sud. Yep, great, thank you. Longitudinal study, in-depth, qualitative. We do phone interviews. We started with 62 people and we're following them through. We're up to our 23 GFN5 are reporting barriers to switching or quitting at two years. We've now got two years of data from them. The 2022 GFN Fiverr, we looked at the facilitators of quitting or switching. So what we want to do today is hear from you about barriers to switching to a harm-reduced product. It could be heat not burn or vaping, whatever you have in your country. And the barriers that are stopping people from, I think we'll focus on switching, but you can talk about quitting, it's similar, right? The barriers to switching, we have, that's the sheet that's on those, what are they called? Sheets. Yeah, the sheets, there's one, the barriers one is up, and then we have the facilitators. So first, if you will brainstorm in groups, the barriers. to whatever group you're, and we'll do that in a minute. Then we will get some feedback from you all about the barriers. Then the next one will be look at the facilitators. What have helped people to switch? And what's facilitating that transition or change? Again, for the group that you are in and focused on. Now, groups. As people were coming in, I've been asking what you're interested in. This one here, could you put your hand up? That one there is focused on the barriers to switching for people with low INNCOme. This group over here, hola, hola. This group over here are focusing on the barriers to switching in South America. Multiple issues there. Low INNCOme, language, you know, non-English speaking countries. So they're focusing on South America. It will touch on low INNCOme, it will touch on non-English speaking. We have... Did we have another one sorted out? Because really what the other groups will be depends on you and what your interests are. I would really like to see a group focused on the barriers to switching for people with mental health conditions. So is anyone interested in that? Yes? So okay, this is the group here that will focus on the barriers to switching or quitting for people with mental health conditions. Over here, do we have any more people interested in countries that really are more heavy on the heat, not burn? Korea, Japan, if there's anyone else interested in that. What other interests are there? Is there a group that wants to focus on countries that have regulated, and that's the focus, or are going towards prohibition? So Australia. A group that... Does it have to be a specific focus? The barriers to switching for people with mental health conditions, because that's common across the world, perhaps. Or you can have like a region. There could be a region.
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Judy Gibson: People with major health problems. Mental.
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Judy Gibson: It just could be anxiety. ADHD.
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Marewa Glover: Comorbidities that might work for you, the comorbidity group. Why don't we do a comorbidity group? So those are people that are obviously seeing the doctor a lot and would be relying on, yeah. Okay, so that group over there is looking at comorbidity. If you want, yes? Have we got enough people that want to form a group around people with excess weight, excess adiposity? Yeah, I mean it could be the same comorbidity group, people with comorbidities. Yeah, I think over there, right? Comorbidities and multiple health conditions. They're coming into contact with the health professionals all the time, so that will be that group over there. Any other interests? Young people, yes? Yep, so all right, let me explain the sheet. So we've done a pre, just to make it kind of easier, we have the sheets already with some categories on them. So with our voices of the 5% study and the analysis we did of the barriers, we came up with four Ds, you know, that makes it easy for people to remember. So we have, oh, I can't see them. Sorry, these boards are blocking. So the four Ds are distance, it's just too far away from smoking. It's too foreign. And it's too different from what they currently do. So anything in that kind of nature, you can just write it in distance. Doubt, doubt. It's as harmful as smoking. I don't know. But people are saying that it's dangerous. So they have doubt about it. So they'd rather not do it. Difficulty, the device. It's got too many buttons. I don't know how to use it. There's so many of them. I'm coughing, so anything about the difficulty of switching. And the other one is dilutes, diluted. So it's just, it's too weak, it doesn't work, I don't like it, I prefer smoking, there's no hit, you know. It's diluted, it's like you're a meat eater and it's like tofu. So, and then there's room for other barriers. And there's room for just notes, which is what you were saying, where have you gone, about potential ways to overcome these barriers. The facilitators one has a similar framework on it. So we have the four Ds. Now when we're talking about facilitators, why do I have the 4D, the barriers? It's because in our 2023 GFN Fiverr, What facilitates people switching is overcoming those barriers, is doing away with those barriers. So someone might say, oh, I went to a vape shop and they were really useful and they showed me how to use the device. That's overcoming difficulty. So that's why the four Ds are there. And then we have a section, this section on the side is benefits. It was a huge category in the people that had switched, the benefits of switching. And then there's a space for other. We just haven't worked out, there were some groups, do you want to move around now or any more ideas for forming a group? Barriers to switching for people with comorbidities over there, low INNCOme people here, South America over there. What was your suggestion, you want one? barriers for people who are interested in quitting and... How about a real universal one?
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Bengt Wiberg: Women and smokeless nicotine powder, snus, moist snuff, it's used
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Marewa Glover: So do we have enough interest in having a group focused on barriers to switching for women in the world? Women. Sorry? Women? Great. That group down the back is going to focus on the barriers for women and facilitators. Age? Older age? or just age generally. Okay. So we'll have you. Did you have a topic here? Mental health. This was for people for mental health conditions. People with comorbidity issues over there, including weight, including other addictions, including multiple health They're coming into contact with the health system all the time, so there's particular barriers they're going to face. So that's that one over there. And haven't got any down the back there. We haven't got many here for Japan, Korea, countries where the main product is heat, not burn, if there's anyone else here. You were doing low INNCOme. What are you interested in over here? What would you like to focus on? Journalists. The barriers to switching for journalists. So you might want to come and join a group. And you're doing? Women, okay. And so then we have another group over here. What would you like to focus on? What would you like to focus on, Bernd? Do you have a topic? Asia, you want to go to Asia, the Asia group? Yep. What about you? You're another journalist.
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Gal Cohen: Okay, good.
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Marewa Glover: Raluca, what group would you like to join? Okay. So we don't have one there. All right, have we moved around? Sorry, Asia. All right. So if you're all clear, if you could start, you need somebody to write on the board. You need someone to write on the board. You'll need someone to feed back when we hear from the different groups. So, you need someone to write and you can start. So, what we'd like now is just to hear back, you don't have to read everything because there's so many of you and we need to, we've still got another focus, another piece of paper. So, how are you going Sud? Down there, are you guys ready?
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Tomás O'Gorman: Are you guys ready to report back? All right.
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Marewa Glover: OK, everybody, we just want to hear back from each group, you know, a general... You know, what's interesting is, are the barriers the same? Are there differences? How is it varying across these different groups? So, if we could have someone from each group who's going to feed back and... Right. Might have to get Steve to come up and... I know, yeah. People are still talking. I'm trying to get their attention. Yeah. Okay, thank you. Are we ready? So, would you guys like to talk first about... Okay, everybody, could we have your attention? And we're going to hear back from our Japan, Korea, Asia group. where they have heat not burn as sort of more the primary product. Thank you. Thank you. Thank you. Thank you. Can we focus over here please and hear the feedback?
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Attendee: Hello everyone. Yeah, good morning. We are from the Asia group. We have only four people with us today. So our group has been given the task of covering Asia. So we talk about Japan, some of the Southeast Asia, things like Indonesia, Singapore, and Malaysia, where I come from. And we're covering again the domains that has been entrusted to us. So if I go one by one, Maria, is that right? Yeah? Yeah. All right. OK. How many minutes? Just briefly, yeah. So some of the issues that we have to switch basically from conventional cigarettes to reduced-risk products would include things like distance. In some of the areas that we cover, looking at Indonesia, some of the archipelago, and also in Malaysia as well, I assume things like Japan as well, there's going to be areas which are impacted by distance, geographical distance. For example, in East Malaysia or Borneo, there's a lot of mountains in the area, so not only vaping access, but also healthcare is a bit reduced in some of these areas. So vaping is quite uncommon in certain countries because of this distance maybe. Of course, there's certain policies probably in place by the industrious player and so on, but geographical distance is definitely in, because not only to access the tool, but also to access information. And this can be seen as well in some of the doubts area or domains where the information scarcity is there. A lot of information is sometimes misinformed. For example, our healthcare providers even in certain countries would say that vaping is even worse than conventional cigarettes. and this is especially impacted by the regulation as well and a lot of countries are also impacted in Southeast Asia are impacted by the black market. So we have a lot of misinformation that occurs because of this so it doesn't not only come in the form of media coverage but also from the healthcare professional and this is very worrisome when your own doctor could not make the differentiation between reduced-risk products and against cigarettes. They say that even vape is even worse than cigarettes, you know, things like that. So some of the other difficulties would be, you know, there's too much mixed information. If you go to, let's say, a vaping store, especially a vaping store which is not legalized or so-called not registered with the government, in some of the countries you have, we have a vape stores or these will be more of the illegal vapers or sellers or vendors, and there's no registration yet in some countries. So the products are too much, too many, different concentrations, some of the labelling are also INNCOrrect, they don't have the proper concentrations. So when they give advice, when these vendors or sellers give advice to the population or whoever is purchasing them, they are giving wrong advice and they are not able to actually educate what are the proper strength that the person are going to take for the first time and so on. So this leads to the improper instruction and also untrained sellers or vendors which are probably, you know. underground or selling inappropriately to young school children and so forth, which leads to the problems of young vapers, which happens a lot in our countries where the enforcement might be reduced. Our policy is not so strong compared with other countries. There have to be more investment into enforcement and regulations into these countries, including Southeast Asia countries such as my countries as well. And the regulations, of course, are not uniform, and we cannot blame the countries. Of course, the regulations are not uniform because different countries will have different priorities. But an example would be Malaysia and Singapore, how Malaysia, where the VAPE is basically all over the place, There's no proper regulations yet. Singapore is very strict on that. Some of the Singaporeans are accessing vape through Malaysia and basically they come in as illegal vapes, which are then sold in Singapore. So these are some of the issues. So how do you overcome that? Again, it is not one problem that can be solved. Of course you need some sort of regulations and governance by each country in Asia, and the tax must be risk-proportionate. Now this is an issue because in certain countries the tax might be reduced or very low, or in certain countries because of how people perceive it, so they would actually increase the tax and this happens in Malaysia as well, we need people who are trained, especially the medical professionals or not necessarily doctors, but if you go into selling vape, especially vendors and retailers, they need to be so-called, some sort of basic education on how they should relay the information to the buyers or to the population, and there must be a responsible media practice. Of course it has to cover the healthcare professional because this would be the biggest opponent in reduced risk product in Southeast Asia as well. Thank you. That's all.
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Marewa Glover: Thank you very much. Great job. Next group, one, two. We have low INNCOme. Is that right? Excellent.
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Andrew Manson: Hi. For the low-INNCOme areas, I mean, first of all, things we noted were that people on low INNCOme are not necessarily smoking factories-made cigarettes. They're often smoking rolling tobacco or illicit tobacco. And they're suffering quite often stresses and pressures, which basically mean that quitting smoking is not high on their priority list. There's a wonderful phrase from Sam here about intersectionality and in the fact that also people on low INNCOme are probably facing mental health problems or they're in marginalised groups. So there's a lot of There's a lot of influence of some of the other things that are being said in the room that particularly affect people on low INNCOme. In terms of the sort of 4Ds and other barriers, big ones are just lack of availability. There's less access to online, and often in retail environments or the other environments where they purchase product, the types of products that give them alternatives, credible alternatives, are just not available. The industry is very much focused on the premium end. because they need to make a profit, the products need to be sustainable, and there aren't enough products that are affordable for people on low INNCOmes. device delivered nicotine requires maintenance. It's not just buying the device, it's maintaining the device. And if you don't maintain the device, the experience is poor or becomes poor and people become disenchanted and go back to cigarettes. There's a lot of peer pressure amongst these groups. there's a feeling amongst lower INNCOme groups that these sort of products are not for them, they're for other sorts of people, there's a community of smokers and sometimes, I think Charlie mentioned that, When life is tough, the cigarette is the only pleasure left, and you don't want to give it up. There are more important things in these people's lives than quitting. Their health concerns are on a day-to-day basis, not on a long-term basis. When we come back to the Ds, in terms of doubt and difficulty, information access is hard. Often, you know, information is from tabloid press or from unreliable sources and there's a lack of trust and access of health professionals that might be able to give them reliable advice. In terms of difficulty, the cost of devices is prohibitive and and the availability is restricted. And I think the thing I mentioned before, cigarettes and use of cigarettes reinforces identity in some of these groups and identity becomes, again, very important for people on low INNCOme and in low socioeconomic groups. In terms of the dilution, Basically, the products that are currently available are still not as good as cigarettes in terms of delivering nicotine at a rate that's controlled by the consumer. So you can't puff harder or softer on a snooze. A lot of vaping devices will give you a a smooth delivery of nicotine, but you don't have the same flexibility that people do with cigarettes. When they use a cigarette, they can puff lightly on it, they can puff heavily on it, they can deliver the amount of nicotine they need for their situation. And cheap products do not deliver the same sensory experience. and only some of the more sophisticated products come close to delivering the sensory experience of a cigarette and cheap products are just frankly inferior. So there's huge barriers and quite honestly they seem to be a group that is only now being looked at because As I said, manufacturers need to make a profit, and there's no money in selling cheap products to low-INNCOme people. It doesn't become sustainable, and governments and regulators seem unwilling to fill in the gap.
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Marewa Glover: Excellent.
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Andrew Manson: Is there anything I missed, guys?
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Marewa Glover: Excellent. Thank you very much. Next group. Who's really... Colin?
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Colin Mendelsohn: So we're looking at people with mental illness. So I think what you said was very similar to our group, really. We didn't find much in the way of area of distance. In terms of doubt, we recognised that people with mental illness typically rely on cigarettes for relief of their symptoms and to help them to cope and so giving up smoking is a big concern for many of them. And you mentioned also pleasure and it often is the only thing that they, you know, their one last pleasure which they enjoy so they're reluctant to give that up but it does help them to cope and that's Just coping is obviously the first priority for many people. But the main things we looked at were difficulty. So for people with mental illness and who typically use other substances, there's a fear of their mental illness deteriorating if they quit smoking because they often self-medicate with nicotine. There's a fear of relapse if you're using another substance. People worry that if they give up their cigarettes they will relapse, which of course is not true. but that's what they're worried about. There's a lot of misinformation in this group that don't have access to the same resources, so they don't know as much about these things as other people. We've got stigma here. I'm not sure quite why we decided on stigma, but I'm sure there's a very good reason. And there is the issue of these people being heavily dependent. Oh, that comes more under dilution. They tend to be heavier smokers, they're more heavily dependent, so they're less likely to be able to quit, and they may well feel that vaping or whatever it is, some other alternative won't be strong enough to help them. If you've got mental illness and you're just struggling to cope, you may not see cigarettes as a priority. It's probably way down the list, even though you're more likely to die from that than from your illness. It's often way down the list, so isn't going to get urgent attention. It's harder to get support if you have mental illness, you don't have the same network, you may not have the same access to service providers or know how to access them, so it's harder to access these services. Your peers tend to smoke as well and there's a whole social aspect that you belong to that smoking group. There's the cost issue, often it's more expensive to get started on vaping. which is a problem for people with fixed INNCOmes. And there are often cognitive issues as well, which interfere with their ability to research and explore the options available. And stress, of course, will undermine their ability to achieve that goal. And that one I covered. So yes, that's all we have, I think. Homeless and in prison. Oh, sorry. Yes, so another group that we mentioned is the homeless people and in prison who have less access and have more difficulties using these products. Yeah, okay. Thank you very much.
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Marewa Glover: Just going over to Latin America now. We'll come to you next, Sud.
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Attendee: Okay, we are the Latin group in Spanish. I will do it in English. We are the LATAM group, or as I call it, the Wild West. And why is that? Because in LATAM, most of the countries, they have either a prohibition or a lack of regulation for these alternatives, which is the worst scenario we could ever have. Smokers in Latin America, they have only two choices, quit or die. And the harm reduction concept is not accepted at all. So going back to the exercise. What did we find as distance? First of all, technical barriers and age barriers. Those who are younger, they might be more used to new technology. They are more willing to accept and to change to new technology. But what happens with people who is older, from my generation and up? The cost. Latin America, most of the countries, they are really poor. People do not afford to buy the The goods, so the cost of devices and also considering that they are not legally available is also a huge barrier for us in Latin America. And prohibitions and lack of regulations, which as I said before, is the worst scenario we could ever have. And that is what really puts at risk the population that lives in Latin America who is willing to switch to a better alternative. Regarding doubts, there is a lot of misinformation. In Latin America, most of these alternatives are considered even worse than smoking, which is totally wrong. The media terrorism. We all know what had happened with Ivali, and the Ivali issue in Latin America was huge, as huge as many false cases of Ivali started to appear, and the same patient with Ivali was hospitalized two, three, or five times, And he was discharged five times the same patient from the hospital. So there is a lot of misinformation and media terrorism regarding that. Wrong medical advice. The medical and scientific community is not aware of the alternatives. It's not aware of the science behind these alternatives. It's not aware of the concept of harm reduction. And it's not accepted. Many times I hear when I talk to medical colleagues, primum non nocere. First, do not harm. and what is to cause harm. For me, the harm is to let somebody who smoke without any other option rather than to keep smoking. That's the real harm. Well, the medical community inertia, they are not willing to accept new concepts. Lack of courage and lack of information of the political class. There's a huge misinformation amongst the political class, amongst the congressmen, the parliament, ministers of health and they all consider that Non-combustible alternatives are as harmful or worse than combustible cigarettes And last but not least the censorship that the vaping communities that the user suffers in our media Difficulties well lack of informed choices and the black market as I said before most of the countries they have either a prohibition or lack of regulation So the only way people has in Latin America to switch to a better alternative is go to the black market, which leads to lack of quality controls and product standards. And as I said before, that's what really puts population at risk because they do not know what they are using, which are the ingredients that the product has, which are the levels of nicotine that they have. So that's really complicated. The lack of selling expertise or Knowledge poor Or the lack of seller advice Since these alternatives are not legally available many of the people who sells these devices They are not 100% aware of which are the difference between one the other they are not in the right spot to provide the proper advice to the one who's willing to switch and to a help that people switching to make the proper transition to these less harmful alternatives. And well, regarding other barriers, something that we see in our region is the PAHO influence on public health policies and the coercion that PAHO exerts with the MOH. Legal challenge to small and medium companies. Small and medium companies are totally unprotected in Latin America. regulatory and tax uncertainty, since these products are not legally available. The regulatory framework and taxes is totally, it's the Wild West. And the criminal control, the criminal cartels taking over the market and controlling the market. So that's the scenario in Latin America.
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Marewa Glover: Thank you. Very interesting. Okay, Sud, you're up.
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Sud Patwardhan: I'm going to hand the mic to Rebecca from Uganda. She's a KAC scholar and it'll be right for her to represent what might be the issues among women in tobacco.
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Rebecca Amoding: Thank you. We're dealing about the barriers and about women. So ours is really so brief because mostly it takes men. We looked at the weight management issue because us as women, one who smokes as a woman believes when she smokes, it will reduce her appetite on feeding. So she would really get scared if she sees that she reduces on the amount of nicotine taking in, she will eventually gain weight. We didn't talk about the distance, that one was under the doubt. Okay, then the difficulties, the difficulties, one, we looked at the cost, the cost of maybe we are switching from tobacco to the safer nicotine products. When you, for my case in Uganda, or Africa, really the, this snus and the vapes tend to be costly than the cigarettes itself. For example, you can get one vape, And if you tend to buy the cigarettes, you'll be 100 and something cigarettes. So those women will definitely find it comfortable to get to purchase the cigarette, which is combustible. Then the stigma, the stigma type, the stigma you tend to find that when you get to smoke, so you're hiding. He talked about when life is bad, you get to hide your negative energy in smoking, so it puts down your anxiety. Yeah, that one also comes to the pregnant women. Pregnant women, really, sometimes the first, second trimester, if you want to manage the nausea, so when one puts in the nicotine, it tries to help them manage the nausea and they don't begin giving, bringing out the vomiting or what, and even in the third trimester, I mean the last trimester, when you're so anxious, will I give birth, will I do what, how is it going to, so it is a way of managing the anxiety. We talked about discretion, please, can you? Okay, then for the other barriers, Women, as women, really look at vaping for a main thing. I've seen people vape around. It's not really in a bad sense. But when one vapes, brings out a big smoke. So as me, a woman, I am sensible. So if I bring out that big smoke, oh, I'm like, wow. Everyone is going to look at me. But then when I smoke, that person smoke, it is only a small amount of smoke that comes in and we are so sensitive about our environment and the people around us. Thank you. I hope I'm so clear.
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Marewa Glover: Thank you. Okay, last group. Thank you.
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Gal Cohen: Thanks. So we did health comorbidities. And first, just in terms of definitions, who we were talking about were people who are experiencing COPD, cardiovascular disease, diabetes, cancer. Also, to some extent, use disorders, cannabis, alcohol, opioid. The population tends to be older. A lot of the information that they get is coming in through their health care providers or social workers. And so that's also kind of part of the who. In terms of which products we chose to include, heated tobacco and oral as well as vape products, because there is increasing use of these different choices. In terms of, you know, why and how, you know, we asked everyone to do a pie chart of ranking of what is the relative impact of doubt, difficulty, distance, and dilutes. And so we ranked them that doubt was by far the greatest impact. We had it at about 57% of the pie. And there's misunderstanding both of the risk associated with continuing to smoke in this population. You figure, hey, I'm already 60 years old, and it hasn't gotten me yet, as well as the benefit that still exists in switching at that age. And there's certainly a ton of misinformation about the negative effect of products As well as misunderstanding of the actual efficacy, particularly within the health care community, it's not really part of the paradigm. The next issue was the vaping experience. And so, you know, cigarettes have been used for decades. The heated tobacco products are getting, are probably the closest in terms of experience, but in the U.S., you know, they haven't really been part of the landscape because of patent issues, although that may be changing. We've certainly seen in Japan that there is an opportunity there. And part of it, too, is there's not really an understanding or a place for the dual-use journey. And so the reality is that whether using NRT or using the substitute products, there are some situations and use cases in which you're going to use a cigarette. And over time, you're going to feel more comfortable with alternative products and use them more. But there's not really an understanding of that journey. And likewise, outside the US, the strength of these products is limited. In terms of vaping being too different, in terms of the cannabis-using population, very often you might use it in a blunt, and so you'd be expected to smoke it, although vaping is becoming more prevalent. with cannabis use. And, you know, heated tobacco products are, you know, becoming more similar. And then the last thing is variety of choices. On the one hand, there are more choices coming on the market. But on the other hand, there's more prohibition, flavors are going away, and there's more of an illicit market. So, you know, these topics have been brought up by several other groups. But that was overall how we saw the market. There's a lot of, or this area, there's a lot of opportunity and also a lot of challenges and primarily a lot of misinformation and not an understanding of the right role of these products in this community.
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Marewa Glover: So because we had so many people come, which is fantastic, we're sort of running out of time and there was still a facilitator sheet to do. So some people have to go at 11 and so we can quickly throw the facilitators up. You can have a go at that, and then we probably won't get to hear back, but we would love to hear any ideas you have on the facilitators to switching among your groups. Would you be willing to just quickly sort of throw some things up on the facilitator sheet? And we will do up a summary and hand it out at the end of the conference, so you'll get this fed back to you. Would that be okay? All right, so get up there and write on the facilitators, two switching for the group that you are talking about, please. And we'll just do that for the last 14 minutes, and then we'll let you go. Thank you. Thank you so much for coming. I just want to use the last few minutes to thank Judy. Thank you very much for coming and helping to co-facilitate this workshop. Thomas, where are you? Where is he? Thank you so much for coming to help co-facilitate this workshop. A little gift for you. And then as you all leave, you will also receive a little gift from New Zealand. You know what this is? You know what New Zealand's about? The All Blacks beat all of your countries all the time in rugby. Rugby. So we have a little rugby ball for you. It's a stress ball because this work is very, very stressful, right? You need a stress ball. And you are now Team Tobacco Harm Reduction. Alright, so Steve has those as you leave the room. Thank you so much for coming and sharing your knowledge. We'll summarise it and get a summary back out to everyone before the end of the conference. Thank you.