Sophie Richardson unpacks how a lack of regulation led to Aotearoa developing a world leading youth vaping problem. We examine how our vaping rates compare to the rest of the world, why, and what we can do about it.
Sophie Richardson: And we're back. It's the first consume this of 2023! You're with me, Sophie Richardson again for the second installment of our Health Mini-series. To kick this episode off, we are going back to one of the last big news stories of 2022. A world first, which is set to change the consumer health landscape in Aotearoa forever.
(Clip from Parlimentary debate)
Ayesha Verrall: This bill will create generational change and it'll leave a legacy of better health for our youth. There is no good reason to allow a product to be sold that kills half the people that use it.
Sophie Richardson: That's Associate Minister of Health, Dr. Ayesha Verrall speaking at the reading.
On the 13th of December last year, the "Smoke-free environments and regulated products (smoked tobacco) amendment bill" passed its third reading in Parliament and became law.
(Clip from Parlimentary debate)
Parliament Speaker: The ayes are 76, the noes are 43. The motion is agreed to.
Sophie Richardson: The new law makes it illegal for people born in 2009 onwards to purchase cigarettes or tobacco. It achieves that by raising the minimum age of purchase every year to one year older than they actually are.
So if we zoom forwards to 2050, your ID will need to peg you at 42 or over. But all those people born 2009 and onwards will still be too young cause they'll be 41. And even if you did want to buy a pack of cigarettes, it'd be really hard to find them cuz the new law also aims to reduce the number of stores that can sell cigarettes and tobacco. Currently there's over 8,000, but the aim is to reduce that to just 500 nationwide.
(Clip from Parlimentary debate)
Ayesha Verrall: It will save thousands of lives and billions for the future health system.
Sophie Richardson: The idea is if you are already a smoker you'll be able to keep purchasing cigarettes, whilst preventing new generations from ever starting. And that's mainly because cigarettes are incredibly addictive. We can't ban them outright and expect existing smokers to just stop. That would be pretty much impossible. But at the same time, most current smokers picked up the habit in their youth, and crucially, they regret ever starting.
So if we can stop people smoking when they're younger that should lead to a huge generational shift. Right?
Although historically outright bans on drugs and alcohol haven't exactly gone well for us.
Prohibition in the twenties led to speakeasies and the increase in cigarette tax in New Zealand is seeing a huge rise in black market imports. But at the same time, all of this is the culmination of decades of work from public health experts and the government. We have some of the strongest smoking laws in the world, which makes what we're about to discuss a bit baffling...
Over the last few years, we've become accustomed to seeing and smelling the long white clouds drifting down our high streets. The smells of cotton candy and watermelon, just filling out nostrils and taking over the designated smoking areas. It feels like vaping is everywhere, but as we'll discover Aotearoa is an anomaly. It's not like this in other countries. And if we go back in time a few years, we discover there is a big reason for that.
Until relatively recently, vapes existed in a gray area of the law. It sounds hard to believe in retrospect, but essentially no one was really sure whether vapes and related products were covered by our existing tobacco regulation or not.
(Enter Candace Bagnall - Smoking, Vape and Tobacco expert / researcher)
Candace Bagnall: The World Health Organisation doesn't define e-cigarettes as a tobacco product.
Sophie Richardson: This is longtime public health analyst Candace Bagnall.
Candace Bagnall: That's the first thing that we probably didn't realize. I think a lot of assumptions were made that e-cigarettes were tobacco products because they contain nicotine, but that isn't actually how they're defined.
And because of that, because of the WHO's decision, they basically said to countries, you can define it as a tobacco product or not. It's your call.
Sophie Richardson: This gray area became black and white four years ago.
News Clip: Tobacco company Philip Morris is facing charges laid by the Ministry of Health over a new battery powered tobacco product.
Sophie Richardson: Philip Morris was selling a product called Heets. It was basically a type of e-cigarette that worked by heating tobacco instead of burning it. As far as the Ministry of Health was concerned, Heets were illegal. Philip Morris on the other. Well, they weren't so sure.
Candace Bagnall: And Philip Morris won. And as a result of that, we, everybody realized that we didn't have any proper regulations for these new products.
Sophie Richardson: The ramifications of that didn't just affect their admittedly slightly niche Heets product. The ruling also applied to the entire vape market. It left us, unlike our Aussie counterparts and most other OECD countries, with a vaping free for all. It was suddenly glaringly obvious that there were no age restrictions or rules around advertising and marketing.
Candace Bagnall: So that resulted in a whole process of the Ministry of Health taking action to close that gap. But the regulations took a couple of years, so in that time the industry had a free reign and they marketed the products very aggressively to young people. They did the usual stuff that they used to do with tobacco. Taking products to music festivals that youth went to, that sort of thing. And giving away the products and try this it's fun, it's harmless, whatever.
They could say what pretty much what they liked. They had arrangements with youth radio stations whereby the products were given away free if people guess songs and all of that kind of stuff. So it was, it was pretty aggressive and full on. And you could really see the difference between the before and after.
We had a very aggressive industry and no way of, of stopping them until we had the regulations in place.
Sophie Richardson: Those regulations finally did come into effect in November, 2020, instantly cutting off the industry's ability to openly advertise, sell products to minors, and distribute free samples. I mean, come on guys!
But by then vaping had spread rapidly. The marketing free for all had ensured that the sweet smell of watermelon and sickly caramel was everywhere. And as Candace just pointed out, a lot of that marketing was targeted specifically at young people. Looking at the packaging and the flavors, it kind of feels like it still is.
I mean, anyone over 18 up for a "Peach Gummy Candy" vape..? Yeah, I thought not.
So in this episode of Consume This, we are investigating youth vaping. Have we inadvertently created a generation of young people addicted to vaping? People who, thanks to our smoke-free education programs, were increasingly unlikely to become smokers.
And crucially, if we have, does it matter? Has it undone the benefits of that smoke-free work? Or is it really no big deal?
To unpack all of that, let's start on the ground...
Ollie: The first time I vaped I was probably about 10 and a half.
Sophie Richardson: This is Ollie. He's from the Coromandel. We've changed his name for the story because despite vaping for over five years, he's still only 17.
Now look, whilst it was technically legal then to be marketing and selling vape products to a 10 year old, in reality, I don't think that was really happening. So how did our not quite 11 year old Ollie, get into vaping? Honestly, it's, yeah, classic cliche...
Ollie: Um, so to make it short and sweet, I was about 10 or 11 years old riding my scooter at the Skate Park and there were some kids on this bench and they had, um, like these little pens. I thought, nothing of it first, and then they said, oh, you wanna try this? And my exact words were, "nah, vapes for gays".
Sophie Richardson: Despite the slightly homophobic reasoning from Ollie the first time around, he trusted his instinct.
Ollie: I went away and then I was watching them and I was like, that's more and more appealing. And then I see them holding it like a cigarette. They were like, oh, you sure? I'm like, ah, I've sort of been warned about cigarettes.
Sophie Richardson: So the first time around Ollie turned them down, but he kept seeing them around the skate park.
Ollie: I admired how cool they looked, you know, they were the popular kids. Everyone's looking at them. They're the king of the skate park.
They have their strut on, they have their walks, they have their clothes, how they would dress. They're blowing smoke out, well vapor out of their mouth. And they just looked. They just looked like they knew that they were on top. The coolest people I had ever seen. Like that sounds like I'm being sarcastic, but I thought they were the shit.
Sophie Richardson: As we spoke to Ollie, it became clear that he's never been the cool kid in his crowd. At times, he struggled to make friends and in school he didn't quite fit in, at least not in the ways he wanted to, and at the skate park? Well, in his own words, he was one of the best scooter riders in the Coromandel, but also a bit of a nerd.
Against that backdrop. It's easy to see why being invited into what he saw as the cool older crowd was so appealing. It satisfied a desire we all hold to be accepted and included. This kind of longing for popularity and status is something that pops up a lot through our conversation. Eventually vaping became his primary way of connecting with other people. Sophie Richardson: We'll hear more about that soon, but that journey kicked off here at the skate park when around a week later, he changed his mind and decided to give vaping a go.
Ollie: Obviously, I coughed my lungs out cuz I never vaped before.
Sophie Richardson: But he stuck with it, hanging out with his new friends and continuing to share their vapes.
It's not very covid safe.
Ollie: And um, it sort of became smoother and easier to vape and I just, just couldn't really stop. It, it feels like you are hooked into it, where as soon as you start and you get this feeling of happiness, sort of like a buzz. And it, it's, you think, oh, I can stop when I want. But no, you can't because your first times and your initial times of vaping, you'll feel like you're on top of the world. You'll feel so relaxed out. Um, but it, it, it hooks you and there's no doubt about it.
Sophie Richardson: Despite being one of the best scooter riders in the Coromandel - and now I don't know much about competitive scootering - but my producer Tom did look at his TikTok and he said he can do some impressive tricks. But despite all that, the skate park stopped being somewhere he'd go to practice.
It took on a different importance to him.
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Ollie: I was physically going to the skate park just to vape. Because it was out of sight of every parent that knew me and had sort of an escape. And then I started to rely on it a bit. And when I say rely on, I mean, I couldn't really go an hour without inhaling some sort of nicotine substance.
And then I touched cigarettes, hated it, but then somehow always found a way to vape.
Sophie Richardson: Ollie clearly developed a vaping habit very young, but the thing that surprised me when I started researching this episode is that he's not unusual. None of the researchers, teachers, or healthcare workers that we spoke to were shocked when I shared his story with them. Mostly they gave kind of a knowing look and replied that they knew of many other similar cases.
But how does that compare to what we we're seeing in other countries? Our public health researcher, Candace Bagnall, has been busy working on this...
Candace Bagnall: I've been working on comparing New Zealand youth vaping prevalence with other countries.
The easiest way to compare that data is through regular vaping, which is sometimes called current in other countries and there is a lot of variation there which makes it very difficult to compare the data. But even so, it's really obvious that New Zealand's youth vaping rates are much higher than comparable countries like Australia and the UK. Much higher.
In 2021 our regular vaping rate in year 10 students was 20%. That's really high compared with, for example, the UK which was around 8%, and in Australia it's understandably a lot lower because access is much harder in Australia.
Sophie Richardson: The reason it's harder to access in Australia is because over there, to purchase a nicotine vape, you need a prescription.
A prescription, which is only available to existing smokers. That's a system that Candace and various other public health experts we spoke to are in favor of implementing here. Interestingly, our producer Tom, was in Australia recently and was told by several people they get around the rules by ordering their vapes online from stores based here in Aotearoa.
Candace is still working on her research paper, so she was a little hesitant to give us an exact comparison, particularly with Australia, where Covid related issues mean they haven't updated their survey data for a little while.
Candace Bagnall: But even still, it's really, the difference is really clear. New Zealand is ahead of most other countries in terms of youth vaping. With the possible exception of America and they're in a league of their own, of course.
Sophie Richardson: So the academic research and the statistics all point to us having a world-leading youth vaping habit. Yay. New Zealand world first!
We are the land of the long white watermelon strawberry cloud. And unsurprisingly, given the age of the people we are focusing on, that's having an impact in our schools.
(Enter school Principal Sheena Millar)
Sheena Millar: Certainly kids are coming into high school knowing about vaping, having tried vaping or vaping regularly.
Sophie Richardson: This is Sheena Miller. She's the principal of Onslow College in Johnsonville.
Sheena Millar: It's really interesting cuz I'd say that about 40% of students have got quite regular contact with it, but it'd be even higher if you're talking socially cuz there's definitely kids who are doing it at school. Regularly doing it at school.
Whether it is because they just happen to be with a crowd and they do it cause it's cool or they're actually addicted. But there's also socially, I think it's much higher than that. I think there's lots of kids who on the weekends, as soon as they leave school, all of those things, they are vaping. Yep.
And they will argue quite stridently that there's no health implications.
Sophie Richardson: But to Sheena and the other teachers we spoke to, there are observable implications.
Sheena Millar: There are kids who excuse themselves in class to go to the bathroom to have a vape. Um, percentage wise, I think it's still a low percentage, but it's very high impact for those kids, really high impact for them because that's what they're thinking.
How am I gonna get outta class this in this lesson to make sure that I get my hit so that I don't get caught, then come back, then I have to reengage with the lesson, and then I'm probably thinking about how I'm gonna make sure I get it in the next class. So it becomes this self-fulfilling disengagement kind of prophecy.
Sophie Richardson: And that's one of the biggest issues that all the teachers we spoke to told us about. Sure they were concerned about the potential physical health issues, but it's the problems associated with addiction that are causing the day-to-day problems.
Sheena Millar: We have made a connection for some of our kids around irritability and, um, aggravated kind of behaviors.
You know, when they haven't been able to have a vape and you'll say to them, what was that about? That's not how you usually interact with other people. And when you unpack it, some of them will say, well, I just didn't, I couldn't organize to have my vape. So certainly we're seeing that.
We are definitely seeing issues around vapes being sold, not being supplied. That causes arguments at school. Uh, kids buying vapes and working out that they are just those one off ones that have been refilled and they're actually really not working or they're not good or whatever. So yeah, we are seeing those sorts of behaviors seeping in.
You know, so-and-so is threatening to have a fight with so-and-so. Why are you going to have a fight? I paid him X amount of money and I haven't had my vape delivered. That's the sort of thing that we are seeing on a regular basis.
Sophie Richardson: That also fits with Ollie's experience.
Ollie: If I went a day without it, I would, I would cry. I would break down. And it's horrible. Your brain isn't sitting right.
You are, you are just, you are almost shaking, and you are mentally, you're mentally ruined until you have that sort of relief and, uh, feeling of... relaxation or calming down all the, all the buzz if you wanna call it that.
Sophie Richardson: As you can hear there, Ollie tends to play with his microphone when he is feeling a bit anxious. Sorry about that.
One of the arguments that gets thrown around a lot is that vaping is just displacing smoking. That people who smoke are switching across and people who start, well, if it wasn't for vaping, they would have become smokers. If that argument is to be believed, then vaping, despite its negatives is still a net win.
As we heard earlier smoking eventually kills over half of its long-term users. Cigarettes are pretty much the most harmful consumer product we can buy. There are still arguments taking place about the physical health implications of vaping, but it's generally accepted as less bad.
Sophie Richardson: The displacement argument is very convenient for the tobacco and vape industry, but is there actually any truth in it?
Sheena Millar: You know, smoking became unacceptable in all sort of circles really, and especially amongst teenagers. Kids were very much of the, why would you do that? You know, it's not a good thing to do.
Sophie Richardson: So does Sheena see more students vaping in school than there were previously smoking?
Sheena Millar: Yes, I do. Especially since we were seeing such a reduction.
You know, when I started teaching in the early nineties, part of your duty was going onto the field and you'd see the puffs of smoke down the back and you'd be walking down there to where kids were having a cigarette and that had reduced and reduced and reduced and reduced. And people didn't want to sit with people or be with people who were smoking cuz they'd smell of it.
Kids would say to you, no, no, I don't. I'm not hanging out. I didn't hang out with her at lunchtime. She had a cigarette and I don't wanna smell of it. And if I went home smelling of it, mum would think it was me anyway, you know? So there'd been a real change. And so I think what we saw was this gradual decrease and then we saw the vaping start and it's just been like vroom how quickly it's become the norm and socially accepted among kids to do it, is really really scary.
Sophie Richardson: Again, this is basically the consensus amongst the other teachers that we spoke to. They'd seen smoking rates amongst students steadily decrease as education campaigns cut through and societal attitudes towards it shifted and became less favorable. Ollie also remembers his time at school being similar.
Ollie: Yeah. Oh, absolutely. I never knew someone at my school that smoked, but vaping... if you saw the most innocent, naive 13 year old girl, that the quiet girl, the smart, the A+ student girl, she was vaping. Yeah. One half to three quarters of everyone.
Sophie Richardson: This suggests to me that far from displacing smoking vaping has actually created a whole new market.
Another way to consider this is by looking at total nicotine use over time. If vaping was displacing smoking, we'd expect it to remain constant with people who would've got their nicotine from cigarettes turning to vapes instead. If vaping was helping people to quit altogether, we might even expect to see a decrease.
Professor Janet Hoek at the University of Otago has put together some research on this. She specifically looked at year 10 students, and the data is very revealing. From 2015 to 2019 daily total nicotine use hovered around 4%, but by 2021, that jumped up to almost 10%. That's around 150%! Digging further into her research reveals the increase is entirely driven by vaping. This absolutely matches what Sheena and the other teachers have been telling us.
At least in young people, we can confidently say that the growth of vaping is massively outpacing the decline in smoking. But now that we have regulated and restricted sales to over eighteens, where are all these school-aged children getting vapes.
As it turns out, there are a few different ways. There are the classics: getting a hookup from older friend or sibling, or pocketing a parent's vape when they aren't looking - sneaky buggers. Then there's still a chunk of shops that just don't care. Since the new laws were introduced various mystery shopping investigations have uncovered physical stores that continue to sell to minors, and then there's online...
That's how Ollie brought his first vape.
Ollie: So I looked up vape, took mom's credit card, got the first vape I saw, got the first vape juice I saw, and then got it ordered to my house. There was no ID, no questions about it.
Sophie Richardson: And of course one of the first things he did with his new toy was to show it off at school.
Ollie: Because I was just like, oh, now that I have a vape I can let people use it and I'll be the cool kid. I'll be popular. Everyone will like me.
Sophie Richardson: And this plan that actually kind of played out.
Ollie: I walk into the bathroom and then I just see the swarm following me, like a little magnet. Just following me into the bathroom, and then I'm just like, yeah, just give it back to me or just give it back to me in class. And then just kids one after the other all just going into the bathroom, and then I get my vape back at like three hours later and it's completely dead.
Sophie Richardson: This experience was very affirming for Ollie. It finally gave him the feeling of popularity and status that he'd been seeking.
Ollie: Oh yeah. I felt like I was the king of the school at that point.
Sophie Richardson: But there was one teacher Ollie had a connection with who could see what was really going on.
Ollie: And she was like, yeah, you know, people are sort of only being around you for, uh, vaping.
And I said, what? And she just explained to me. Have you, have you ever noticed how when you have a vape, people want to be friends with you, but when you don't, they don't wanna know you? And I was like, oh yeah, I do notice that now. Once I didn't bring my vape to school that day, they just didn't want to know me.
People would take my my literal school bag and search my school bag because they wanted the vape.
Sophie Richardson: But Ollie wasn't ready to give up on his newfound popularity. Instead, he doubled down.
Ollie: I was the vape dealer. I was the one who could get you anything. I was the guy who was known for getting people vapes.
It felt really good. Everyone knew who I was. I was making so much money from it. But I also, that feeling of, um, popularity and, uh, being well known. It never crossed my mind how serious it actually was.
Sophie Richardson: His system worked something like this. He took orders from people at school, gave those orders to an older friend who bought the vapes, then sold them on for a markup. For a while they were highly successful and Ollie made a ton of money. He even sold a range of disguised vapes, which are specifically designed to look like objects that wouldn't be out of place in a school bag or a teenager's bedroom.
Ollie: They're disguised as everyday items like this one has a USBc port on it and you can take this cap off and it shows a USBa port as so you can act like it's plugging into your computer.
Like you can buy a hairbrush vape. It looks like a literal hairbrush that you get from the warehouse, but you can unscrew it and there's a disposable vape in there.
Sophie Richardson: But eventually, despite all this concealment, he got caught and the business came crashing down around him. This in combination with being disruptive in class, partly a symptom of his nicotine withdrawals and a few other issues led him to being excluded at 15.
And again, this isn't a problem that's unique to Ollie or his school. All the teachers that we spoke to reported encountering informal sales networks, but they don't all share the same approach Ollie's School did.
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Sheena Millar: I mean, because a punitive kind of approach, what we are seeing is it doesn't make a lot of difference.
Sophie Richardson: This is school principal Sheena Miller again.
Sheena Millar: The schools that are standing kids down or telling them they can't be at school because of vaping haven't got a lower amount of vaping than the ones who are trying to do it from a health perspective.
We talk all the time about schools being communities and places of relationships and places to support people, and yet, you know, when you're part of a family, it's not really socially acceptable to exclude someone from a family.
Yet, somehow it's socially acceptable to exclude someone from school rather than there being a whole lot of resources that can be put in. So we do things that we know aren't gonna solve the problem, just move the problem. And I feel like we've got a little bit of a tsunami coming if kids continue the way they are. If our solution to this is excluding them from schools.
Sophie Richardson: Yeah, I think Sheena's on the money there. Um, if you just exclude everyone, where are they going to go? I think that goes for a lot of problems in society, not just vaping. So keep up the good work, Sheena.
So I think that's probably answered our first question. We do have a youth vaping issue. Our vaping rates are considerably higher than other comparable countries. And we are seeing the effects of that in our schools and on our young people. It feels like we've created a generation of vapers who were increasingly unlikely to ever take up smoking. And that's at least partly due to the period after the Philip Morris court case when we allowed marketing to run wild. So in a very real sense, we have created this issue for ourselves when, as we can see from the approaches taken by other countries it was entirely avoidable.
Instinctively, all of this doesn't feel great. I'm sure a lot of you feel the same way, but the second part of the question we started with is, does it matter?
Well, as we've heard, it's clear that from at least some young vapers, we are seeing negative side effects of addiction and nicotine withdrawals, and that's affecting their day-to-day lives. That seems reason enough to be concerned. Right. But what about the physical health impacts?
Well, as far as that's concerned, there's a broad agreement that yes, it is less bad than smoking, but that's about as far as the consensus goes on this issue .And being less bad than smoking... well, that's a low bar.
Candace Bagnall: Tobacco is one of the most harmful products, consumer products that has ever been invented. Smoking kills two-thirds of long-term users. There's nothing else like it. It's not an ordinary product. Vaping, well, we don't know. We just don't know. We know it's less harmful, but how less harmful?
You're still taking stuff into your lungs vapor with a whole lot of chemicals, but we just don't know. So, you know, we didn't understand the impact of smoking for a long time, did we? But I do think there's more and more evidence coming out all the time, especially with respiratory problems.
It worries me that people are hearing the messages as messages of harmlessness or safety rather than relative harm, which is a very difficult concept to communicate to the general public.
Sophie Richardson: So where does that leave us? Well, frankly, it's a bit of a mix. Sure vaping is less physically harmful than smoking. But given we've spent so much time and energy on anti-smoking education and regulation, it does seem a wee bit foolish to take such a lax approach to vaping.
We've allowed marketing and big tobacco companies to set the tone, and now we are playing catch up. There isn't exactly a right answer because there can be public health benefits to vaping in some very specific context and circumstances, but kids as young as 11 getting addicted to nicotine, especially at a time when their brains are still developing, that does seem a bit insane.
As we've heard, there are great people out there doing good work in the field, but there's still a long way to. There are more youth focused regulations in the works too. The Ministry of Health released a public consultation document on just that at the start of the year. These include setting lower maximum nicotine levels in disposable vapes.
Candace Bagnall: Kids prefer to use disposables. And disposables the limit in New Zealand is 50 milligrams per milliliter, and that's more than twice as high as the 20 milligrams per milliliter limit In the UK and Europe.
Sophie Richardson: The new proposals suggest a lower limit of 35 milligrams per milliliter. That's still 75% higher than the European.
It also includes limiting the marketing of flavors and setting proximity restrictions so that vape stores can't be right next door to schools.
Sheena Millar: I find it alarming. You know, if you walk around and you look at the places that are selling vapes, they're often very close to schools. The closer they are to a school, the least likely they are to be open on a Saturday and a Sunday.
Sophie Richardson: These are all measures that are supported by public health experts and teachers.
If you'd like to read the consultation document or make a submission, we've put a link to it in the show notes.
You know what? It might not be a very satisfying conclusion to this episode, but that's where we are slowly trying to feel our way out of the youth vaping epidemic and through the cloud of Watermelon and candyfloss that we've created for ourselves.
As we wrap things up, I ask Ollie what advice he'd give to someone younger, someone in the same position as he was back in that skate park.
Ollie: Uh, don't ever fall into the peer pressure. It's not cool. You're gonna waste your money. And when I say waste your money, you're gonna waste your money. It's gonna take your social life.
It's gonna take your family life away like it did to mine. It's ultimately never gonna be worth it because you're gonna be missing out on so many opportunities. You're gonna potentially have side effects from it that will affect you for a long time. And it's very, very, very.... (Ollie's call drops out)
Sophie Richardson: After talking to us for well over an hour, Ollie's connection gave up the ghost.
We probably should have called him back and let him finish, but somehow leaving it unresolved, hanging in the ether just feels right.
Sophie Richardson: This episode of Consume this was made possible with generous support from the Ministry of Health. It was produced by Tom Riste-Smith and presented by myself, Sophie Richardson.
If you want help to stop vaping, support is available via Quitline on 0800 778 778 or via text on 4006. I've also put all that information in the show notes..
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