“It’s been an incredible journey”: Interview with pro-vaping advocate Louise Ross
Showing people that there is a life beyond smoking is at the heart of everything we do. It’s also at the heart of what Louise Ross does.
Louise, a former smoker of around 20 years, has worked in the tobacco control field since 2004.
She previously served as the manager of the Leicester Stop Smoking Service, leading a team of advisors who helped more than 30,000 clients quit smoking. Currently, she is the business development manager for the Smoke Free App. Since its inception, this app has received around six million downloads – more than any other stop-smoking app.
Louise is a prominent pro-vaping advocate and recently spoke on BBC Radio 5 Live to discuss the benefits of vaping and the importance of communicating its benefits to frontline healthcare professionals and cigarette smokers.
We caught up with Louise to learn more about her background and career to date.
You’ve worked in tobacco control/smoking cessation since 2004, having worked in nursing. What prompted the career change?
I used to run a care home. I stopped smoking in 2004 and three weeks later, I came across a job advert for running the Leicester Stop Smoking Service and thought, ‘I can do that now’. I applied for it and got it!
I knew nothing about the area, but I learnt on the job. I’ve always been a good team manager who’s quick to learn, and I thoroughly enjoyed the role.
What did you take from the experience at the Leicester Stop Smoking Service?
When we went vape-friendly, we had to convince people because there was no evidence at all. There was only my gut feeling. Nobody had done any studies on this. If I tried to do it now with no evidence, it could be a lot harder. But at the time, I pushed it through and said, ‘we are going to do this’.
We started out small and gave out vapes, partly because we were given free supplies. I went down to The e-Cigarette Summit in London, and I spoke at the second summit about our experience. Lots of firms gave us free samples, which made a big, big difference.
We stressed that this wasn’t medication and wasn’t licensed; we were offering people free samples and asking them if they wanted it.
People took them, and our success rate zoomed from about 50% to more than 70%. That was enough evidence for me to take to senior management and tell them, ‘We’ve got to do this on a bigger scale. We need to start using some of our nicotine replacement therapy (NRT) funding to buy vapes’. We did that and never looked back.
I subsequently became famous in the vaping world! I became famous for having been a pioneer in this area and encouraging others in my position to adopt a similar approach.
The Leicester Stop Smoking Service was the first in the country to go ‘e-cig-friendly’ on No Smoking Day 2014. What did it mean to you to achieve this milestone?
It was very, very important. I’ve talked about it a lot since – I probably bore a few people because they’ve heard me talk about it many times now! But yes, it was huge. And it was actually the first service of its kind in the world to become e-cig-friendly.
It’s been done by many services since, but we were the first to do it. That fact is an immense source of pride for me.
Do you remember when you first heard about vaping and what you thought about it as a smoking cessation method?
When vaping came along in around 2013, I saw real potential in its ability to help people quit smoking. I was worried at first that it might denormalise quitting and had the concerns that a lot of people still have today. But from talking to users, I realised what a game-changer vaping is and how it takes the pain out of stopping smoking.
Anyone who’s smoked knows how hard it is to stop, but those I spoke to who vaped said it was so easy. It’s almost like some opponents of vaping don’t like the fact that it’s easy. They think people should suffer when they’re quitting, but we should be opening the door for people and letting them through. Vaping is a gateway out of smoking, not a gateway into smoking.
If you look across the world, the countries that have demonstrated a positive and enabling attitude to vaping have seen their smoking rates drop. However, countries that are resistant to vaping have more flatlined smoking rates.
You can look to the UK and Ireland as respective examples. Ireland still has a big smoking problem and is anti-vaping, while in the UK, smoking rates have fallen as vaping rates rise.
How have you found working in this industry? Which aspects have you enjoyed the most?
I’ve rarely worked directly with clients; I’ve always been a manager of people who do the advising. But what I enjoy most is educating advisors to make the best of the opportunities they have and showing their clients that they care about the outcomes.
You can have an advisor who goes through the motions, gives their client some patches, and tells them what to do. But to convey that enthusiasm, keep people focused, and reassure them that they’re not going to go through hell when they stop smoking takes a real set of people skills.
To see the advisors display these skills is incredibly exciting, and the effectiveness of their approach is borne out by the results they achieve.
Enthusiasm and the ability to communicate and motivate mean more to me than specific qualifications, although they’re a bonus for advisors to have. They don’t have to have been smokers, either. We’ve all had our own battles, and as long as they can display empathy towards the person they’re working with and put a plan in place to help them through their journey, that’s all that matters.
On the flip side, which aspects of working in the smoking cessation industry have you found to be the most challenging?
Dealing with people who have the power to stop programmes from happening.
It’s quite easy to educate an advisor. If they said, ‘What about popcorn lung?’, you can sweep straight in with the facts and get them on board. What’s more frustrating is when you’re dealing with key decision-makers who are resistant to vaping.
I’ve been approached by a stop-smoking service lead who wants to make their service vape-friendly but is being told by a senior manager or someone at the council not to go down that route. So, they’re missing a huge opportunity to get more people to stop smoking at a lower cost than if they were using NRT. They won’t do it because they’re scared of the consequences.
There was one senior cabinet lead in a local council saying they’d recommend vaping if we could guarantee that nobody would ever come back and sue them for the harm it causes. It’s a ridiculous and theoretical risk.
I pointed out that there are no guarantees – you don’t avoid cycling because there are no guarantees you won’t fall off and break your leg. But we still encourage people to cycle and get exercise.
If people have smoked for 20, 30 years, or longer, they’re going to die early, anyway. Switching to vaping won’t accelerate that; it’ll slow it down. These people still might die of Chronic Obstructive Pulmonary Disease (COPD), cancer, or heart disease due to historical smoking, but at least they’re being given a lifeline.
How frustrating has it been for you to have to dispel myths and separate fact from fiction?
It’s a huge problem. You often get people who want to quit to the point where they’re confident in using a vape kit and like it, but then they’ll read an article that claims vaping causes cancer, leads to a heart attack, or damages your teeth. They then throw the vape back at you and say it’s going to kill them because of what they’ve read.
And they don’t read the reputable studies that are out there on vaping; they read the news headlines that are absolute nonsense, but it’s these headlines that do the damage.
Some GPs and other healthcare professionals are equally culpable because they get their information from the same sources. We regularly have clients say to us, ‘My doctor says vaping is as bad as smoking’ and ‘I’m better off going back to cigarettes, because at least you know what’s in them’. These kinds of statements are hugely frustrating to hear for somebody in my position.
There is also money in producing studies that show vaping is dangerous. The money is being put up by Michael Bloomberg – he put up millions of dollars to fund research that proves vaping is dangerous.
But a lot of the research doesn’t take historical smoking into consideration. It’ll claim that vapers have heart attacks or get cancer, for instance, but those vapers were smokers for years before they switched to vaping. That history doesn’t magically go away as soon as you stop smoking – if you were a heavy smoker, you’ve got a legacy of poor health, but this angle isn’t featured in these studies. I think they’re being deliberately funded to make a case for vaping leading to serious health issues.
You commented in your interview with Adrian Chiles that “people are scared to transition away from smoking because they’ve seen the wrong information, and once they’re reassured, they fly.” What more should be done at government level to ensure that smokers are receiving the correct information and making informed choices?
It was recommended by Javed Khan in his independent review that there should be a very clear consensus among healthcare professionals about the relative risk and benefits of switching to vaping.
That tobacco plan hasn’t been published yet – the government is, understandably, preoccupied with other things at the moment – but we’re pushing to get it out as soon as possible.
One of the planks in that should be a really good education for all healthcare professionals so that patients aren’t told the wrong things by their doctor who’s read incorrect information.
From your two decades of experience working with smokers, what do you think are the biggest barriers to helping them to quit?
I think one of the barriers is a lack of self-belief from the individual, but the other main reason is simply that they really enjoy smoking.
Even the smokers who say, ‘I only enjoy the first one of the day, the others make me feel disgusting’ haven’t known an adult life without a cigarette. So, they can’t imagine how they’ll cope with distress, anger, celebration, boredom, etc., without a cigarette.
That’s a good reason to switch to vaping because they can use it as a substitute. They’ll get the same hit of nicotine and so on without the same harmful effects as a cigarette. But it’s my job to manage that tension between ‘This is going to kill me’ and ‘I can do something different’. The balance has to be right before they can launch themselves into vaping.
Some will choose to cut down instead of quitting, but I know from experience that cutting down doesn’t do the job. You go down to three cigarettes or even one cigarette a day, but you enjoy that one so much that you can’t wait for the next time you can have one.
People need to understand that completely stopping smoking is the best thing they can do for their health, but, as I’ve said previously, they may not have access to the right information. They may believe that vaping is no better than smoking, which is why they think that there’s no difference between cutting down and quitting altogether.
You now work as Business Development Manager for the Smoke Free app. How have you found this experience?
It’s been an incredible journey. My boss is Dr David Crane, the founder and CEO, and he’s super excited about the success of the app.
We’ve had six million downloads so far. The app is used in 200 countries worldwide, which is remarkable, and it’s our ten-year anniversary this year.
David has worked on this app from a small PhD project to something global that’s received glowing reviews across the board.
As one of David’s team, I’m very proud of what we do. To my knowledge, his app is the only one that absolutely embraces vaping as a smoking cessation method. Representatives of other apps can be begrudging towards vaping and take the line of ‘If it helps you, then so be it’. They recommend NRT much more than vaping.
But the Smoke Free app is much more agile and pragmatic in this respect. I recruited the advisors on the basis that they understood tobacco harm reduction and the benefits of switching to vaping so that they could give valuable information to users.
You alluded to the number of downloads the app has had. Do you set targets along those lines each year? What sort of KPIs do you look at?
Different countries take different approaches, and I can only comment on the KPIs we focus on in the UK.
And as far as our UK KPIs go, it depends on what an area’s commissioner wants. For instance, we’re doing a lot of work with Greater Manchester – the commissioner there will set certain KPIs that are different to the commissioner in Leicester or Nottinghamshire, for example.
We do what is required by the commissioner and take their lead regarding the KPIs they deem appropriate. These might be numbers recruited or the number of minutes the user spends talking to an advisor – we look at all sorts of things when measuring the success of our app.
A large proportion of our customers are aged 55 to 64. From your experience of working with these people, how have you found them to be? Are they harder to convince to stop smoking than younger clients, or is that a stereotype?
It’s hard to generalise.
I think people in their 20s and 30s tell themselves they’ve got years to sort themselves out and they’ll stop when they’re 35, 40.
But then you get to around 40 and realise that you’ve got the ‘lines’ that a smoker has and that you look like a smoker compared with people who don’t smoke. The voice starts to get a bit croaky, and the cough is more ever-present – you realise that you’re coughing more in the morning. Somebody in the family could die of cancer, and you wonder if one day that’s going to be you.
It’s that ‘health anxiety’ between the ages of 40 and 50 that prompts many people to start their journey towards being cigarette-free. Once you’re in the 50 to 60 age bracket, you may become a grandparent, and you’ve got an additional incentive to extend your life. You realise that you don’t want to die at 60 like your granny did and miss your grandchildren growing up. You want to have an extra decade or two.
So, the pressure becomes more acute, and, as a result, you start thinking about things in different ways, and you’re willing to take a chance to stop smoking.
Broadly speaking, what do you think about the government’s 2030 smokefree target?
It’s good to have ambition. We know that there will always be some people who smoke, but getting the total down to less than five per cent of the UK population is vital.
But for me, we need to remember that we shouldn’t leave any smokers behind. If that five per cent includes people with severe mental illness, homeless people, or members of the LGBT community, that’s still important.
It’s great to have a five per cent target; it’s very low, but it’s achievable if you address certain areas that are holding us back. But we still need to focus on the most marginalised groups in our society and ensure they have the support to quit.
Vaping doesn’t suit everybody. There are other options, like nicotine pouches, for example, that are better suited to some people. Whatever option people choose, we need them to move from combustible nicotine towards non-combustible alternatives.
What do you think the future holds for the vaping industry?
I think there are some risks; the growth of single-use vapes is a big problem. It’s turning a lot of people against vaping because of the environmental damage it’s caused.
The industry, as a whole, needs to do something about single-use products and the reclamation of lithium. It also needs to minimise the amount of plastic that’s going into landfill. In summary, it needs to clean up its act.
Prescribing could be another trend to watch out for. Will a product be taken to the MHRA (Medicines and Healthcare products Regulatory Agency) for prescription purposes? I don’t know. It’s expensive, and if that product is licensed, it’s never allowed to improve. So, it has to be a very good product if it can’t ever be improved after acquiring that licence!
There are some benefits to getting a licence as a prescribable product, but generally, vaping is a consumer market, not a prescription market.
Thank you so much for your insights, Louise. Are there any resources that you can point our readers to that they might find useful?
There are two resources I think will be really useful.
I created a training module for homeless people who smoke, which is on the NCSCT (National Centre for Smoking Cessation and Training (NCSCT) website. It requires a quick sign-up process, but I recommend checking it out as it highlights the issue of inequality when it comes to smoking cessation support.
I also contributed to the Yorkshire Cancer Research learning module on vaping. They’ve put together a short film entitled Vaping Demystified, which I urge people to watch. It’s the most positive vape-friendly resource out there.