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For a moment. We'll just wait. Can you? I don't know if you see the little twirly thing at the top. A little squirrely. Great thing. No, I can. And it's when we're there. So any moment now and we will be live. She says it's still twirling, but sometimes it goes live and then still 12. But we'll give it a moment. My whole world is on the internet in my house. Hopefully we should be live in a second and there we go. We're live now. Who's saying we are live? Thank you, Sue. I wasn't sure my button was still great. Ellen said we're live and hello again. Charisma. Charisma was on a session this morning with me. So welcome everybody to a brand new session, something we've never done before. Um And we're doing it on behalf of C three collaborating for Health today. And I'm going to tell you a little bit more about that and of course, I'm not alone. You can see that we've been joined by Louise. Now before I hand over to Louise. Louise want to say to say a bit of a hello and who you are. So people. Yes. Hi, everybody. I'm Louise. Ross. I used to run a stop smoking service in, yes, the city and I had a brain tumour in 2018. So I retired from work and started working again about three months later. So I worked for the National Center for smoking cessation and training and also for the smoke free app, which is a digital solution for stopping smoking. And I do some other smoking related things as well. Lovely to be here and see you all. Brilliant. So, thank you, Louise. So we've got people joining us live um And we'll interact with you guys in a moment and if you're watching us on demand and you're watching us on catch up. Brilliant to have you here. I'm just going to run us through some basics before we start just the usual bit about the platform and about the session and how we're going to run it and then I am gonna go quiet and I'm going to hand you over to Louise, but I will be in the background, pressing the buttons for the slides. So, um C three collaborating for health is a charity and I've worked with these guys for quite a few years now. And really, it's mission is about imagining a world where no one dies from preventable chronic diseases. And as a nurse who's passionate about prevention, my feet would see three. Collaborating for health is just brilliant. And the project we are working on at the moment is fits this criteria of trying to help people to live healthier lives, those preventable chronic conditions. Now, see threes mission is that we try and encourage people to stop using tobacco to improve what they eat and drink and to do more physical activity. And that's why this project fits really well, particularly with our first mission. So this project um and this is why Louise is coming to talk to us, it's called winning Hearts and Minds. Now, see, three has been really fortunate over the years that we work in partnership with the Burdette Tris for Nursing on a variety of different projects. And this one happens to be starting to explore and look at smoking in mental health units in England. And the reason for this is because people with mental health conditions are way more likely to smoke. In fact, 40% of people with mental health conditions will smoke when actually compare it to the general population of 14%. Now, for anyone that I've met before, you know, I'm a cardiovascular diseases, my bag and I'm really trying to prevent people having heart attacks or strokes. So it really is important about getting people to have hopefully less incidence of heart disease. And of course, so winning hearts and minds ties this beautifully and together. So preventing heart attacks is the heart and of course, within mental health that's looking at the mind and I just want to bring your attention to a quote that we had, um, we did some focus groups and some interviews with nurses. And this guy said to me, you know, smoking used to be really good. It was the bait to try and get people into healthier conversations. And he would say, come on, let's go for smoking would defuse situations and say, let's go for the smoke. And he says now what he realized was the intervention, the therapeutic intervention was actually the conversation and how could he repeat that conversation? But without using the cigarettes as the hook for the bait to have it? So this is a part of a series of events that have been happening. Um And Louise will be joining us on Friday with the round table discussion and if any of you are around, come and go join us for that. But we've also got Helen Donovan in some motivational interviewing. My colleague, Joanne Horse has already done something around smoke around cardiovascular disease and mental health. And I did the right back to basics just whilst just smoking due to your arteries. So it's a whole series of education and training that you can all access from the C three collaborating for health website all through Medal. Anyway, that's the comms in the promotion bit to try and entice you to come and learn a little bit more. But now I'm going to hand you over to Louise. I'm going to sit here quietly with my camera often with my audio off Louise, but I am here if you need me and sometimes I might commute. Is that all right? That's absolutely fine, Michaela. And, and I think because we're, this is such a short window of opportunity, I'm going to whiz through some of the activities, um, possibly may even drop some of them so that we can talk about some of the myths and, uh, and deal with, you know, and have plenty of time for Q and A at the end if that's all right. Um So, you know, people will be able to see the slides anyway afterwards, but we'll concentrate on, you know, the interactive stuff. So most of what I'm going to be talking about tonight is about vaping vaping as a means of stopping smoking, a switch to a much, much less harmful way of getting nicotine. And we know from, you know, many years of working with people with poor mental health that, that dependence on nicotine is what keeps people smoking and we have now at our disposal, a way of giving them clean nicotine. Um that may just save their lives and prevent the very um premature death that many patient's with that poor mental health um uh suffer from, unfortunately. Um So this is about knowledge, attitudes and confidence. Next slide, please. Just very quickly, my declarations I've already said, uh you know what my background is, but it's important to note that uh I take no funding from industry of any sort pharmaceutical vaping industry or tobacco industry. Next slide, please. So a little bit of a of a question about where you feel you are as an audience with, with your levels of confidence. How on a scale of 1 to 5, how confidence do you feel in talking to people who smoke about switching to vaping to help them quit or advising them about substituting some of their cigarettes for a Vape or perhaps using a Vape when they're not able to smoke, like, you know, when they're on the ward or something like that. Um, and I think Michaela is going to put this in the chat and people are going to, um, pop their confidence levels in. Um, and it is, it is, it's on and it will keep chugging. That's lovely. So we're gonna move on with the next, the next slide, please. Um, a little bit about vaping amongst adults. We're not talking about young people here who's doing it and how many of them and so on. So, over 4 million adults in Great Britain now Vape and most of those are ex smokers. So they've, they've done it to, um, to unhook themselves if you like from the habit and the, you know, the damage that is caused by, um, by smoking. Um, some will do it because they want to save money. Uh, some will do it to prevent relapse to smoking. Um, the others who aren't actually ex smokers, the ones who are still smoking are doing it to reduce the amount of cigarettes they smoke, generally speaking. Um, so there are very few never smokers amongst the vaping population. Most of them have got a history of smoking. Um, and one of the things that worries us most in, in the field of tobacco control is that because of the, the, the very damaging media stories that get pumped out all the time. A lot of people believe that vaping is, is equally harmful to smoking or even worse. And that's one of the myths I want to clear up during this talk, the most frequent type of device that people use um is a tank device and I'll say a little bit more about the different sorts of apes uh in a little while. But yeah, the majority are using refillable tank devices. Next slide, please. So a little, a little quiz vaping is as harmful of smoking. Is this true or false or are you perhaps not sure? And there's the, the whole thing again. That's great. Um I know that Michaela said people will be answering that as we go along, but our next slide will actually give the answer to that. So, um you'll be able to kind of concentrate on the next thing. It's false. It's not as harmful as smoking. Um despite, um you know, the, the perception of many people and it's because there is no tar, no carbon monoxide in it. That's what you get in a combustible cigarette. Uh, and, and vapes, although they have nicotine in and, and a few other chemicals and flavoring, they don't have the, you know, thousands of chemicals that you find in a combustible cigarette. Next slide, please. So I'm not going to go into detail in all these, but there's the safety, um, and quality of vapes is under close scrutiny. The MHR A cover the, the safety and quality of, of all vapes sold in this country sold legally. Um We know that there is an increasing number of illegal vapes being brought in and the government's commitment another 3 million lbs to support trading standards to actually identify where illegal vapes are coming into the country that will, that will help confidence in the market. But, but generally our advice to people who want to switch is to go to a reputable shop or one of the bigger supermarkets and avoid the, you know, the little corner shops, the phone shops, uh those sort of things who, you know, we suspect are selling illegal vapes. Um The toxicity of vaping is covered off by the committee on toxicology who have demonstrated beyond all doubt that, you know, there is only the tiniest fraction of, um, you know, the chemicals that could possibly cause harm, innovate and at such low levels that, you know, the danger is more or less negligible fire safety is interesting one particularly that for those of you who may be caring for people who spend a lot of time in bed or sitting in their chair, uh, those that smoke in bed, for instance, um, uh, constantly at risk of house fired from, from dropping, um, you know, a cigarette end or a match that's still a, like that sort of thing, you know, in their bedding. So the fire and rescue service are very keen that chronic smokers are encouraged to switch to evade much, much safer. Next slide, please. Um People often say that dates are concerned because they're not regulated. Um And I'm not going to ask for this to go on on the pole because I'm going to go straight into the answer to this again to save time. So the next time it's false, they are very carefully regulated. So since 2016, uh the TRP other tobacco and related products regulations that cover all sorts of nicotine containing products have regulated vapes for safety and quality, um, and everything sold legitimately. Um There is a record of it at MHR A what it contains to what, you know, what volume and so on. So you can reassure your patient's that, you know, this is a regulated product. Um And that if in the future, any of the constituents are found to have a degree of harm that is not acceptable, they will be simply taken off the market. Um, and, and you know, certain chemicals will be banned substances. Next slide, please. Uh, you know, the, the TRPR regulates the size of the tanks, the size of the bottles, what they contain. And, um, uh, as we say, suspect retailers can be reported to trading standards and, uh, you know, they'll, they'll do a raid and sees products next slide, please a little bit of background to the vaping devices. Um, they started off with, you know, the little things that looked like a, a cigarette, a white tube with a little glowing end to them. And if you talk to people who say you have tried vaping, it was, it was awful. It was rubbish. Often. They will have used one of those early ciga light products and found it was, it was a very poor delivery of nicotine. The battery never lasted. Um So you can encourage people to try one of the more modern devices because the technology has absolutely blossomed. Um So, uh you know that the next thing that came along was the tanks which you can see in the uh the picture at the back where you can recharge the device, you can fill it with liquid. And then we have the pods like jewel uh where you got a little nicotine filled pod that you, you pop in a little thing that looks like a USB stick. And, and now we've got the single use disposables which um, are causing their own problems, particularly about environmental issues. Um, the thing is with those, I, I wouldn't want them, I wouldn't want to see them disappear from the market because in the service stops, sorry to stop smoking services. We often hear from older people or people with, you know, arthritis, um, you know, dexterity issues that they love the disposables because they don't have to fast around with, you know, filling up a little tank, they can just, you know, take the product, sip on it and, you know, and, and, and it gives a good delivery of nicotine. Um So, you know, there, there are two sides to, to this particular story. It's a big range of flavours. Um And although there are thousands of different descriptions of the flavor's, it really comes down to the, the same very small range of choices. So tobacco flavor meant fel um fruity flavor, sweet fruity flavours and dessert flavours. And people who um start vaping as a change from smoking often assume that they want the tobacco flavor because that's what they're used to. But once they try, um you know, say a fruit menthol flavour or something like that, they realize that they can kind of unhook themselves even more from that habit of using tobacco because they really like the fruit flavours, the sweet flavours. And we, we hear from women particularly as well that when they started vaping, say, you know, a strawberry flavor or something, it satisfies their, their need for something sweet that that made them put on weight last time they stop smoking. So they, you know, they're actually using this as a, as a way of suppressing the appetite for sweet things and it's, it's helping them not put, put on the weight that typically people put on when they stop smoking. Next slide, please. Now, there's no magic formula about strengths. I'm often asked, you know, if somebody smokes 20 a day, what strength of the liquid should they change to? It takes a bit of trial and error to get it right. Because, um, you know, some people inhaled very deeply and hold the vapor in their lungs for a long time. Some people sip a little bit and don't use it often enough perhaps. So, um I would say normally if, if you're looking at what liquid you should recommend to somebody who was quite a heavy smoker, I'd go for the strongest, which generally in, in shops is the 18 mg, although they can get up to 20 mg. Um If somebody is a social smoker, not particularly heavy smoker, I go for about six mg. A really heavy smoker may need a patch as well as Vape. Um that works really well. So, you know, if somebody is highly dependent on nicotine, try, try them with a patch for um you know, uh the background cover and a Vape as that intermittent product to keep them to keep them going and, and stop them relapsing to to smoking a cigarette next slide, please. Um I'm going to skip these two because we're covering this up. This, this is more for a longer talk. Um So skip to the next one and then the one after that. But the point I will make that arises from that last slide is that um when we, when we talk about nicotine replacement therapy, we often say, you know, you're going to wean down, you're going to, you know, start using your NRT wean down and be off the NRT by the 12th week with people with poor mental health. That is uh it's not advisable to get them off clean nicotine that quickly. I think it's really important to keep them vaping or using NRT for as long as they need to and for, for some people with poor mental health that could be for the rest of their lives. Um And nice are comfortable with long term nicotine use, especially if it stops and relapsing to smoking. Um Obviously do ask questions about this if, if I haven't made it absolutely clear, we have a number of very August bodies supporting this, this line that vaping is a really good way of stopping smoking. It's not just me making it up. Um You know, including the Royal College is the challenge group for smoking in pregnancy is a very key one in my mind. So, you know, if somebody is expecting a baby, if vaping is stopping them smoking, it's doing its job. We've been using nicotine with pregnant women for decades now to very good effect. And if they want to Vape, you know, if they're committed to staying smoke free, let's encourage them to do that. And that's what the Royal College of Midwives and the Challenge Group on smoking and pregnancy says. Next slide, please. I'm keeping an eye on the time because it was whizzing by um, I'm going to pick out one thing from here. Uh And that's the study with the stop smoking services that found that at a year after quitting, those that vapes were twice as likely to still be smoke free. In comparison with those who use nicotine replacement therapy, they find it satisfying. And, you know, when you think that 70,000 additional ex smokers every year um created because vaping is available, that's a really important figure to remember next slide, please. Um So it doesn't just um make itself useful for, for, you know, for complete abstinence. That gradual change from being a full time smoker to a part time smoker can be facilitated with vaping. And we, we often come across the phenomenon of accidental quitting. So it might be that, you know, one family member starts vaping and the others say, sure, catch me using that and yet the curiosity um peaks their interest and they might have a puff on it and think actually I could, I could get on board with that Um, and so we see this sort of, you know, buy one, get one free sort of phenomenon that you get two for the price of one. Um, one person has, has set out to quit with the bait. Uh, and somebody else in the family also gets sort of like pulled along with them, which is, it's great if a whole family can quit together. Next slide, please. Um, I'm going to skip that one because I've already covered some of that. Um But I'm going to talk here about prescribed vapes. There are no vapes on prescription currently. MHR, I would love to see a manufacturer come forward with something that they want to get a medicinal license for. It's a very expensive process and it takes a long time. We're still hopeful that this might happen because it would help with some flexibilities. You could prescribe it for under eighteens who have probably been smoking since they were, you know, 10 or 11 and really need an exit from smoking. Um uh It means that, you know, it could be prescribed in, in mental health units and so on. Um rather than having to procure and, you know, give, give them out as a consumer product. But I always say to people don't hold your breath and wait for a prescribed product, go out to a shop now and buy something because you could be improving your health right now. Don't wait for, for something to be prescribed next slide, please. Um And um the MHR A yellow card system covers Vape so, you know, any adverse events can be reported to the MHR A. But remember it doesn't prove causation, just correlation that something happened at the same time. You know, we, we hear people say that, you know, they got a terrible, terrible cold once they started vaping but, but people who stop smoking, you know, tend to get what they call smokers flu anyway and start to, you know, cough a bit more and it, it's a temporary thing, it soon resolves. Um, but, you know, they report the same health benefits overall as those equipped with nicotine replacement therapy. Uh, and remember those vapors have a history of smoking and, you know, you can't disaggregate the, the cumulative harm that they did themselves when they were smoking from what they're experiencing right now as, as people who are vaping next slide, please. Um So in mental health settings, a permissive policy on vaping can, can comfortably displace smoking and the need to smoke. Um, the important thing is, you know, what happens when they, when they go home? Have they had the right information about sticking with, with vaping rather than going back to smoke cigarettes. This is a really important issue on discharge. But the more they are encouraged to, to make a complete switch while they're in patience and hopefully followed up in, in the community once they're discharged by a community nursing team who understands the value of them continuing debate that, you know, the better they will do and the less likely they are to go back to, you know, much more toxic smoking. Next slide, please. Um People worry people in your position as, as nurses in the field sometimes worry about not being an expert in this. And I would reassure you that you don't need to be an expert, you need to have some confidence. Uh And maybe do some learning about it. You know, this, this is a good start. Um, the NCSCT do a course of free online course about tobacco harm reduction vaping. Um And it's about where to find the answers. If you need them at the NC SCT, we're very happy to take questions. Um, you know, you can just email into inquiries, uh, if you've got something that you're stuck on and we're, you know, we're always respond. Um But yeah, get yourself equipped with, with more knowledge and that confidence that will really help next slide, please. Um So some commonly asked questions I've already dealt with, you know, that it's not worse than smoking at all. We do know what's in these threats. Um, uh, and people say, well, you know what, if in 30 years time they find that vaping is bad for you. People often quote, you know, the thalidomide stuff that we didn't know that thalidomide was going to be dangerous, but we've got so much better. Science's now. So we know, you know, we've been on or reasonable doubt that nothing is happening when people Vape that is going to go on to cause them long term harms. It's not known. But then think of the COVID vaccine, we didn't know anything about the long term uh effects of that, but it was so important to get people vaccinated that, you know, everybody was encouraged to do that and, and you can liken vaping to that, that we know beyond all reasonable doubt that without the tar and the carbon monoxide, uh you're not going to get the cancers, the respiratory disease and the cardiac disease. Next slide please. And this is the one that I want to particularly just go into popcorn lung is a thing that we're asked about every single day of clinical practice in the stop smoking services, popcorn, popcorn lung is not a thing with vaping. Uh It's talked about greatly, but it, it comes from a very old myth about one particular chemical that is used in the popcorn industry that is no longer a substance that is found in Vape liquid. Um So you can reassure people that it simply isn't a thing. Heart attacks. There was a study come out of California that said that people who Vape were much more likely to have heart attacks. What they didn't say in the, you know, the media stories about this is that those heart attacks um generally happened before vaping even started. So it was, it was smokers who had had a cardiac episode um changed to vaping their, their, their cardiac episode was recorded as a post vaping heart attack. And it wasn't, it was, it was before that the lung injury. Um uh a volley a very short lived episodes in American medical history, illegal street vapes were being bought mostly by young men uh that contained cannabis products uh and vitamin E acetate as a cutting agent. Um and that caused lung injury. It wasn't anything to do with nicotine vapes but people still talk about um volley as though it was to do with that gateway into smoking. This, this isn't a thing either in any country in the world where vaping is encouraged, like the UK smoking rates are going down faster than ever before. So it's clear that it's displacing smoking, it's not causing a youth epidemic either where obviously very exercised at the moment about the increase um in young people trying it, but that's exactly what it is. And, and the ash surveys show that, you know, there's, there's experimentation just like young people experiment with all sorts of things. Um But the ones, the young people who are vaping regularly, most of them were previously smoking and people ask about swapping one addiction for, for another. I heard there's a lot today um at the hospital, I was doing an event at it's the same nicotine, you're just using it in a much safer way. I'm going to stop there because otherwise we're going to not have time for questions. Um, if that's all right with you Michaela and everybody else, it certainly is. Yes. Absolutely. Because I can see some questions coming in and I thought I'm a fire for that. But I think before I go to those questions, I'm just going to take a bit of a, well, a bit of a bit of an opportunity to say, I've just learned lots. I thought I knew a bit about thinking, but the regulation of it, I think because you just can't buy them anywhere. It feels like that. It's a bit of a free for all. So I've really learned a lot there and I still thought about popcorn long. I didn't know it's because of the products and I've been writing lots of stuff down. But if it's all right with you, I'm going to go to some of the questions first and Zoey's learned so much as well. She said, so Zoe was one of the first to put a question in if actually made a comment, saying she knows so little about how to advise people on vaping. And now she said she's let loads but or let lots but she was on that pregnant bit or she's not pregnant, I don't think. But she was saying pregnant women are, if they're pregnant women advised to change to vaping. And I think you covered that one, didn't you? But she also wants to know, are there any follow up studies on the babies or Children of moms that baked during pregnancy? Is anything out there? Oh, absolutely. Yes. Um, it's, it's, it's being watched over time and there's a lot of studies going on at the moment, looking at pregnant women and their outcomes. The most key one to look at. If, if you Google vaping in pregnancy Queen Mary University London QMUL, um you'll get Peter Hayek's study that showed that women who Vape during pregnancy had better outcomes, in fact, than those who used nicotine replacement therapy and pregnancy. So birth weights were good. Um, you know, outcomes for, for babies were good. Um It gives us more confidence that this is the right thing to do because if you, if you, if you frighten women off using a Vape, they'll go back to smoking as well. So, yeah, we're, it's something that's most definitely being watched and loving that success weight. You're twice as likely. That is, you know, at one year twice as likely because it's, it's pleasurable. It's a, people enjoy doing it. Nobody enjoys wearing a nicotine patch. You know, they get itchy skin. If they use it all orally, it gives them hiccups or, you know, sore mouth, it makes your nose run that sort of thing. Whereas, you know, baking is, you know, people find it, it's a pleasurable and that's sweet. It, yes, and it's also relevant in mental health circles because of the kind of community, you know, vapors, talk to each other. And for somebody who's isolated a chat with somebody else who's also vaping can be companionship, you know, they feel part of the sort of affinity group. Uh So I'm going to ask you a really dark question now and I possibly should know the answer to this, but I'd say well on one of them because I'm not a mental health nurse. Um So, and I've done a lot of interviews with people with nurses who work in acute settings. And they were saying a lot of the challenges is trying to when people have to go off site. So not even outside but off hospital premises to be able to smoke, then freeing up nurses for that time. It's really very hard, particularly when everyone's more short staff than ever. Yeah. Is, do you still have to go off site to Vape or can you Vape on site? It depends on the local, on the NHS Trusts policy. And I always strongly encourage trust to make a policy that is positive about vaping uh at a very strict about smoking, you know, not smoking. So, you know, smoking not allowed vaping permitted. Obviously, in certain areas, you don't want it necessarily in the dining room, say, but certainly in the grounds, it should be allowed anywhere apart from maybe right at the front door or underneath office windows, you know, people don't want the vapor, um, sort of drifting into windows but what it does is make it worthwhile people thinking about switching. So, even for visitors, you know, they may think, well, I can't bloody both smoke but okay, I'll buy a Vape for, for visiting the are anti or whoever. And, you know, again, you might see that accidental quitting but it's good for staff as well. You know, you mustn't forget that NHS staff smoking drones, you know, that it is actually higher than the general population. Um You know, if you look at NHS staff as a whole, so getting them switching is a really good thing for, for the NHS staff themselves for the patient's. So they don't come back in from a smoking break, wreaking fags. So a good policy. Absolutely. And I'm having flashbacks now to when I was a young nurse and then the days when you could smoke in the coffee shop in the coffee rooms on the wards, and I always have my little packet of 10 cigarettes in my pocket with some Poland's. I thought no one could hardly see, see through the, it was terrific. Now, we've had a really good comment coming from Catherine and says, so she said we've focussed on smokers trying to quit. And really that was, that was what we wanted you to come and look at on this session and he was talking about and you already started to address this, but I think it's wife picking it back up again and I'm going to read it all out for those people who are watching on demand. So, Kevin has said you focused on smokers trying to quit. What about the youngsters who haven't smoked before but try vaping as a trend. What's the impact on them? Now? I know you did talk about that, but I think it might be just worth revisiting. Okay. So you're talking about the health impacts, are you? I think so. Yes. Yes. Yes. Yes. Um It's important to not exaggerate the health impact in America. They try and frighten young people off vaping by, you know, severely exaggerating the risks. They talk about brain worms and all sorts of stuff that simply isn't true. The risk there is that you, you discredit yourself as a trusted authority. So I would recommend that you have a look at the Ash Resources. Um uh They partnered with Sheffield City Council and brought out some very sensible guidance for teachers, for parents, for young people that selves um to get a sensible and rational and balanced view of what the risks are. The main risk if somebody has never smoked of, of starting to bait is that they become dependent on nicotine and, and that's what Catherine just added in addiction impact. Sorry, but she's just added that in. Yeah. Yeah. You know, so, so that it gets harder to get through a school day. Without having a Vape. Uh you know, that the young person is having to find money to Vape that they wouldn't have had to if they hadn't started. But it's, it's a complex picture because there are some young people who have got anxiety disorder issues. Um You know, so, so, you know, CAMS users, for instance, looked after Children, Children that have, you know, come into contact with the criminal justice system are much more likely to firstly be smokers. Um and actually need an exit out of smoking. So don't just assume that all young people vaping, you know, that that's a bad thing to some of it. It's a better choice for some of them. It may be an alternative to self harming or using cannabis. Um So uh we need different approaches for different types of, of young people and what is, what is young, you know, because we're not necessarily talking about 10 and 11 year olds were talking, you know, also about 15, 16, 17, 18, you know, they're nearly adults anyway, how long would we want them to smoke for before they actually go on to something safer? And one of the a different, yeah, and actually one of the, one of the, um I would say one of the nurses who dealt with sort of the, that 15 16 year old young people, she was saying that she's finding more and more now because years ago, it was a huge proportion of them were smokers huge. But she said she felt it was massive. And now she said it's almost in the, it's a bit chatty to smoke at that age and you don't smoke. Now that actually for that it doesn't feel like the numbers are anymore. But actually there's a big shift in the, in the thought of it. So, we're almost on time, we're almost on time and I'm just going to read out one of a couple of more of the comments, if that's all right, just to just to give you some feedback straightaway. So although people will be doing their evaluation, so charisma said this is really good. I had no clue, but now I do. Thank you. And so charisma I know works in private care. Shawn Marshall said, what an interesting session, so many areas that it can affect and improved. So glad I've joined it and I think it's really, it's been so insightful. Well, and I just kept thinking, I wish I either wish vaping was around whilst when I was younger because I, I smoked a lot when I like many of us. Uh and, and so, but if I can just circle all the way back around to something you said around healthcare professionals and being smokers because I ran a project which was looking at weight and nurses and nurses are more likely to be heavier than the general population. Um And, and we know that smoking is there as well. So is there any sort of words of wisdom for because these are all healthcare professionals on the call now on the session? Now, any words of wisdom for them? And it's great that we spent a lot of time talking about mental health. But let's look after our staff to have you got any. Absolutely. Yes. Um We're as part of my job on the smoke free app, we're doing a number of staff, tobacco dependency offers. Um So uh Greater Manchester Nottingham share, Lester share, we're doing a special offer which is behavioral support from the app, uh free vapes free Nrt. Uh any NHS staff particularly looking at um you know, routine and manual workers as well. Although, you know, there's a lot of nurses amongst the people that are using this particular service. Anybody can use the app though anyway, you know, even if your trust hasn't got um uh tobacco dependency offer, you can suggest that they do. Um you know, because it's, it works out extremely cost effective. Um uh you contact me for details but, you know, you could use the app yourself and the joy of this for nurses is that you don't have to turn up at a particular time at a clinic to get your support. We're available 24 7. Um And you know, and then you can simply go and buy your products, um you know, at a, at an outlet near you. So it could work really well. It's, it's, uh, yeah, I feel fantastic. Well, thank you. I, I've learned lots and I know that everybody here has learned lots and actually anybody watching on demand will learn lots and, and that well, demystifying and getting rid of those myths that we do, we do hear about all of the time. So Catherine says, fabulous session. There we go. And Zoe says, thank you for your expertise and your time. So I'm going to say a huge thank you to everybody of you guys joining in. So for those of you that are of course, a huge thank you to you to Louise. I'm gonna pop the feedback in the chat now. So everybody and this is the great bit about this Louise. Now, people can actually do their feedback straightaway. I've popped it in there and the feedback will start happening. Now, of course, remember everybody you don't do it, we'll follow you up and we'll just click the button again and it sends it back out to you for more feedback. Now, Helen, who's on the call, who's on the session she's going to be doing on in July all around this bundle that we're looking at around smoking and mental health. So don't forget we've got some of the other ones, what I've done around just what smoking does to you, arteries. Joe's done around smoking about mental health and cardiovascular disease. It's amazing session on vaping. We've got a roundtable on Friday afternoon. Don't, if you can register for it, then please do. You'll find it through the, the usual links that we've got. But if not, don't worry, please try and watch us on demand as well. And that's one that I think will be really good because you're joining us along with some other people as well. Um, that are going to be talking about this wider discussion around it. And of course, Helen's will be in July around motivational interviewing and smoking. So a huge thank you, Louise and thank you to everybody else. I'm going to click that. Let's go off live button now. But if you could just hang on for me for a moment, Louise, that would be really good. So I'm going to say bye bye everybody. Thank you so much for a thing.