The Sax Institute’s video series, From Data to Decision: The Power of Research Policy, delves into the intersection of research and public health policy. This series aims to shed light on how scientific research influences policy decisions that shape our health landscape. This is the second in our series, following our interview with Professor Bronwyn Hemsley.

In this episode, we look at the evolving landscape of nicotine vaping regulation both in Australia and internationally with Associate Professor Becky Freeman from the University of Sydney. Associate Professor Freeman shares her insights on how research is driving policy changes and vice versa. She discusses the challenges and successes in regulating vaping products, the impact of her research on policy, and the importance of collaboration between academia, NGOs, and policymakers.

Disclaimer: this transcription has been automatically generated.

Hugo: Hello, and welcome to the Sax Institute’s new video series. It’s entitled, “From Data to Decision: The Power of Research Policy.” That pretty much sums up what we’re trying to do. We want to explore the impact of research on public health policy. For our first episode, I’m delighted to welcome a very distinguished public health researcher, Becky Freeman.

Becky is an associate professor at the School of Public Health here at the University of Sydney on Gadigal land on a very wet and windy Friday afternoon. Becky has over 20 years of experience working in tobacco control. She’s also very interested in how social media influences public health and the potential of the internet to circumvent tobacco advertising bans. More recently, she’s been involved in research and policy around vaping. And that’s what we’re here to talk about today, because vaping is an emerging public health issue. There’s been a lot of movement in the regulation around nicotine vaping, both here in Australia and internationally. At the same time, it’s an emerging research subject as well.

And the amount of research on that has been ramping up. So I’d love to get a better understanding of how these two things are interacting, how research is impacting policy, and maybe vice versa as well. So, Becky, welcome and thanks so much for taking part in this video series.

Becky: Thanks so much for having me. Even on this rainy day, it’s nice to have a chance to talk about this. When we think about vaping, I think we all have a really clear picture in our heads right now of these brightly colored devices that smell like fruit or lollies or pancakes, and there’s lots of kids using them. But about ten years ago, when e-cigarettes were first invented, it was literally a little plastic cigarette. They had a few puffs on them. They weren’t really that popular. They didn’t get used that much, and it seemed like quite a fringe issue. Now, you fast forward to today and we have these products like I just described, clearly marketed to kids and sold to kids. And that’s what really spurred me to want to work in this area.

When we started hearing stories from parents and teachers saying, “What are these products? Why are they popping up in our schools? What is this in my kid’s bag that looks like a pen he’s sucking on? How is it getting in here? What’s going on?” And then, of course, you just had to walk around the CBD here in Sydney, and every other shop seems to be selling these products. When you look at the legislative environment in Australia, where nicotine is classified as a poison, you think, “What’s going on here?” You can’t just add nicotine to any product you like and sell it. Nicotine vapes are technically an illegal product, but when you tested these things that were being sold in convenience stores and petrol stations, they invariably contained nicotine.

That’s what really spurred me on, wanting to work with the Cancer Council in New South Wales, in particular, in gathering evidence and research to get a clear picture. How big a problem is this? Who’s using these products, and where are they getting them from?

Hugo: And briefly, what do you think the important findings are of your work?

Becky: I think Generation Vape has been such a great project because it’s really provided that information that we had kind of a blank slate on. We had some population-level data saying these are increasing in use, but we had no real concrete information on where kids are getting these products from, how they are using them, why they are using them, how much they are paying for them, and what the devices are like. Having a concentrated survey like that, funded by New South Wales Health Cancer Institute, the Federal Government, Cancer Council, and New South Wales Institute, brought all these partners to the table who were calling out for this data because they wanted to do evidence-led policy change from the beginning.

Hugo: When you’re thinking about research, were you shaping the topics around the idea of impacting health policy?

Becky: 100%. To me, that’s the main impetus for doing this research—knowing that what we had in place, the policy where nicotine is a Schedule 7 poison and nicotine vapes aren’t legal to be sold, you had to have a prescription to get your hands on one, yet we’re seeing vapes being sold everywhere. Clearly, our policy is not working. Something is falling down here. What’s going on? Surveying young people, their parents and teachers, and young adults across the community to get a clear picture to say, “What policy response do we need?” It became very clear after our first wave of data collection that it was about access. Young people said it was super easy to get their hands on these products. They knew exactly where they would have to go if they wanted to vape, and they were being offered them by friends, could buy them in shops, and get them online.

Becky: This is a product that technically isn’t legal. Working with policymakers, program managers, and NGOs from the very beginning, because Generation Vape is 100% backed by the Cancer Council in New South Wales, has been crucial. I’ve had really good relationships with NGOs as part of my academic career, always being invited to work with them and lead this project as the chief investigator. It’s exactly what a researcher would want—it’s fantastic.

Hugo: Were policymakers embedded at every stage of this? Were you talking to them before you started on your research project and then during and after? How does that work?

Becky: Yeah, I don’t think we can really separate out academia, NGOs, policymakers, and politicians. It’s artificial to put all these people in separate rooms. There’s so much crossover. Most of our public health policy is driven by evidence. Without it, you’re just guessing what might work. I don’t want to do research that doesn’t have any real-world impact. I want it to be useful, valuable, and immediately get in the hands of people who can do something with it. Of course, I love to publish in journals and go to academic conferences, but seeing your research being read at a parliamentary hearing or having a politician quote your research in a press release and then say, “And because of this research, we know we need to go in this direction,” is what most public health academics live and breathe for.

Hugo: Who exactly are you talking to? Do you just sort of pitch them cold? Is it ministers, civil servants? How do you make the initial pitch to them?

Becky: This is going to sound very technical, but it’s all about relationships. I’ve worked in this field for a really long time now, and I know my accent is Canadian, but I’ve been in Australia since 2004. People who work in tobacco control are really committed to the field, so people in NGOs and the policy space have been around for a long time. We have a lot of experience going through things like the plain packaging laws together, and you form working relationships. You work with people you like to work with, you get invited to the table, and it’s a dialog back and forth. One of the most valuable things you can do as a public health academic who wants to influence the policy space is to work with NGOs. They understand that they need to push for policy change, bring the public along with them, and bring MPs along with them. They want to be evidence-based, and as an academic, that’s the part I can contribute.

Becky: People who work as public servants behind the scenes play a crucial role too. You don’t always see them talking to the media or being the leading voice, but their role is crucial in getting your work into the hands of decision-makers. Having excellent relationships with public servants, who you can help prepare briefing papers for and respond to their emails quickly, makes you a valuable resource. Then, when it’s time to ask questions like, “What’s going on with vaping? We need some answers here,” you’ll be the person they turn to.

Hugo: So that’s a long-term thing, building up relationships?

Becky: Yeah, it’s a long haul. It’s not like those ads you see on social media promising “seven easy tricks to lose belly fat.” It’s the same with public health advocacy. My students often ask, “What can we do to be effective public health advocates?” I tell them, first of all, you need to be in it for the long term. Plain packaging is a good example. The UK Medical Association pitched it in the 1980s, and we didn’t see it become policy in Australia until 2012. That’s a long time, with lots of little wins along the way. Being committed, forming relationships, being useful, valuable, and responsive are key. It doesn’t mean you never criticize the government. When you have strong relationships, you can sometimes step back and say, “I don’t support that move the government made.” There’s trust, and you can do that.

Hugo: Is there any point in talking to the tobacco companies or manufacturers?

Becky: No, I wouldn’t recommend it. There’s a long history of the tobacco industry co-opting science, obscuring results, lying about their products, using front groups, and doing behind-the-scenes lobbying without disclosing who they are. There’s nothing to be gained from trying to have an honest conversation with them. The goal for tobacco control is to put the tobacco industry out of business, and the World Health Organization’s Framework Convention on Tobacco Control actually includes ending tobacco industry interference in public health policymaking. They are not a legitimate stakeholder in tobacco control.

Becky: For vaping, you see high-profile campaigns fronted by vaping retailers, but when you look deeper, the tobacco industry is funding those campaigns because they want vaping products sold as consumer goods. They want the same model as cigarettes—sold in every community and every street corner. Even in remote Australia, it’s easier to get a pack of cigarettes than a loaf of bread. They want that model for vaping.

Hugo: How effective do you think your research has been in directly impacting policy?

Becky: I think the biggest policy change we’ve seen is that all vapes, regardless of nicotine content or device type, are no longer allowed to be imported into Australia unless they’re for medicinal purposes or prescribed by a healthcare professional for quitting smoking. There was a massive loophole where non-nicotine products were not regulated properly. Our research in Generation Vape identified that as a reason why good policy on paper wasn’t working. We showed that young people could easily get their hands on vapes, and they knew they contained nicotine. We drew sharp attention to this loophole, and our researchers and partners were invited to a policy roundtable to present our findings. Treating non-nicotine vapes like nicotine vapes closed that loophole.

Hugo: And just showing that vapes themselves were being sought out for flavors and nicotine, and were easy for kids to get, was important?

Becky: Yes, our research showed that kids knew about the harms and addictiveness of vapes but still found them readily available and socially acceptable. They were getting mixed messages from social media marketing. It became clear that education alone wasn’t enough—we needed a policy push. Addressing access and supply was crucial.

Hugo: Do you think publishing in high-profile journals like The Lancet has the same impact as being in front of a parliamentary committee?

Becky: Publishing in academic journals is important for peer review and international sharing, but it’s just the first step. It needs someone to advocate for it to have real-world impact. I’ve published in both domestic and international journals, but a big international journal isn’t a guarantee of policy impact. It’s more about getting the research into the hands of those who can use it.

Hugo: You’ve had quite a bit of media interest in your research. What role do you think media plays in ensuring research has an impact?

Becky: I think media is crucial for policy impact. Even if you can’t meet every politician or public servant, they all consume news media. Being on news programs and presenting your research helps get in their ears and brings the public along. Not every media experience is positive, but overall, it’s important for policy change. Science communication, distilling complex research into meaningful impacts for the public, is a real skill.

Hugo: Do you think enough is being done to engage researchers and policymakers?

Becky: I’d love to see more direct engagement between policymakers and researchers. Formal systems like conferences or policy evidence exchanges could be useful, but forming relationships, being available, and sharing work directly with policymakers is also effective. Working with media offices at academic institutions can help get your work out there. Small community radio or social media can be good starting points. Media skills can be learned like any other research skills.

Hugo: You recently returned from a tobacco control conference in Panama. Any interesting lessons on research translation from there?

Becky: The World Health Organization’s Framework Convention on Tobacco Control is the epitome of research translation. It’s based on proven policies and interventions to reduce tobacco use. It brings together public health, law, economics, government, and NGOs to ensure the process is evidence-based. NGOs play a crucial role in keeping the process honest and calling out tobacco industry interference. The treaty process, driven by consensus, can be manipulated by the tobacco industry, so having skilled policymakers and NGOs involved is important.

Hugo: Well, thanks so much for talking to us, Becky. That was a fascinating conversation, and vaping is a great case study on how research and policy can interact and lead to significant policy changes.

Becky: Thank you very much.