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E-Cigarettes: Minimizing the risks, Maximizing the potential . Non-Smokers’ Rights Association/Smoking and Health Action Foundation. cartridge + atomizer + battery. cartomizer + battery. Innovations. Innovations—batteries . Adjustable voltage Adjustable smoke volume

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e cigarettes minimizing the risks maximizing the potential

E-Cigarettes:Minimizing the risks, Maximizing the potential

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

cartridge atomizer battery
cartridge + atomizer + battery

cartomizer + battery

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

innovations
Innovations

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

innovations batteries
Innovations—batteries
  • Adjustable voltage
  • Adjustable smoke volume
  • Improved battery life
  • Consistent charge

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

innovations flavours
Innovations—flavours
  • Refillable cartridge
  • Refillable tank/clearomizer
  • Replaceable cartridge

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

burgeoning popularity
Burgeoning popularity
  • US sales have doubled every year for past 3-4 years; 2013 sales estimated at $1.7B
  • Big Tobacco is buying e-cigarette companies
    • Major multinational tobacco companies—BAT, Imperial, Japan Tobacco–buying e-cigarette companies or developing their own products
    • Major US tobacco firms also getting involved (Lorillard bought Blu; Reynolds American launched Vuse; rumour of Altria takeover

of NJOY)

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

slide7

Awareness and use of e-cigarettes

Internet Searches: E-Cigarettes, Snus, NRT, Champix

(Ayers et al, American Journal of Preventive Medicine, April 2011)

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

awareness and use of e cigarettes
Awareness and use of e-cigarettes
  • Two large US surveys in 2010: national online study (n=2650) and Legacy Longitudinal Smoker Cohort (n=3650) (Pearson et al, AJPH, July 2011)
    • Ever-use = 11.4% current smokers; 2% former smokers; 0.8% for never smokers
    • Current use = 4.1% current smokers; 0.5% former smokers
  • Two large UK surveys in 2010 and 2012 (n=12,500 adults, incl 2,100 smokers) (Dockrell et al, N&TR, May 2013)
    • Ever use = 22% smokers; 0.5% non-smokers (2012)
    • Current use = 7% smokers (2012)

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

awareness and use of e cigarettes1
Awareness and use of e-cigarettes
  • Little Canadian data; ITC 4 country survey, n=1500 (Adkison et al, AJPM , Mar 2013)
    • 40% Canadian smokers aware of e-cigs
    • 4% smokers ever use; 1% current use
    • 64% believe e-cigs are less harmful than cigarettes
    • E-cig users in all 4 countries: 85% use to help them quit; 80% use because they are less harmful; 75% use to cut down; 70% use when can’t smoke
  • Questions added to 2014 CTADS and next YSS—Quebec only

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

awareness use youth young adults
Awareness +use: youth/young adults
  • Canada: 1211 respondents, age 16-30; 456 smokers, 755 non-smokers (2012) (Czoli et al, SRNT 2013)
    • Ever use = 33% smokers; 6% non-smokers
    • Current use = 14% smokers; 1% non-smokers
  • France: 3400 students, age 12-19 (2012) (Dautzenberg, Open Journal of Respiratory Disease, 2013)
    • Ever use = 33% daily smokers, 16% non-daily, 4% non-smokers
  • Poland: 13,700 students, age 15-19/20-24 (2012) (Goniewicz et al, Pediatrics, Oct 2012)
    • Ever use = 23% youth; 19% young adults; 3% non-smokers
    • Current use = 8% high school; 6% young adults
  • US: 24,000+ students, grades 6-12 (2012) (MMWR, Sept 2013)
    • Ever use, high school = 10% (4.7% in 2011)
    • Current use, high school = 2.8% (1.5% in 2011)

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

health canada s position
Health Canada’s position

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

health claims are illegal but
Health claims are illegal, but …

“While electronic cigarettes are technically a "smoking alternative" rather than a smoking cessation device, the range of nicotine strengths offers some obvious potential as an aid in one’s attempts to quit smoking….” (Wister Oct 2012)

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

sale with nicotine is illegal but
Sale with nicotine is illegal, but …

(www.epuffer.com)

(www.esteamcanada.com)

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

current situation in ontario
Current situation in Ontario
  • Retailers are openly selling and promoting e-cigarettes and related paraphernalia
    • Head shops
    • Flea markets
    • Mobile sales at workplaces
    • Kiosks in malls
    • Convenience stores
    • Gas stations
    • Specialty e-cigarette stores
    • Pharmacies
    • Internet

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

slide15

Superstore, southern ON, 2011

RexallPharmaPlus, Ottawa, Jan 2013

Website, London ON, retailer Sept 2011, http://noifsandsorbutts.ca

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

current situation in ontario1
Current situation in Ontario

Websites

Blogs

Testimonials

YouTube videos

Many forms of e-cigarette promotion

Countertop displays

Retail signage & billboards

Newspaper ads

Retail trade journal ads/articles

Company brochures

Celebrity endorsements

E-cig company sponsorships

Price discounting

Fax blasts + mass emails

Internet

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

the controversy
The controversy
  • E-cigarettes are unproven cessation devices; should be required to undergo same rigorous testing for safety/efficacy as other NRTs
  • E-cigarettes have potential to undermine major tobacco control gains
  • E-cigarettes are clean drug delivery device that can satisfy smokers’ addiction to nicotine and to smoking behaviours
  • Even if untested, health risks of e-cigarettes could not come close to those of cigarettes

Opponents

Proponents

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

opponents
Opponents
  • Long-term health risks of inhaling PG not known
  • Lack of quality controls, manufacturing standards
  • Misleading, false, incomplete labelling—ingredients not fully disclosed
  • Unproven cessation claims
  • Risks from nicotine e-liquid
  • Tobacco control successes may be undermined
    • Will increased social exposure and promotion of ‘smoking’ re-normalize smoking?
    • Will e-cigs lead to smoking/nic addiction among youth?
    • Will dual use increase tobacco consumption?
    • Will e-cig use complicate enforcement of smoking bans?

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

proponents
Proponents
  • Substantially lower health risks than cigarette—risks must be compared to cigarette
  • Exposure to all tobacco smoke toxicants significantly reduced
    • TSNAs in e-cigs are at levels are comparable to those in NRTs
    • Main ingredient (propylene glycol) safe for oral consumption; used as solvent in medications
    • Only 1 death, 1 hospitalization ever reported
  • Effective in helping smokers  cigarette use
  • Effective in helping smokers quit smoking

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

nsra position on e cigarettes
NSRA position on e-cigarettes

Evidence-based

Balanced—minimize risks, acknowledge potential benefits

“E-cigarettes are almost certainly much safer than tobacco cigarettes, and to date there has been little real-world evidence of harm from e-cigarettes.”

“E-cigarettes have tremendous potential to help smokers reduce their cigarette consumption and to quit smoking altogether.”

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

nsra position on e cigarettes1
NSRA position on e-cigarettes
  • All e-cigarettes—with and without nicotine—should be subject to the same legal framework
  • E-cigarettes should be subject to the same regulatory controls as tobacco products:
    • cannot be sold to minors
    • cannot be displayed in retail stores
    • cannot be sold wherever tobacco sales are prohibited
    • cannot be promoted except in adults-only venues and in direct mail to a named adult
    • cannot be used in indoor public places & workplaces
    • cannot be used on school grounds

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

conclusions
Conclusions
  • Early stage issue; much work remains to be done
  • Interests of smokers/tobacco control best served by providing balanced, accurate information
  • Health organizations and practitioners have role to play in advancing e-cigarette policy—
    • research
    • public opinion surveys
    • public education
    • local voluntary policies
    • local bylaws
    • advocacy for legislation

Non-Smokers’ Rights Association/Smoking and Health Action Foundation

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