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1 Melodie Tilson, Director of Policy Non-Smokers Rights Association/ Smoking and Health Action Foundation PTCC Knowledge Exchange 18 June 2014
2 Disposable Rechargeable with pre-filled cartridges
3 Rechargeable Refillable with liquids
4 Rechargeable Refillable with liquids
5
6 Altria bought Green Smoke Feb 2014; subsidiary NuMark launched MarkTen brand Aug 2013 Imperial Tobacco bought Dragonite Sept 2013; launching own product in 2014 Lorillard bought Skycigs (UK) Oct 2013; blu (US) 2012 BAT division Nicoventures launched Vype July 2013 Reynolds American subsidiary R.J. Reynolds Vapor launched game changer Vuse brand June 2013 Japan Tobacco agrees to buy E-Lites (UK) June 2014; strikes deal to market Ploom (US) 2012
7 Number of Media Clips Program Training and Consultation Centre
8 Number of Media Clips Program Training and Consultation Centre
9 Chemicals Implied safety (use, second-hand vapour, etc.) Cessation success (through testimonials) Harm reduction Health risks Product safety (e-cigs, nicotine e-liquid/ cartridges) Legality Cessation Youth Industry Public Health 9
10 Little Canadian data to date ITC 4 country survey, n=5953 (Adkison, AJPM, Mar 2013) 40% Canadian smokers aware of e-cigs 4% smokers have tried them; one-third of triers are current users (27% in 2014) Two-thirds of all respondents believe e-cigs are less harmful than cigarettes 85% of all respondents use e-cigs to help them quit; 75% to cut down; 70% when can`t smoke Questions added to CTADS and next CSTADS
11 Percent of smokers and recent ex-smokers Prevalence of e-cigarette use in the UK Any Current use has plateaued at 16% of current smokers & recent ex-smokers Daily N=11,318 adults who smoke or who stopped in past year
12 Ontario: n = 2895 youth, grades 9-12 (OSDUHS 2013) Ever use = 14.6% (30% with nicotine, 70% without) Awareness = 77% Males more likely to have tried than females (18.6% v. 10.3%) US: n=18,866 youth, grades 6-12 (National Youth Tobacco Survey 2011, 2012) Ever Use- Middle School E-cigarette Use Among US Students (Percent ) Ever Use-High School Current Use- Middle School Current Use- High School
13 All electronic products for administration of inhaled doses of nicotine are new drugs under Food and Drugs Act ; require market authorization from Health Canada before sale
14 Sales Convenience stores Gas stations Pharmacies Head shops Flea markets Kiosks in malls Vape shops Internet with nicotine Promotion Countertop displays POS signage, billboards Ads in magazines, newspapers Retail trade journal ads, articles Celebrity endorsements Sponsorships Branded merchandise Product placements Price discounting Company brochures Internet
15
16 Effective in helping smokers cigarette use (Adkison 2013; Caponnetto 2013; Polosa 2011) Effective in helping smokers quit smoking 2 RCTs found e-cigs as effective as nicotine patch (Bullen, Lancet, Sept 2013; Caponnetto, PLOS, Jun 2013) E-cig users 60% more likely to report continued abstinence than those using licensed NRT or no aid (Brown 2014) ~ 15 surveys of e-cig users report high quit rates (Dawkins 2013; Etter 2011; Siegel 2011; Polosa 2011) Large multi-country survey (n=3587): 92% said ecigs helped them reduce consumption; 96% of former smokers said e-cigs helped them quit (Etter 2011) Small studies case studies; prospective; randomized cross-over
17 Categoria 7.2 mg nicotine e-cig vs. 4.8 mg nicotine e-cig vs. no nicotine e-cig 300 smokers (unwilling to quit) 1 year abstinence rates: 13%, 9%, 4% (Caponnetto 2013) Elusion 16 mg nicotine e-cig vs. nicotine patch vs. no nicotine e-cig 657 participants 6 month abstinence rates: 7.3%, 5.8%, 4.1% (Bullen 2013)
18 Nicotine absorption from electronic cigarette use Some studies show that e-cigs can deliver nicotine effectively and significantly reduce cravings (Farsalinos 2014; Dawkins 2013; Vansickel 2013; Etter 2011; Bullen 2010) in desire to smoke in first 10 min appears independent of nicotine absorption; may be due to satisfying the addiction to smoking behaviours (Bullen 2010) (Farsalinos 2014)
19
20 Will vaping in public places and workplaces where smoking is prohibited promote dual use? trigger relapse? undermine quitting?
21 Sustained use among adults confined almost entirely to smokers and ex-smokers Most users motivated by wanting to quit or cut down Youth who ve never smoked rarely use e-cigarettes Use of e-cigs to quit overtaken NRT More effective than NRT sold in shops As e-cig use has grown, quit attempts; quitting rates; and smoking rates (ASH research: ) (Smoking Toolkit study: )
22 UK medicines licensing regime for nicotine containing products Products available on prescription Tobacco Products Directive regulation of electronic cigarettes Products not available on prescription 5% sales tax Higher sales tax 20% in UK Advertising allowed for products on general sale (GSL) but no celebrity or health professional endorsement, no free samples, must be targeted at adult smokers etc. All tobacco advertising prohibited, prevents brand sharing, promotion of smoking. Products available on general sale Can make health claims MHRA regulation is flexible; there are no upper limits. No health warnings on packs Flavours require a marketing authorisation Age of sale 12 but can be varied by product so could be higher for electronic cigarettes. Cross border advertising banned by 2016; up to Member States to decide on domestic advertising (billboards, Point of Sale, buses etc.) Products widely available Can t make health claims Upper limits for nicotine content will be set and likely to be in force by % health warning on packs about nicotine on front and back of packs Member States retain powers, e.g. on flavours, domestic advertising. Children and Families Bill allows for age of sale of 18 for nicotine products.
23 Evidence-based Balanced 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.
24 All e-cigarettes with and without nicotine should be subject to the same legal framework Federal government must establish/enforce adequate manufacturing standards E-cigarettes should be subject to the same regulatory controls as tobacco products: Ban on sales to minors Ban on use in indoor public places & workplaces Ban on use on school grounds Restrictions on promotion: Controls on youth-friendly flavourings Ingredient disclosure
25 Ensure consensus around approach to the issue Leverage agreed-upon key messages to ensure public health is speaking with unified voice Develop clear calls to action Continuously insert public health voice in media coverage through proactive means and through responding to media coverage via letters to the editor or opinion editorials
26 PHUs and local partners can play important role in driving policy change on e-cigarettes Conduct research, public opinion surveys Provide balanced, meaningful public education (media, materials) Recommend meaningful regulation; speak with one voice: Local voluntary policies, bylaws Provincial and/or federal legislation
27 Melodie Tilson, Director of Policy x3 Follow us on
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