Welcome to the wild, wild west.

Transcription

1 Welcome to the wild, wild west. E-Cigarettes in 2014 Adam Bramwell Utah Department of Health

2 Right now, it s the wild, wild west. -Mitch Zeller Director of the FDA's Center for Tobacco Products

3 The wild state of E-Cigarettes in 2014 More than 450 different e-cigarettes are available for purchase today. No industry-wide standards for product safety: chemically or electronically. No advertising restrictions: can say nearly anything, wherever they want. No retail licensing requirements: they can be sold anywhere. Rapidly increasing usage rates by adults and (illegal) underage youth alike. No FDA regulation of these products yet.

4 The Changing Face of The Frontier

5 The Nuts & Bolts of an E-Cigarette

6 The questions you all want answers to Are e-cigarettes safe for long term, repeated, habitual usage? Are these effective cessation tools? But they contain nicotine, right? What about the secondhand smoke or vapor? As somebody who works in substance abuse, what should I say when people ask me about these things?

7 What s on the market? There are over 450 brands of e-cigarettes currently for sale. They come in all sorts of shapes and sizes with all sorts of bells and whistles. From any one of those brands to the next, they can be extremely similar or like night and day.

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37 Let s talk about the juice again. Most e-cigarette juice or e-juice contains the following: Water Flavoring Nicotine (Not all do, and not a requirement: but most does.) Propylene Glycol Vegetable Glycerin

38 Where are people getting these things? The main hubs of e-cigarette sales are, in no particular order: Convenience Stores Smoke Shops and/or E-cigarette Shops Online Which of those avenues do you think are most popular? Depends who your customer is. Of age? Online. Some estimates say 70%. Underage? At a smoke shop.

39 Who They Could Be Sold To

40 Let s talk about marketing That quote from Mitch Zeller comes from an AP article entitled Old Tobacco Playbook Gets New Use By E-Cigarettes. And that about sums it up.

41 Masculinity and Freedom

42 Femininity and Freedom

43 The Safer Alternative

44 But, that s not all they re up to. They have learned a thing or two since their advertising hey-day, though. The industry is taking it to the next level by: Attacking indoor clean air acts Positioning e-cigarettes as cessation devices And relentlessly attacking the point of sale

45 Attacking Indoor Clean Air Acts

46 Positioning As Cessation Tools

47 Freedom of Sale: Product Placement and Lack of Licensing

48 What s around the bend? You may have noticed: most of the ads that I ve shared have been for one brand in particular Blu. Why might that be? And in knowing that, we get a little view onto the frontier of this wild, wild west we re talking about.

49 R.J. Reynolds Vuse

50 Why does marketing matter? Recall what you have often heard from the general public about e-cigarettes: It s just water vapor it s safe! I m going to try an e-cigarette to help me quit. I can smoke this wherever I want. I quit smoking three months ago and haven t had a cigarette since. [drags on their e-cigarette] The e-cigarette industry s marketing money is what is shaping the dialog on this product.

51 And in this corner, public health One of our talking points is that e-cigarettes are unregulated, untested and unproven and that there isn t enough research on them yet. While this is true of what our major problem with e-cigarettes are, it also is telling of the rock and hard place situation we re in. We can t come out and say these things are deadly. We can t unequivocally say these things cannot help you quit. We can t tell kids that if you play with these, you ll graduate to cigarettes for sure.

52 So then what ARE we saying? An undisputable fact and one that the majority of folks are not aware of is that e-cigarettes are included in the Utah Indoor Clean Air Act. Our billboard that you may have seen.

53 Is that all we re saying? C mon! Points from the Utah Departments of Health s official policy statement on E-Cigarettes: At the present time, no one can predict the long term consequences for individuals and society of e-cigarette use. We encourage the US Food & Drug Administration (FDA) to start exercising their regulatory power. Under the right circumstances, it may be possible that e-cigarettes could be helpful in reducing the number of people who smoke cigarettes and die from tobacco-related disease. However, e- cigarettes also pose several potential risks to public health. Until more research is available, the Utah Departments of Public Health recommend establishing retail licensing for those that sell e-cigarettes as a critical policy measure.

54 What s the sheriff have to say about this? Minors cannot purchase or be in possession of these devices or any accessories (such as an empty device, or the liquid). E-Cigarettes (or any device that heats a nicotine substance) fall under the Utah Indoor Clean Air Act.

55 Nicotine Usage by Product Utah s Youth, 2013 Cigarettes Cigars Hookah Chew Snus E-Cigarettes 5.9% 3.8% 4.6% 2.0% 1.1% 0.7%

56 E-Cigarette Usage by Utah Youth: 2011 vs % 7.0% 5.9% 1.1% 2.9% 1.9% 2.8% 1.9% 8th Grade 10th Grade 12th Grade Total

57 Adult E-Cigarette Usage in Utah, 2012 vs % 10.2% 4.8% 1.9% E-Cigarette Usage Cigarette Usage

58 Looking closer at the 4.8% 4.8% Of those 4.8% -- 60% report that they are currently using both e- cigarettes and conventional cigarettes regularly. E-Cigarette Usage % report that they have never tried a cigarette.

59 Bottom line what should we be telling patients that use these? Tread lightly: these things aren t tested, so instead of seeing your e-cig as a permanent replacement, see it as your way out. Make a strategy to taper down your nicotine concentration, and pick a true quit date.

60 The Most There tobacco vapers industry, would also be seeing stop massive, its vaping. tobacco rapid This sales would migration in free eliminate fall, decides of any current precancerous hoist smokers the risks white into of vaping. flag, deep divests nicotine The scale themselves inhalation of this 200 of would times smoked be a day akin tobacco that to products, 73,000 which times and Utah occurred a drops year. all Laws when global digital opposition on cameras the to effective Books replaced tobacco film control like plain packs and tax rises. cameras. We d see unparalleled declines in smoking caused But thankfully, continued research would indicate that the levels of As disease, starting with cardiovascular and respiratory exposure smoking to disease nicotine rates from plummet, vaping was the akin inventors health of risks e-cigs of share coffee the Nobel Prize for Medicine. The history of tobacco control has a final chapter on the triumph of harm reduction and the role of innovation. E-cigarettes have made smoking history. Best Case Scenario drinking. diseases Minors Continuing cannot research purchase also affirms that or secondhand be in possession vape is inconsequential to any health outcome, despite particle sizes of vape of being these comparable devices to that or in cigarette any accessories smoke. (such as an empty device, or the liquid). E-Cigarettes (or any device that heats a nicotine substance) fall under the Utah Indoor Clean Air Act. Self service sales are not allowed.

61 Smoking All Global indoor uptake cessation smokefree of e-cigarettes stalls areas after allow a would continual vaping, be on but 40 the year slowly scale decline of because emerging cell phones. most evidence Most smoking smokers about vapers its would harms also switch, keep meets smoking. but the many decades Many people smokers long who resistance would who have would and never self-absorbed have smoked including otherwise vapers quit would rights children prevaricate and arguments would convince start we vaping, themselves saw with first cigarette attracted that cutting smoke. by back its coolness Smokers by using light and e-cigs no rather up risk under than hype, the quitting and cover then of was a maintained vaping-allowed good enough. by nicotine The policy numbers dependency. in who stop smoking smokefree are indoor easily areas, eclipsed but brandish by the number e-cigs taking to nightclub up vaping security who have staff never when smoked. confronted. Significant Smokefree proportions policy of these collapses having become as unenforceable. nicotine dependent, drift into smoking. Continual lung basting over years with nicotine and fine particles is revealed in longitudinal studies to be far from benign, but by then the imagined benevolent genie is well out of the bottle and showing himself to be a different shade of evil. Worst Case Scenario The net impact of all this would be a massive increase in smoking prevalence and vaping.

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63 Adam Bramwell Utah Department of Health Tobacco Prevention & Control Program