The Newfoundland and Labrador Alliance for the Control of Tobacco (ACT) and the Non-Smokers’ Rights Association/Smoking and Health Action Foundation Presenter: Melissa Moore Program and Education Coordinator – ACT

Disposable Rechargeable with pre-filled cartridges

Rechargeable Refillable with e-liquid

Rechargeable Refillable with e-liquid

 Canadian Tobacco, Alcohol and Drug Use Survey (CTADS) first to include questions about E-cigarette use.  9% of Canadians aged 15 and over have ever tried an e-cigarette  20% of youth aged have tried  20% of young adults aged have tried  26 percent of users report using an E-cigarette containing nicotine  51% tried using it as a cessation aid (success in this area was not measured) Non-Smokers’ Rights Association/Smoking and Health Action Foundation

Against For  E-cigarettes are unproven cessation aids: should have to undergo same rigorous testing for safety/ efficacy as other NRTs  E-cigs pose health risks to user/others  E-cigs have potential to undermine major tobacco control gains  E-cigarettes are clean drug delivery devices that can satisfy smokers’ addiction to nicotine and to smoking behaviours  Even if not fully known, health risks of e-cigarettes are lower than risks of cigarettes

 Big Tobacco has taken over many of the e- cigarette companies  Imperial Tobacco, British American Tobacco, Phillip Morris international, Japan Tobacco have all bought e-cigarette companies  What is their motivation?

 Most studies lack scientific rigour; small sample sizes, short duration of use  Most studies involve first generation devices  All small studies  Bias—industry funding; self-report survey data; analysis  Lack of quality controls/ manufacturing standards means study results cannot be generalized

 Adverse impact on lung function including increased airway resistance  Health effects of inhaling propylene glycol and/or vegetable glycerin for months/years unknown  Long-term health risks not yet known  Lack of quality controls, manufacturing standards  Huge variety of devices, components, e-liquids/ cartridges in largely unregulated marketplace

 Nicotine poisoning in children  Explosions and fire

 Will e-cigarette experimentation and use serve as gateway to nicotine addiction and/or to smoking among youth?  Will e-cigarette promotion and use undermine quitting?

(CTADS 2013; Propel, Tobacco Use in Canada, Special Supplement: E-cigarettes, 2015) Ever use of e-cigarettes by age and smoking status, Canada, 2013

29 April 2015

 Most e-cigarette users also smoke  More than 80% are dual users  For college student smokers…repeated e-cig use is a predictor of continued smoking  But dual use may be a step toward quitting  Studies show e-cigs can help smokers reduce their cigarette consumption

 E-cigarettes can deliver nicotine effectively Experienced users Using tank or mod  E-cigarettes can deliver levels of nicotine that are comparable to or higher than typical tobacco cigarettes  E-cigarettes can help smokers quit smoking

 Most smokers who try e-cigarettes do not continue to use (~1 in 3)  Overall, the research to date is inconclusive regarding the effectiveness of e-cigarettes as cessation aids  However,  Most studies are of poor quality  Most studies have used first generation devices  Few studies assess frequency of use  Many studies define any experimentation—even if only once—as e-cigarette use

Nova Scotia - May 31, 2015 New Brunswick - July 1, P.E.I. – Sept. 1, Quebec – Nov. 26, 2015 Ontario – Jan. 1, 2016 British Columbia –Bill 14 received Royal Assent May 14, Manitoba – Bill 30 received Royal Assent Nov. 5, Newfoundland and Labrador - ??

 ACT does not recommend banning e-cigarettes at this time because of the lack of research available as to their effectiveness in helping people quit smoking and the possible hazards that may be associated with their use. Instead, ACT believes that e-cigarettes should be subject to the same regulatory controls that are in place for tobacco products. These include but are not limited to:

 All current and future smoke-free legislation and policies should include a statement that e- cigarettes and any new product which mimics smoking are also prohibited under the policy.  No sales of e-cigarettes to minors (in NL this is those under the age of 19)  No sale of flavoured e-cigarettes  No display of e-cigarettes in retail establishments  No promotion/advertising of e-cigarettes

 More research—high quality; longitudinal studies  Balanced, accurate reporting of the research; meaningful relative risk information  Adequate, enforced manufacturing standards  No sales to minors; controls on promotion; no use in indoor public places/workplaces  Legalized sale of e-cigarettes with nicotine

 Advocate for updated current tobacco policies to include e-cigarettes  Promote, inform and educate your members/community about policies  Letter to government in support of regulation

 The e-cigarette is not approved by Health Canada to help people quit smoking.  The amount of nicotine in each e-cigarette is unknown.  The ingredients in the e-cigarette are also unknown and can be very different depending on the brand.  Because the e-cigarette is a newer product, the research is insufficient at this time.

Melissa Moore – Alliance for the Control of Tobacco Presentation adapted from the Non-Smokers’ Rights Association/Smoking and Health Action Foundation