Wireless Access SSID: cwag2017 Password: cwag17

E-Cigarettes: Public Health and Public Policy Neil McKeganey Ph. D E-Cigarettes: Public Health and Public Policy Neil McKeganey Ph.D. Christopher Russell Ph.D. Centre for Substance Use Research Glasgow Scotland

Smoking in the United States Smoking rates within the U.S. have fallen consistently over recent years. But: Around 480,000 deaths a year attributable to smoking 16.7% of men and 13.6% of women smoking in U.S. Smoking costs the U.S. an estimated $11B a year.

E-Cigarettes Public Health and Public Policy E-cigarettes represent an unmatched opportunity to improve the health of current smokers by enabling those smokers who cannot quit to switch to a much less harmful means of consuming nicotine?

FDA Commissioner Announcement on Tobacco Harm Reduction Last Friday Commissioner Gottlieb made a major announcement embracing the principle of tobacco related harm reduction. FDA has identified reducing the nicotine content of combustible tobacco products as a key part of the new strategy. The contribution of reduced risk products including e-cigarettes have been recognized as having a key role to play in reducing the harms for those smokers who cannot quit. This is a major shift in policy.

E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys (Shu-Hong Zhu et al BMJ 2017) The substantial increase in e-cigarette use among US adult smokers was associated with a statistically significant increase in the smoking cessation rate at the population level.

E Cig Use/Non Use Last Year Quit Attempts and Cessation (Shu-Hong Zhu et al BMJ 2017) E Cig Use in Last Year Quit Attempts% Cessation >3 months% Used last year 65.1 8.2 Used one year or more ago 48.4 5.4 Never Use e-cigarettes 37.8 4.6

U.S. Vapers Survey 2016 Patterns of cigarette smoking and e-cigarette use amongst 20,676 adult frequent e-cigarette users in the United States Frequent e-cigarette use defined as use over at least 20 of the last 30 days.

Smoking Vaping Status of Study sample (n= 20,676) Number % Smoker Who Became Vaper Ceased Smoking 15807 70.5 Former Smoker Who Became Vaper 2483 11.1 Dual User (vaping and smoking) 1330 5.9 Non Smoker Who Became Vaper 1056 4.7 Vaper Who Relapsed to Smoking 129 0.6 Vaper Who Started to Smoke after Vaping 31 0.1

STEs initiated e-cigarette use for primarily health/harm reduction reasons.

Majority of STEs have experienced significant improvement in at least one respiratory symptom and one cardiovascular symptoms since switching to exclusive e-cigarette use.

Reduced Interest in Smoking

Majority of daily users have become less interested in smoking since becoming a daily e-cigarette user.

Role of Flavours

Daily users increasingly likely to initiate e-cigarette use with fruit-flavoured liquid; decreasingly likely to initiate with cigarette flavours.

Fruit, candy, and dessert/pastry flavours most popular current flavours with each group.

Reduced Nicotine Content

Daily users increasingly likely to initiate e-cigarette use with liquid containing 1-6 mg/ml nicotine; reduced initiation with 19-24 mg/ml.

Current daily use within each group characterised by use of liquid containing 1-6 mg/ml nicotine.

Smokers Now Switching Earlier Away from Smoking to Vaping

Increased proportion initiating e-cigarette use as lighter smokers (1-10 CPD) over time, displacing heavier smokers (21-30 CPD).

Low Level of Addiction to E-cigarettes

Self Reported Dependence Measured Using Validated Scale (n= 17940)

The Problem “I hate e-cigarettes. I hate the fact that they contain nicotine and come in flavors that are designed to attract kids. I hate the companies that make money out of selling e-cigarettes. We are never going to be saying to our young people “here try these, they are 95% less harmful than cigarettes”.” - San Francisco Public Health Official, 28 July 2017.

Maximising the Benificial Impact of E-Cigarettes Ensure that a range of device types (closed and open systems) continue to be available. Ensure that vapers can continue to access non smoking/tobacco related flavours. Ensure that e-liquids in variable nicotine strengths continue to be available. Do not stigmatise vaping as a sign of personal failure or a threat to public health. Do not include vaping in smoke free policies.

Declaration of Funding The U.S Vapers Survey was funded by Fontem Ventures. Fontem Ventures has had no role in influencing the collection of data, the analysis of data nor in the publication and presentation of the findings of our research. Thank you for listening.

Wireless Access SSID: cwag2017 Password: cwag17