E-Cigarettes and Youth Smoking Agenda Tobacco Awareness E-Cigarettes – The Facts Nicotine -The Common Denominator What should be our response?

The Evidence is Irrefutable The evidence as presented in the Surgeon General’s Report for 2014 was compiled by 75 experts, peer reviewed by a group of 100 and again reviewed by 20 scientists. 31 of the last 50 reports have looked at smoking. The evidence that causally links smoking to serious health impacts grows steadily.

Causal Links

Impacts of Tobacco physical emotional psychological financial PERSON Emotional Mental Spiritual Social Physical physical emotional psychological financial spiritual social

Commercial Tobacco Use The Problem Premature death and disease Damages the health of non-smokers Puts health of the unborn at risk Costs the economy- health and productivity Creates financial hardship and poverty Promotes Social Injustice Pollutes the environment Creates dependency (addiction)

Youth and Young Adult Smoking 99% of smokers start by age 26 In Manitoba 13% of young people age 15-19 smoke 27% of young adults age 20-24 smoke

Optimism Bias Tendency to make overly positive assumptions. Viewing the future as rosy despite the bad choices we are about to make.

E- Cigarettes – The Facts Ist generation: look and feel like regular cigarettes. 2nd generation: larger batter, larger atomizer and new circuitry –deliver more nicotine 3rd generation: allow for customization

E-cigarettes - Proliferation Early 2014 – 466 brands and 7,764 flavors. Increasing at about 10 new brands per month. Majority of brands contain nicotine.

Youth and E-Cigarette Use Awareness: (US) 89% amongst ages 13-17 and 94% amongst ages 18-21 Useage: (US) ages 13-17 at 14%; ages 18-21 at 39% Canada?? Not much data Quebec Survey CCS (2012-2013): 8.5% of grade 6 and 22% of 1st year high school; 1/3 of all high-schoolers have tried e-cigarettes 18% of those who tried were non-smokers 31% of high schoolers who have never smoked an e-cigarette are interested in trying one.

Is this impacting on youth? In June 2014, a Senate and House Leaders report (US) concluded that e-cigarette companies are aggressively promoting their products to youth. (cf tobacco comp. in past) Tactics: sponsorship of youth-oriented events, free samples, sales to youth in stores, and thru social media and web-sites.

Celebrity Endorsements Blu E-cigarettes, the top selling brand, was purchased by Lorillard in 2012, merged with Reynolds in 2014 and then sold to Imperial. Similar Promotion tactics previously used by the tobacco industry are now being used by e-cigs which are not subject to the same restrictions. Celebrity endorsements by actors such as Stephen Dorff and Jenny McCarthy are now being prominently aired and printed. Total promotion budgets for e-cigs went from $5.6 M in 2010 to $82.1 M in 2013 56% of all e-cig paid advertising was by Blu. Web site endorsements (health claim)

E-Cigarettes – The Facts Unregulated as to product ingredients or emissions. What are the constituents of the flavorings used? Propylene glycol is a known irritant when inhaled. What precautions are taken to prevent young children from danger of nicotine poisoning? Are there emissions that are unsafe to by-standers? Pregnant women? Health Canada advises Canadians not to purchase or use ESP’s because these products may pose health risks and have not been fully evaluated for safety, quality and efficacy.

E-Cigarettes – The Facts Electronic cigarettes without nicotine and without health claims (cessation aid) can legally be imported and sold in Canada provided they meet general safety requirements of the Canada Consumer Product Safety Act. Electronic cigarette products with nicotine and/or health claims require authorization prior to being imported or sold in Canada. To date, no electronic cigarettes with nicotine and/or health claims have been authorized by Health Canada.

E-Cigarettes – The Facts Are E-Cigarettes as harmful as tobacco smoking? Initial research into health effects would indicate that there is risk, but significantly less than that posed by tobacco smoking. Harm Reduction – There is not consensus on the potential to utilize e-cigarettes as a way to reduce/quit smoking tobacco products (American Association of Public Health Physicians)

What We Need To Know More research is needed to determine a number of factors: (American Heart Assn.) Type and ingredients of current e-cigarettes Profile of current users How e-cigarettes are currently being used Health effects and toxicity Environmental effects

What We Need To Know Psychological Effects Marketing and Communications Surveillance Economic Studies (taxation) Legal and Regulatory Issues

Nicotine - Common Denominator 70% of experimenters with tobacco (nicotine) become addicted 10% of experimenters with alcohol become addicted 30% of experimenters with cocaine become addicted

Smoking Cessation

What You Should Know About Nicotine Nicotine is an extremely addictive substance 70 -80% of smokers would like to quit 50% try each year Only 3-5% remain quit after their initial attempt On average it takes 8 quit attempts before they quit for good.

What You Should Know About Nicotine Nicotine mimics the action of a neurotransmitter called acetylcholine, causing the brain and its receptors to affect many functions such as muscle movement, breathing, heart rate, learning and memory. Also causes the release of other neurotransmitters and hormones that affect things like mood and appetite. Smokers Use Nicotine to raise the level of dopamine in their brain. (feel good) Exposure to nicotine changes the way your brain functions. Need to smoke to get pick up and to replenish dopamine and replace discomfort of withdrawal with “feel good”

What Should Be Our Response To E-Cigarettes and Youth? Research funding needs to be made available to expand our knowledge about e-cigarettes and their use by young adults (Cf Quebec) E-Cigarettes should not be sold to minors. E-Cigarettes should not be sold in flavors that appeal to children. E-Cigarettes should be restricted as to where and how they can be marketed.

What Should Be Our Response To E-Cigarettes and Youth? E-Cigarettes should not be displayed in retail venues. E-cigarettes should be banned on school grounds. E-cigarettes should not be sold in venues where the sale of tobacco products is prohibited.

Questions?