Across Canada municipalities and other jurisdictions are considering banning e-cigarettes. Is this the best thing to do to protect the public? What are the issues, the
concerns, and what does the research so far tell us about e-cigarettes.
Overall
the argument has been that we do not know enough about e-cigarettes
and the best thing to do is to ban them just in case. Recently Red
Deer banned e-cigarettes and in the words of Deputy Mayor Lynne
Mulder a ban is reasonable “because we don't know whether it's safe
or not safe, we have selected to ban it anyway."
Is
it reasonable?
There
is no shortage of evidence regarding the nature of e-cigarettes or of
the people who are using them. Following are the five major points
made by those supporting bans and then a summary of the evidence
regarding those points
Just
like 2nd
hand smoke, 2nd
hand vapour is harmful to others. We don’t know what is in that
vapour and until we do we should not be exposed to it.
We
do know what is in the vapour.
In
the last two years both the journals Biomedcentral Public Health1
and Nicotine and Tobacco Research2
have published studies concluding that there is no harm in being
exposed to second-hand vapor.
Second-hand
vapor has nothing in common with second hand smoke. It has none
of the toxins that result from burning tobacco. It is
indistinguishable from what comes out of an approved and recommended
pharmaceutical nicotine inhaler3.
The nicotine and the trace elements found in second-hand vaper are
not only a fraction of that found in cigarette smoke but fall far
below Canadian federal safety guidelines. There is no danger to
anyone from exposure to second-hand vapor.
It
is common to state findings of various toxic elements in the liquids
used in e-cigarettes but what is too often not stated is that these
occur at levels far below what could harm anyone (just like arsenic
levels in fruit, vegetables, game and fish4).
Claiming
that we cannot know what is in 2nd hand vapor or that we cannot know
if it is safe or not is clear only true if you ignore the science.
There is no health evidence in support of banning vaping in public
places.
“The
last thing we need to do from a public health perspective is have a
product like e-cigarettes renormalize smoking behaviours.” - Dr.
Robert Strang
Vaping
does not allow people to get around smoking bans for the simple
reason that it is not smoking. It is not a loophole. It is an
alternative to smoking and a real threat to the tobacco industry. It
is bizarre to suggest that a product that has been so successful in
getting smokers to switch is undoing decades of tobacco control. The
anti-smoking movement had its origins in trying to get people to stop
smoking; thanks to e-cigarettes people are quitting smoking at a
greater degree than ever before.
Though
some e-cigarettes may look like cigarettes, they don’t smell like
them and they are about 95% less harmful. They are such an
obviously better alternative that they make cigarettes look even
worse than they are. Why would anyone prefer cigarettes when they
could instead use a product that doesn’t smell up their clothes and
hair, tastes so much better, and is so much safer?
Regulating
e-cigarettes as, or like, a tobacco product, undermines its appeal
and effectiveness as an alternative to smoking. It undermines
public health to discourage smokers from trying e-cigarettes.
E-cigarettes are making real inroads on replacing smoking but
legislating them like tobacco products would end up supporting the
tobacco industry and worse, keep curious and smokers who want to quit
from trying them.
And
let’s not lose sight of the big picture - if vaping can replace
most smoking we would see an almost unimaginable decline in tobacco
related illness.
Ultimately
this is a product designed and marketed exclusively to smokers. A
recent study in the British Journal of General Practice found that
just .2% of vapers (that’s 2 out of 1000) were people who had not
been daily smokers5.
Gateway
to tobacco use: “Many kids who might not otherwise smoke are
choosing to try electronic cigarettes, and that can lead to tobacco
use and addiction, which is a concern.”
First
of all, legitimate studies of children experimenting with
e-cigarettes such as the one from Britain’s Action on Smoking and
Health6
have found that not only is it rare but that almost all children who
try e-cigarettes have already tried or are smoking cigarettes.
For
those kids who have never smoked, there is no evidence that using
e-cigarettes (or Nicorette) leads to smoking. What we do have strong
evidence for is that e-cigarettes have become the strongest gateway
away from smoking - that is- the largest market for e-cigarettes are
smokers who want to quit. One recently published study in Addiction
Journal of 5800 smokers trying to quit found that those using
e-cigarettes to quit were twice as likely to be successful at
quitting as those using traditional methods like nicotine gum7.
Another study from the Journal of General Internal Medicine8
found that e-cigarettes were experienced to be much more appealing
and effective than nicotine inhalers and seen as a more attractive
choice for smokers wanting to quit.
As
far as arguing that e-cigarettes lead to smoking it would require
that a person would deliberately make the choice to move to a product
that also delivers nicotine but that in comparison tastes bad and is
really dangerous to their health.
E-cigarettes
are seriously threatening cigarette sales. Shouldn’t we
support any product that reduces the damage that smoking inflicts on
public health?
The
Canadian Lung Association is greatly concerned that e-cigarettes with
candy-like flavours, such as chocolate and vanilla, are being
marketed and sold to youth. “These products have candy-like
flavours, which appeal to children and teenagers and can be bought by
those under the age of 18.”
Every
product that adults consume uses flavour, and adults prefer having
that choice. Flavours in e-cigarettes entice adults away from
smoking. A recent study of over 10,000 vapers found that 66% of
them preferred non-tobacco flavours9.
Just like the flavours added to Nicorette gum (mint, fruit, cinnamon;
or Nicorette cherry lozenges or the mint inhaler)10,
the flavours in e-cigarettes are not put there for kids - they are
there to meet the demands of adult consumers. Adults prefer products
that taste good and they like the range of flavours that make
e-cigarettes so much more appealing than cigarettes.
Though
people like to raise the fear of children using e-cigarettes,
legitimate studies such as the one from Britain’s Action on Smoking
and Health, found that not only is it rare but that almost all
children who try e-cigarettes have already tried or are smoking
cigarettes11.
Yes,
some children will try e-cigarettes. Many more children will be
trying unflavoured regular cigarettes - is it because they are
attracted by the taste of tobacco? No, it’s because some children
will try anything they can get their hands on. But the Canadian
e-cigarette industry as a whole refuses to sell to children, and the
Electronic Cigarette Trade Association of Canada supports specific
federal regulations barring the selling of e-cigarettes to minors.
E-cigarettes
and E-liquid have no quality control standards and are unregulated.
Even
though e-cigarettes are still quite new we understand them much
better than we do cigarettes. Cigarette smoke contains over 4000
chemicals but e-cigarette vapor has very few constituents which are
quite easy to test for and to control. Study after study has shown
that any toxins in e-cigarette vapor exist at just a fraction of what
exists in cigarette smoke and even more importantly they exist at
levels way below Canadian federal safety guidelines.
It
is true that e-cigarettes are not regulated as health products.
However, because in Canada these are sold and marketed exclusively as
recreational consumer goods, they are subject to numerous and
extensive federal consumer product safety guidelines. These
guidelines apply to everything from the constituents in the liquid to
the child proof packaging to the labelling and even to the batteries.
Everything in e-cigarettes conforms to federal standards designed
specifically to safeguard the wellbeing of consumers and the public.
That
being said, ECTA or the Electronic Cigarette Trade Association of
Canada in cooperation with an independent accredited testing lab and
scientific consultants have developed even more stringent standards
than the Canadian government requires. These standards include
regular third party testing.
As
well, ECTA members and pretty well everyone in the domestic industry
refuses to sell their products to minors. (Most of the perception of
an uncontrolled industry comes from the American market which is much
less safety-oriented than the Canadian market).
In conclusion
Recently a letter from over 50 scientists from 15 different countries written to the director general of the World Health Organization warned that “excessive restrictions on lower risk products will have the unintended consequence of protecting cigarettes from competition from less hazardous alternatives. “If the WHO gets its way and extinguishes e-cigarettes, it will not only have passed up what is clearly one of the biggest public health innovations of the last three decades that could potentially save millions of lives, but it will have abrogated its own responsibility under its own charter to empower consumers to take control of their own health, something which they are already doing themselves in their millions” said Professor Gerry Stimson, Emeritus Professor at the Imperial College in London .
Most of the moves to banning seem to come from confusing vaping with smoking when in fact e-cigarettes compete with and have the potential to make smoking not only seem foolish but also make it almost obsolete. Banning e-cigarettes not only supports the cigarette industry but removes the likelihood that thousands of smokers who have tried every other means might finally find the way that works for them.
By: Paul Bergen
By: Paul Bergen
References:
THRA.ca - Tobacco Harm Reduction Association of Canada
THRA.ca - Tobacco Harm Reduction Association of Canada
1
Biomedcentral
Public Health: Peering
through the mist: systematic review of what the chemistry of
contaminants in electronic cigarettes tells us about health risks.
http://www.biomedcentral.com/content/pdf/1471-2458-14-18.pdf
http://ntr.oxfordjournals.org/content/early/2013/12/10/ntr.ntt203.short
“Using
an e-cigarette in indoor environments may involuntarily expose
nonusers to nicotine but not to toxic tobacco-specific combustion
products.“
3
Rest
of the Story:
Metals
in Electronic Cigarette Vapor are Below USP Standards for Metals in
Inhalation Medications
http://tobaccoanalysis.blogspot.co.uk/2013/04/metals-in-electronic-cigarette-vapor.html
“While
the article scared many vapers by comparing the metal levels in
e-cigarette vapor to that in cigarette smoke, it failed to inform
readers that the levels of metals in electronic cigarettes are
generally comparable to those in nicotine inhalers.”
4
http://www.foodinsight.org/Questions_and_Answers_about_Arsenic_in_Food_and_Beverages
5
British
Journal of General Practice: Electronic Cigarettes: Fact and
Faction. http://www.smokinginengland.info/latest-statistics/
6
Action on Smoking and Health: Use
of Electronic Cigarettes in Great Britain.
http://www.ash.org.uk/files/documents/ASH_891.pdf
“Regular use of electronic cigarettes amongst children and young
people is rare and is confined almost entirely to those who
currently or have previously smoked.”
7
Addiction
Journal:
Real-world effectiveness of e-cigarettes when used to aid smoking
cessation: a cross-sectional population study.
http://onlinelibrary.wiley.com/doi/10.1111/add.12623/abstract
Among
smokers who have attempted to stop without professional support,
those who use e-cigarettes are more likely to report continued
abstinence than those who used a licensed NRT product bought
over-the-counter or no aid to cessation. Study consisted of
over 5800 adults.
8
Journal
of General Internal Medicine:
E-Cigarette Versus Nicotine Inhaler: Comparing the Perceptions and
Experiences of Inhaled Nicotine Devices.
http://link.springer.com/article/10.1007/s11606-014-2889-7
9
E-cigarette
Forum:
Big Survey 2014.
http://vaping.com/data/big-survey-2014-initial-findings-eliquid
10
Nicorette Gum.
http://www.nicorette.ca/products/gum
11
Action on Smoking and Health: Use
of Electronic Cigarettes in Great Britain.
http://www.ash.org.uk/files/documents/ASH_891.pdf
