The New Challenges of e-Cigarettes

8/10/2019 The New Challenges of e-Cigarettes

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The New Challenge of e-cigarettespresented to

Myra Wisotzky, MSPH

Technical Advisor, Tobacco Control


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Overview

What are e-cigarettes? What are the challenges?

How is the public health community

responding to the challenges?

What is your role as a journalist?

Selected resources for more information


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In recent times e cigarettes have become more

common in Kampala where vaping anelectronic cigarette is almost similar to

smoking a traditional cigarette.

Quick Google scan:

Your country + e-cigarette


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What are e-cigarettes?

Designed to generate inhalable nicotine aerosol (vapor) When user takes puff, the nicotine solution is heated and the

vapor taken into lungs

Invented in early 2000s - first available on global market in

2007


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E-cigarettes (ECs) or Electronic

Nicotine Delivery System (ENDS) ECs/ENDS consist of:

Electronic vaporization system

Rechargeable batteries

Electronic controls

Cartridges of the liquid that is vaporized.

Cartridges typically contain between 6 and 24 mg ofnicotine, but sometimes can contain more than 100 mg.

Nicotine is an addictive chemical that, in excessiveamounts, can be lethal (0.5-1.0 mg per kg of weight of theperson).


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Tank


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Tank systems

Larger devices

Heated with

batteriesvoltage

varies Users fill tank with

liquid nicotine, or e-

liquid

Powerful

Big nicotine kick


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Tank


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Mods


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Some terminology

E-cigarette (EC)

Electronic Nicotine Delivery System (ENDS)

Vapour

Vape

Vaper

Vaping E-juice


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An explosion of brands

A proliferation of flavours

Internet search of EC websites (2012 and 2013/2014)

466 brands (each with its own website)

7,764 unique flavours

Net increase of 242 new flavours and 10 new

brands per month over the 17 months between 1stand 2nd search

Zhu, SH Tob Control 2014;23


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Many flavors: Appealing to kids


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Kids brands work to keep names off

e-cigarettes By Associated Press May 26, 2014 | 7:49am

....keep notable names like Thin Mint, Tootsie Roll andCinnamon Toast Crunch off the flavored nicotine used inelectronic cigarettes.

General Mills Inc., the Girl Scouts of the USA and TootsieRoll Industries Inc. . have sent cease-and-desist letters tomakers of the liquid nicotine demanding they stop usingthe brands and may take further legal action if necessary.

They want to make sure their brands arent being used tosell an addictive drug or make it appealing to to children


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Why is flavor important?

Important function in determining who is

attracted to a product

Important function in helping people get

startedon a product

Flavored products are disproportionately used

by youth


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Marketing and promotion

Being marketed like cigarettes in the1950s/60s

Marketing on TV and radio, internet,magazines, billboards

Aggressive placement near candy and/ormedications


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Marketing channels and messages

Television, Internet, and print advertisements

Often features celebrities

Promoted as healthier alternative to tobacco

smoking

Promoted as useful for quitting smoking and

reducing cigarette consumption

As a way to circumvent smoke-free laws


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Content analysis:

e-cigarette websites

0

10

20

30

40

50

60

70

80

90

100 95 95 93

88

7673 71

64

44

32 31

22 22

Data "Smoking revolution": a content analysis

of electronic cigarette retail websites. Am J Prev

Med. 2014 Apr;46(4):395-403.


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Indian celebrities join the e-cigarette

Vape-olution

Indian bloggers have started to invoke the

names of Indian celebrities as e-cig

ambassadors.

Times of India recently highlighted two Indian

film actors who have both successfully

stopped smoking tobacco cigarettes.

http://www.vapestick.co.uk/e-cigarette-blog/indian-celebrities-join-electronic-

cigarettes-vapeolution


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Advertising themes for e-cigarettes


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ENDS: A fast-growing market

Use at least doubledamong both adults andadolescents from 2008 to 2012 [Data mainly from NorthAmerica, European Union, Republic of Korea

US$ 3 billionwas spent on ENDS globally in 2013

ENDS availability is widespread.

Slightly over half of the worlds population live in the

62 countries reporting availability of ENDS.

Source: Electronic Nicotine Delivery Systems Report by World Health Organization 2014


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CHALLENGES


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Challenges

Safetynot scientifically proven

Efficacy in quitting smoking not scientifically

proven

Potential to interfere with existing tobaccocontrol efforts

And- there is much we still dont know..


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The safety of ECs/ENDS has not

been scientifically demonstrated.


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Long term effects?

e-cigarettes deliver lower levels of some of the

toxins found in cigarettes

But the long-term effects of exposure to

e-cigarette vapor and to nicotine in the

cartridge is unkown.


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Only a few studies have studied the health effectsof exposure to e-cigarette vapor

Some of the studies show that EC vapor can havenegative health effects

Long-term health effects are unknown at this timebecause e-cigarettes have not been in widespreaduse long enough for assessment


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Contents vary and are not listed

Products vary widely in the amount of

nicotine and other chemicals they deliver

There is no way for consumers to find out

what is actually delivered by the product they

have purchased


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Propylene glycol

ECs/ENDS vapor contains volatile organicsubstances, including propylene glycol, flavours,nicotine

Exposure to propylene glycol can cause eye andrespiratory irritation

When heated and vaporized, propylene glycol canform propylene oxide a class 2B carcinogen


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Nicotine

Nicotine is the addictive component of tobacco

Can have adverse effects during pregnancy

May contribute to heart disease.

Although nicotine itself is not a carcinogen, itmay function as a tumour promoter


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Other chemicals and particulates

EC vapour usually contains some carcinogeniccompounds Much lower than tobacco smoke but higher than in a

nicotine inhaler

In some brands, levels of some cancer causing agents,(e.g. formaldehyde, acrolein) are as high as in thesmoke produced by some cigarettes

EC vapor particles ultrafine (smaller) compared to thebigger size in cigarette smoke. ENDS generate lower level of particles than cigarettes.


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Physical safety

Major injuries and illness have resulted from

e-cigarette use including explosions and fires

Poisoning from exposure to nicotine in

cartridges has occurred and is a risk for

children in particular


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Efficacy for smoking cessation

(quitting)

M k d i ki


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Marketed as a way to quit smoking

May promote dual use - maintain smoking

and use e-cigarettes

May serve as a gateway

May encourage quitters to relapse


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The efficacy of ENDS for helping

people to quit smoking has not been

scientifically demonstrated

Population based studies

Clinical trials

Some conflicting findings


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Population-based studies on

EC/ENDS use and smoking cessation

Analysis of 4 longitudinal and 1 cross-sectional

studies

e-cigarette use in the real world is associated with

significantly lower odds of quitting smoking

Cli i l T i l


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Clinical Trials on

EC/ENDS use and smoking cessation

Analysis of 4 clinical trials suggests that

e-cigarettes are not associated with successful quitting

Are not any more effective than approved

pharmaceutical aids (e.g. nicotine patch)


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Smoking Toolkit Study, England

Recent study in England

People using e-cigarettes to quit were significantly

more likely to succeed than those people using over-the-counter nicotine replacement

Pl t ith d ti


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Placement with approved cessation

products in mainstream stores


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Promoted by Vape stores

El i i B Ch i


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Electronic cigarettes at Boots Chemist

(UK)

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-

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-

-

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As a healthcare provider and retailer,Boots strives to meet your healthneeds by providing products,information and support you cantrust.

We already help people who smoke tocut down, or stop, using medicines,like Nicotine Replacement Therapy,and support services. But, we alsoknow many smokers would like accessto an alternative to smokingtraditional cigarettes, such aselectronic cigarettes.

Therefore, you can buy the Puritanebrand of e-cigarettes from Boots


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Harm reduction


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Are e-cigarettes an opportunity or threat to

public health?

How can we ensure benefits are maximizedand harms minimized?

Gilmore A, Hartwell, G European Journal of Public Health, Vol. 24, No. 4, 532533


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ECs. a weapon of mass distractiondistracting

advocates, researchers, and decisions makers from

time and resources that could otherwise be devoted

to measures we know to be effective, and thecommunity from messages about quitting.

Quoting Mike Daube in Tobacco Control news and views on-line

http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-that-surprised-everyone/

The e-cigarette debate rages on over at

the BMJ (British Medical Journal)
http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-


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advertising of e-cigarettes is not something to worry

about or ban, rather it should be embraced. It is how

smokers will find their way to these new products and itis how new brands will push the cigarette brands aside.

The normal controls on truth and fairness in advertising,

supplemented by restrictions of the type applied to

alcohol, should be sufficient to balance public healthopportunities and fears that something might go wrong.

Quoting Clive Bates in Tobacco Control news and views on-line

http://blogs.bmj.com/tc/2013/10/02/e-cigarettes-and-the-marketing-push-that-surprised-everyone/


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We certainly dont yet have all the answers as

to their long-term health impact, but what we do

know is that they are much safer than

cigarettes,

Professor Ann McNeill, lead author from the National Addiction Centre, Kings College London, UK


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Controversy in public health

some experts welcome ENDS as a pathway to the

reduction of tobacco smoking

others characterize them as products that could

undermine efforts to denormalize tobacco use

ENDS, therefore, represent an evolving frontier, filledwith promise and threat for tobacco control.



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Whether ENDS fulfil the promise or the threat

depends on a complex and dynamic interplay

among the industries marketing ENDS

(independent makers and tobaccocompanies), consumers, regulators, policy-

makers, practitioners, scientists, and

advocates.



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PUBLIC HEALTH RESPONSE

Regulation of ECs and

ENDS

W ld H lth O i ti


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World Health OrganizationDecision adopted October 17, 2014 at Conference of Parties

Framework Convention on Tobaco Control (FCTC)

Prevent initiation of ENDS by non-smokers and youth; Minimize potential health risks to ENDS users and protect

non-users from exposure to their emissions;

Prevent unproven health claims from being made aboutENDS;

Protect tobacco-control activities from all commercial andother vested interests related to ENDS;

Invites parties to consider prohibiting or regulating ENDS;

Urges parties to consider banning or restricting advertising,promotion and sponsorship of ENDS;

Invites parties and WHO to comprehensively monitor the useof ENDS.

ECs/ENDS are largely unregulated:


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ECs/ENDS are largely unregulated:

More needs to be done

U i li EC /ENDS


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Union policy statementon ECs/ENDS

Prevent ENDS marketing and promotion to and ENDS uptake by

non-smokers, pregnant women and youth

Prevent ENDS marketing and promotion that discourages smokersfrom quitting

Minimize potential health risks to ENDS users and non-users throughprohibiting unproven health claims from being made about ENDSand protecting existing tobacco-control policies from interference

Ensure that there is control over the amount of nicotine and othersubstances delivered by e-cigarettes to minimize the health risk toconsumers

The Union strongly supports EC/ENDS


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The Union strongly supports EC/ENDS

regulation, preferably as medicinesif not then

Ban advertising, promotionand sponsorship;

Prohibit ENDS for tobaccocessation;

Prohibit ENDS in retail

stores; Prohibit sale to minors

Prohibit flavors appealingto children

Prohibit use in publicplaces, workplaces or publictransportation;

Set consumer safetystandards for EC cartridges;

Packaging and labellingconsistent with those formedicines;

Clear information andwarnings on the productsproven health risks,ingredients and usage.

Protect ENDS regulation

from commercial or vestedinterests (Article 5.3)

The Union Position on ECs/ENDS


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The Union Position on ECs/ENDS


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Margaret Chan, Director General


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World Health Organization (WHO)

What is the next challenge? The next challenge isthat the tobacco industry is increasing itsdominance over the market for electroniccigarettes. This should not come as a surprise.

One company used this years World No TobaccoDay to call on WHO, and call on all of yourgovernments, to promote electronic cigarettes as

a way of protecting some of the lives that theythemselves are killing with the other productsthey sell.


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Transnational tobacco companies


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Lets not forget

Smoking tobacco is the single largest

preventable cause of death in the

worldresponsible to 6 million deathseach year.


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We must not allow e-cigarettes to detractattention from what should be our key focussmoked tobacco.

Policies on e-cigarettes must therefore becombined with those making tobacco evenless desirable and available

Gilmore, A; Hartwell G. European Journal of Public Health, Vol. 24, No. 4, 532533


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In summary Quickly evolving/expanding market and use

Much not known about their safety or utility inreducing harm or quitting smoking

Potential for public health benefit AND

Potential for public health harm

Transnational tobacco companies: The fox in the

chicken coop

Governments need to regulate ECs/ENDS toprotect public health

R fl ti d Di i


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Reflection and Discussion

What is yourrole/responsibility asa journalist as itrelates lung healthand e-cigarettes?

What are thequestions that your

public would like tosee addressed?

What issues SHOULDthe public see/

hear/ read about?

What are some

potential themes or

storylines for e-

cigarettes?


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For more information:

Some useful websites and

organizational links

www.tobaccofreeunion.org


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www.tobaccofreeunion.org

ldl f d


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www.worldlungfoundation.org

h i / b


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www.who.int/tobacco

f


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www.fctc.org

b f kid


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www.tobaccofreekids.org

l b l b l


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www.globaltobaccocontrol.org

d / b / l b l/i d h


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www.cdc.gov/tobacco/global/index.htm


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the media are not the holders of

power, but they constitute by and

large the space where power is

decided.

Manuel Castells, Spanish sociologist associated

with research on the information society,communication and globalization

e-cigarette sessions at


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e cigarette sessions at

45thWorld Lung Conference

Poster session # 43

31 October 10:1511:15

Meet the expert

1 November 8:009:00

Room 122/123


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Thank you!

[email protected]

Documents

The New Challenges of e-Cigarettes