E-cigarette regulation and policy: UK vapers’ perspectives

Dr Hannah FarrimondDep’t of Sociology, Philosophy and Anthropology

University of ExeterH.R.Farrimond@exeter.ac.uk

http://socialsciences.exeter.ac.uk/sociology/staff/farrimond/

April 2015

Introduction to e-cigarettes and vaping What is the policy/regulatory dilemma? Regulated as tobacco, medicines or consumer

products= international inconsistency and ideological (as well as scientific) debate

Qualitative study to uncover main arguments underlying regulatory ‘position’ of vapers in UK (n=55)

Conclusion: What is the way forward with vaping for public health and cessation services in the UK? If and how should vapers (as users/stakeholders) be part of that?

Summary of argument

‘Vaping’= nicotine in propolene glycol/glycerine No tobacco, no combustion, no carbon monoxide State of science: no long-term; recent studies

(Farsalinos et al., 2015) ‘many magnitudes safer’ Exponential rise in e-cigarette use: estimated 2.1

million users in UK (ASH, 2014)

Is vaping a ‘game-changer’ for tobacco control?

The rise and rise of vaping

What are these products?

Picture: www.erowid.orgPictures: www.thingiverse.com

?

Regulatory confusion

International regulation UK regulation

Dynamic regulatory environment

Banned it (Brazil) Prohibited sale (Canada)

or use (Australia, except as prescribed)

FDA/CDC regulate as tobacco product, individual US states= only tobacco flavour

In the UK: EU Tobacco Control Directive, implemented 2016

Stronger liquids as medicines (issue with expense)

No advertising Bans on vaping in

public places? (Wales= yes, England= no)

‘The rise of the electronic cigarette is a consumer-led self-help public health movement…What other public health initiative could claim so many ‘converts’ in such a short time?’

Stimson, G (2014) European Journal of Public Health,24 (4): 534-535

Public health response: For

Characterizes e-cigarettes as ‘harm reduction’ in relation to smoking

Points to (few) RCT’s that show more successful quit attempts using e-cigarettes than NRT or nothing

Little so far on benefits of choice/pleasure/ownership of vaping

Public health response: For

Don’t know the ‘harms’ of vaping (e.g. toxic chemicals in vapor?) so should operate precautionary principle

Perpetuates nicotine addiction in those who may otherwise have quit

Tobacco companies buying up e-cigarettes to preserve market share

Young people may be tempted into using fruit/sweet flavours = new generation of nicotine addicts

Renormalizes smoking after its ‘denormalization’ Chapman, S. (2014) E-cigarettes: does the new emperor of tobacco harm

reduction have any clothes? Eur J Public Health (2014) 24 (4): 535-536

Public health response: Against

Evidence of passive smoking/harm to others =the primary driver for legislation around the globe banning smoking in public enclosed spaces

Extension of the concept embodied in the term ‘passive vaping’

WHO supports ban on vaping in enclosed public places due to ‘passive vaping’

Concept of ‘passive vaping’

But WHAT IS ‘passive vaping’? (given no combustion)

‘Users' perceptions of e-cigarettes and vaping: A Q-methodological study’

Postal study with 55 vapers/e-cig users 45% (25) from vaping forums, 55% (30) from ads

in vaping shops, non-vaping forums, work networks, libraries across UK

Purposive sample of different ‘viewpoints’ 51% (28) men/49% (27) women Quitters 62% Dual users 38% Data collected Sept ’14-March ’15 Response rate 67% (very high= motivated?)

Empirical study

10 open-ended questions on the following topics 1) ban on advertising e-cigs 2)health warnings on e-cigs 3) childproofing e-liquids 4) age restrictions 5) a limit of nicotine strength 6) regulating e-cigs as medicines 7) ban on smoking in enclosed public spaces 8) individual establishment bans on vaping 9) ban on sale of products 10) own suggestion of where restrictions might be appropriate

Written answers ‘can you give your response to each policy and explain WHY you think this?’

Further comments on back…

Thematic analysis (Braun & Clarke, 2006)

Measures

Yes to childproofing liquids/safety

Most agreed with age limits (either 16/18)

‘Over 18’s only, they do contain nicotine which is addictive’ (P43, female, aged 51)

Challenged notion flavours are just for children

Theme One: Protecting Youth

‘the flavours aren’t marketed at children! I’m 43 years old and love apple pie and candyfloss and chocolate brownies. Is tobacco flavour more adult?’ (P6, female, aged 43)

Broadly supportive of health warnings if they related to addiction

Views on bans on advertising divergent; most through marketing should encourage vaping for public health benefits; a few not due to unknown risks

Question: should we encourage/discourage e-cig use (in public health)?

‘This (warnings) would be welcome, so long as it is grounded in science rather than conjecture’ (P47, male, aged 42)

Theme 2: Promoting health

Mostly against this type of regulation (like patches/gum)

Many did not conceptualise their vaping as therapeutic but as hobby/enjoyable ‘I vape because I want to, not because there is anything wrong with me’ (P25, male, aged 47)

‘It would be great if the NHS could use this within a stop smoking scheme’ (P4, female, aged 34)

Theme 3: Regulating as medicine?

No support for overall ban on sale (unsurprisingly)

Bans in public places not justified by scientific evidence: ‘don’t agree, smoking was banned in the light of the proven evidence of secondary effects which as far as I have read to date, does not exist for e-cigs’ (P8, female, aged 69)

Theme 4: Competing rights

But support for autonomous decision-making; rights of individual establishments to ban vaping on their premises

‘I have no automatic right to vape wherever I feel, as long as it is private property’ (P10, male, aged 47)

Some not vaping in response to social convention and norms e.g. around food, children, hospital

Also: ‘stealth vaping’

Theme 4 cont.

Political concerns e.g. Big Tobacco will benefit if regulated as medicines (as only big companies can afford clinical trials); tax for governments; stifling innovation (e.g. 2nd 3rd gen devices shown to be more effective than cigalikes)

Political concerns about regulation

Broad position in favour of protecting children/safety, with ‘light-touch’ regulation embedded in the scientific evidence

Not representative sample, but fits with survey data from Australia (Kolar et al. 2014) and US (Sumner et al., 2014): an international regulatory position?

Reference to existing social norms around smoking =management of negative social identity

Conclusion

Millions ALREADY vape

Reactivation of ‘rights-based discourse’

Large online international trade

Consensus around safety/children, but would tighter regulation (e.g. bans on public vaping, products) have any effect?

Final thoughts:

Or has the vaping genie already escaped from the bottle?

Picture: www.youtube.com, user ‘vapegenie’