Paul Lambert Public Health Specialist

*Battery-powered devices that converts liquid nicotine into a mist, or vapour, that the user inhales.

*There's no fire, no ash and no smoky smell.

*Has three main parts: 1. a rechargeable lithium battery

2. a vaporisation chamber

3. a cartridge – containing nicotine, water, glycerol, flavourings

*2 main types of e.cigarettes 1. Cigalikes – disposable or prefilled cartridges

2. Tanks – refilled with liquid

3

1) E.cigarettes will help improve public health by providing a less harmful product for smokers to obtain their fix?

* A) Yes

* B) No

* C) Not sure

4

2) E.cigarettes are a trojan horse that the tobacco industry will use to push their core business?

* A) Yes

* B) No

* C) Not sure

5

3) E.cigarettes should be regulated as:

* A) A medicine

* B) A tobacco product

* C) A consumer good

• Gateway effect?

• Marketing of e.cigarettes

• The role of the tobacco industry in manufacturing and promoting e.cigarettes

• Children/young people and non smokers

• Long-term impact

7

8

Electronic cigarette use among current adult cigarette smokers in Great Britain (2010-2015)

ASH 2015

9 ASH, 2015

05

101520253035404550

2009

-320

09-4

2010

-120

10-2

2010

-320

10-4

2011

-120

11-2

2011

-320

11-4

2012

-120

12-2

2012

-320

12-4

2013

-120

13-2

2013

-320

13-4

2014

-120

14-2

2014

-320

14-4

2015

-120

15-2

Perc

ent o

f sm

oker

s try

ing

to s

top

E-cigsNRT OTCNRT RxChampixBeh'l supp

N=10411 adults who smoke and tried to stop or who stopped in the past year; method is coded as any (not exclusive) use

Aids used in most recent quit attempt

www.smokinginengland.info/latest-statistics

The best thing a smoker can do is quit completely, immediately and forever *Tobacco harm reduction is nothing new.

*Toxicants in e-cigarettes? Other than nicotine, what else do e-

cigarettes deliver? A number of studies have looked at this, with at least 8 toxic compounds identified .However all of these were at significantly lower levels than in conventional cigarettes

*PHE Review – e.cigarettes are 95% less harmful to health than

normal cigarettes

www.smokinginengland.info/latest-statistics 12

61.6

37.9 42.7

0

10

20

30

40

50

60

70

E-cigaretteuser

Non user Total

Perc

ent

N=2596 current smokers from Nov 2014

Only a minority of current smokers believe e-cigarettes are less harmful than cigarettes

*Estimated to be worth £91.3m a year *Increased by 340% in 2013 to reach £193M

*Over 200 brands of e.cigarettes with a plethora of flavours *Market made up by independent companies and tobacco companies

*Independent companies position e-cigarettes as a normalised

necessity – the ultimate, socially acceptable, smoking alternative for someone addicted to nicotine.

*E-cigarette brands owned by tobacco companies are being promoted through celebrity endorsements and channels where traditional cigarette advertising is banned

Four core functions • Promotion - Recruit new users – press, TV, magazines, social

media

• Product – Safer (healthier) “Safe” nicotine, Cessation, Get them to use more, Lifestyle (sociable, social status)

• Price – Cheaper than smoking

• Place – Smoking/vaping anywhere / beat smoke-free Plus: Leverage stakeholders

Celebrity endorsements are not prohibited

16

18

Warrington Wolves have a partnership with UK electronic cigarette brand TRUVAPE.

*The e-cigarette market is evolving rapidly

*Current use among adults is confined to current and ex-smokers

*Current use among children is rare and found mostly among older children and the most frequent smokers

*1% of children expect to try e-cigarettes soon

*It is vital to continue to monitor changing patterns of e-cigarette use to inform policy

20

76.1

16.3

3.7 2

1.9

%

I have never used them

I have tried them once ortwice

I have used themsometimes (more thanonce a month)

I use the often (morethan once a week)

I use them regularly(every day)

Current regulation

• UK &EU: Consumer product regulated under General Product Safety Directive

• October it will be an offence to sell e.cigs to under 18’s, including proxy purchasing.

2016

• EU Tobacco product Directive

The two ways of placing e-cigarettes on the market: 1) as a medicine, if companies choose to make a claim that e-cigarettes help smokers quit smoking or contains over 20 mg/ml of nicotine 2) as a consumer product (if companies do not make any health claims) subject to certain safeguards, including: • a limit on nicotine strength of 20mg/ml • quality and purity standards • Restrictions on advertising • Permit advertising on TV, but prohibit promoting smoking or any imagery

that might be reasonable be associated with tobacco brands • a size limit and safety mechanisms for e-liquid bottles and refillable

cigarettes. • It will not regulate domestic only advertising (e.g. billboards and PoS)

*We will protect the market monopoly of conventional cigarettes

*Product innovation will reduce/ possibly stop

*Product prices would increase, possibly to the point at which switching to a low-risk e-cigarette would be much more expensive than continued smoking

*We will contribute to disease and death of millions of smokers prevented from moving on to safer nicotine products

*The TPD rules are a progressive step to reduce the promotion of e.cigarettes to non smokers and young people. However they do not address all the concerns about the marketing of e.cigarettes.

* Have the potential to save millions of lives, however quality control is a concern which can vary widely amongst devices.

* Model the idea of smoking and nicotine addiction - Potential to glamorise the image of smoking (again)

* The tobacco industry trade press suggest it has little to lose and everything to gain: if e-cigarettes take off, it will control the market and maximise the returns; if they don’t, it will simply revert to business as usual.

* Tobacco control, by contrast, has much to lose: the clear ‘no to smoking’ message, numerous policy gains including Article 5.3, reputation and unity of purpose.

* The long-term success of any market is dependent on recruiting new generations of consumers

* Regulation/restrictions must be balanced against the risk of what these might mean for population wide progress toward the goal of reducing smoking.