Electronic Cigarette Public Discussion Response to Options

Electronic Cigarette Public Discussion Response to Options

Contents Contact Details... 3 Options to prevent uptake... 4 Non-Regulation... 4 Option 1.1 Continue with the status quo... 4 Option 1.2 Public education... 4 Part Regulation... 5 Option 1.3 Restrictions on sale & advertising... 5 Option 1.4: Prohibit sale to people under 18 years of age... 5 Option 1.5: Prohibit sale of flavoured e-liquids... 6 Full Regulation... 6 Option 1.6: Regulate e-cigarettes in the same way as tobacco... 6 Options to prevent renormalisation of smoking and protection from second hand vapour... 7 Option 2.1: Continue with the status quo... 7 Option 2.2: Prohibit use in existing smoke free public places... 7

Contact Details Name: Paul Barnes Title: Organisation: Address: Email: I am a current electronic cigarette user and former cigarette smoker of twenty years. Though the use of electronic cigarettes enabled me to quit tobacco cigarettes, I did not have any intention to quit. I would like to thank the Department of Health and Human Services (DHHS) for the opportunity to respond on the options proposed in the Discussion Paper 1. 1 https://www.dhhs.tas.gov.au/ data/assets/pdf file/0007/192832/electronic cigarettes discussion paper FI NAL.pdf : DHHS Electronic Cigarettes Discussion Paper

Options to prevent uptake Non-Regulation Option 1.1 Continue with the status quo As it stands within Tasmania the current status quo allows the propagation of vapour products that do not contain nicotine, however this does carry certain drawbacks as any nicotine containing liquids fall outside of any regulatory framework and as such carries risks for those that wish to use the devices with nicotine containing liquids. Whilst this approach is the most hands off approach in that effectively nothing changes from a regulatory or legislative point of view, there is no population level benefit for harm reduction following the use of nicotine free devices. The only benefit to such an approach from a DHHS perspective is that there would be no changes to the current system thereby incurring no initial costs or on-going costs. It is therefore clear that a definitive harm reduction strategy that encompasses a variety of strategies for greatest flexibility is needed. The country with the lowest smoking prevalence rate (Sweden) sees the highest use of smokeless tobacco (Snus) that has largely replaced traditional tobacco use with only a ~12% smoking prevalence rate, and substantially lower tobacco mortality rate. 2 The current standards within the United Kingdom allow for the on-air and broadcast advertising of vapour products under strict guidelines. 34 These codes of advertising allow for regulatory oversight by the Advertising Standards Authority. Using this method, uptake of vapour products by youth has been, and continues to be minimal. 5 Option 1.2 Public education With regards to community education and awareness raising activities, the key point here is to ensure that the information provided is factual, current and updated regularly as the research into vapour products continues to ensure that the community have the latest information in a concise format that is easy to understand. In principle, community awareness raising activities would provide the necessary information for consumers to make informed choices about the product, however this is clearly offset with the simple fact that by providing these awareness raising activities the products will gain greater attention from those that are not necessarily looking to either switch from tobacco, or those that currently do not smoke. It is clear that correct information must be given in order to avoid public misconceptions that the devices are often referred to in the same vein as tobacco smoking. Statistics from ASH UK indicate that the negative press has significantly altered the public perception of these devices with an 2 http://www.estoc.org/key-topics/the-swedish-experience : European Smokeless Tobacco Council, The Swedish Experience 3 https://www.cap.org.uk/advertising- Codes/~/media/Files/CAP/Codes%20BCAP%20pdf/The%20BCAP%20Code.ashx : UK Codes of Advertising Practice (Broadcast) 4 https://www.cap.org.uk/advertising- Codes/~/media/Files/CAP/Codes%20CAP%20pdf/The%20CAP%20Code.ashx : UK Codes of Advertising (Non- Broadcast, Sales Promotion & Direct Marketing) 5 http://www.cancerresearchuk.org/about-us/cancer-news/press-release/2015-06-12-research-shows-mostchildren-do-not-regularly-use-e-cigarettes : Cancer Research UK press release of survey findings

increase in the number that believe that they are more harmful than or just as harmful as smoking traditional combustible cigarettes. 67 Part Regulation Option 1.3 Restrictions on sale & advertising Implementing restrictions on the display of vapour products and the associated advertisements would limit the exposure of these devices which are shown in multiple countries across the EU 8 as having a positive net effect on the rate of combustible smoking prevalence. By restricting the display and advertising of said products, the DHHS is effectively sending the message that these products are harmful. This will have the unintended consequence of making the products more difficult to purchase effectively with the appropriate guidance whilst simultaneously planting the "seeds of doubt" in the minds of the user on their safety and effectiveness, which may lead them to relapse back into tobacco smoking. Other unintended consequences to consider would be the cost burden on the retailers to ensure the products are out of sight, similar to the UK tobacco 'shutters' prevalent in all stores that sell tobacco. Granted, the devices should only be sold by authorised retailers and to those of the legal age which in most countries is 18 years of age or over. Controlled guidelines on advertising, both broadcast and non-broadcast that are regulated by an independent body similar to the Advertising Standards Agency in the UK would ensure that any advertising is responsible and could not be viewed as 'encouraging' non-smokers. Implementing such restrictions would prove costly to the vendors and retailers both in the short term with the costs associated with storing the products out of sight, and also longer term as many newer users of these devices may relapse. This would not have any net health benefit. Option 1.4: Prohibit sale to people under 18 years of age With the current availability of vapour products, youth uptake has been minimal despite the lack of formal regulation, however placing age restrictions on any product often leads those not of the appropriate age to defy the regulations in place. Whilst restricting sales to those under the age of 18, consider the current underage smokers that may benefit from switching to a substantially lower risk product that may or may not contain nicotine. Many UK Stop Smoking Services are in the process of becoming 'e-cig friendly' in order to encourage smokers to switch to vapour products 9 including those that are under the legal smoking age of 18. The primary benefit of preventing youth uptake therefore requires a delicate balance to ensure those that are smoking are able to switch with support, whilst simultaneously preventing current non-smoking under 18s from taking up either product. There would of course be significant costs to ensuring that the regulation is being complied with, either via 'mystery shopper' style purchasing or via enforcement officers in conjunction with appropriate signage for retail outlets which would need to be designed and manufactured as a 6 http://ash.org.uk/media-room/press-releases/:electronic-cigarette-use-among-smokers-slows-asperceptions-of-harm-increase : ASH UK press release on Harm Perception Survey 7 https://www.gov.uk/government/uploads/system/uploads/attachment data/file/311887/ecigarettes report. pdf : Public Health England, E-Cigarette Report 8 http://ec.europa.eu/public opinion/archives/ebs/ebs 429 en.pdf: Eurobarometer, Special Report 429 9 http://www.freshne.com/in-the-news/pr/item/2100-electronic-cigarettes-could-offer-smokers-healthbenefits : Fresh North East press release

standardised item. Initial costs would therefore be high to both retailers and to the DHHS and local authorities with no return on investment for at least three years (figures estimated from the UK smoking ban implementation reports 10 ). Multiple implementation issues may also result in inconsistent compliance with the regulation including the diversity of local authorities and the associated resources available to implement and enforce the regulation effectively. Option 1.5: Prohibit sale of flavoured e-liquids I do not support restrictions on the availability of flavoured e-liquids as one of the primary reasons for an individual to switch and stay off combustible tobacco is associated with taste. With the variety of flavours available, and the well documented improvements in the human body after smoking cessation (improved health, breathing, taste, energy levels and so forth), users can enjoy the motions associated with combustible tobacco with a variety of differing flavours to suit them. Research suggests that whilst there are a wide variety of flavours that can be considered 'youth friendly' many non-smoking youths do not start using vapour products because of this. 11 A community survey designed by a vapour product user, and taken by users also suggests that flavours are a key aspect, if not the key aspect to the success of the product and the effect of remaining off combustible tobacco. 12 Limiting available flavours diminishes the appeal of the product to current smokers and may also have the unintended consequence on newer users to relapse back to smoking. Consistent guidelines on ingredients for flavourings may therefore prove useful in establishing levels of safety whilst still providing the variety which enables many users to successfully cease combustible tobacco use. 13 Full Regulation Option 1.6: Regulate e-cigarettes in the same way as tobacco I can see little or no benefit to regulating vapour products as tobacco products. Whilst nicotine is derived from tobacco, not other component part or ingredient is. For example, most 'advanced personal vapourisers' consist of the battery (often referred to as a 'mod') of varying shapes and designs, with the tank (which contains the e-liquid 14 ), the atomiser (or coil) along with other smaller components such as the mouth piece ('drip tip'). Including these component parts in tobacco regulation is overreaching and burdensome. A recent Senate Bill in California (SB140) defined vapour products as tobacco products, this Bill was subsequently amended to exclude the 'tobacco products' definition. As it stands, SB140 is being held in committee and is likely to proceed no further. Whilst effective regulation of vapour products is welcomed by the majority of the vapour product industry and its users, applying the same regulatory framework to these products that is applied to tobacco products is unjustifiable. Regulated guidelines on advertising similar in nature to the CAP 15 10 http://www.smokefreeengland.co.uk/thefacts/national-compliance-data/ : Smoke Free England compliance data 11 http://ntr.oxfordjournals.org/content/early/2015/01/06/ntr.ntu333.short?rss=1 : The impact of flavour descriptors on non-smoking teens and adult smokers interest in electronic cigarettes 12 https://vapinglinks.wordpress.com/2015/02/01/the-vaping-truth-survey-final-analysis/ : Vaping Community Survey 13 http://www.bsigroup.com/en-gb/about-bsi/media-centre/press-releases/2015/july/e-cigarettes-guidancepublished/#.vaepojkzjzh.twitter : British Standards Institute, E-Cigarette Guidance document press release (PAS 54115)) 14 http://www.smokefreeengland.co.uk/e-liquid/ : Smoke Free England, E-Liquid 15 https://www.cap.org.uk/advertising-codes.aspx : Codes of Advertising Practice

and oversight by an independent body such as ASA 16 provides effective and sensible guidelines to allow the products to be advertised in a monitored and responsible way with the option of banning any advertisements that do not meet the criteria. Restrictions on the sale of vapour products to U18s is also welcomed, however as mentioned previously in this document a balance must be maintained to ensure that current non-smoking youth do not start using either tobacco or vapour products, whilst those that are currently using tobacco have the option to switch to a substantially lower harm alternative with the appropriate guidance. Initial costs of such regulation would likely be high due to implementation of the regulation, including appropriate signage and documentation provision to local authorities. Existing enforcement officers may be utilised to ensure compliance, however existing specialist retailers would be forced to close, many of these retailers are small businesses owned and operated by single individuals with a small staff complement. These employees and business owners would become unemployed, and the business premises would then be empty incurring a loss of commercial revenue to local authorities. Options to prevent renormalisation of smoking and protection from second hand vapour Option 2.1: Continue with the status quo The current evidence suggests that the exhaled aerosol ('second hand vapour') does not pose any significant risk to bystanders. 17 By excluding vapour products from existing smoke-free regulatory framework allows public and work spaces to make their own informed decisions based upon guidance issued by the DHHS, similar in nature to the Health & Safety Executive guidelines. 18 Potential costs of this option include the consultation and drafting of appropriate guidelines for use in public and work spaces, however these costs are likely to be minimal with the burden of enforcement falling to the respective premise owners. The benefits of allowing vapour product use in public and work spaces allows for existing smokers to be encouraged to switch, which may eventually lead to total cessation. Vapour product users have shown in the past to be knowledgeable and encouraging for potential new users, specialist outlets in particular have demonstrated successful interactions with existing smokers. 19 Likely risks include possible confusion for public and work space employees in determining if an individual is using a vapour or tobacco product. A compromise in this instance could be a dedicated indoor area for the use of vapour products. Option 2.2: Prohibit use in existing smoke free public places Based on the current body of evidence on the exhaled aerosol, a total ban of vapour product use or even inclusion in existing smoke-free legislation removes the individuals and premises choices related to allowing or disallowing the use of vapour products. There is little evidence to suggest that 16 https://www.asa.org.uk/about-asa.aspx : Advertising Standards Authority (UK) 17 http://www.ncbi.nlm.nih.gov/pubmed/23033998 : Comparison of the effects of e-cigarette vapour and cigarette smoke on indoor air quality. 18 http://www.hse.gov.uk/contact/faqs/smoking.htm : HSE E-Cigarette Guidelines 19 http://ntr.oxfordjournals.org/content/early/2015/06/25/ntr.ntv129.abstract : Nicotine & Tobacco Research, Vapour Store Owner Beliefs & Messages to Customers

the exhaled aerosol is harmful to bystanders, indeed research suggests that even 'heavy vaping' in 20 21 22 enclosed spaces poses minimal risk. From a public perception point of view, there can be no tangible benefits to the inclusion of vapour products within existing smoke-free and tobacco legislation, indeed the likely consequences of such an inclusion include the primary advantage of vapour products relative to smoking and therefore may discourage smokers from switching and encourage relapse for newer vapour product users. Inclusion of vapour products in tobacco legislation, and subsequent inclusion in existing smoke-free legislation, increases exposure of the product by forcing the users outside, it also increases exposure to the known harms of second-hand tobacco smoke. The message that this option sends effectively punishes vapour product users for choosing the 'wrong way' to quit tobacco smoking, implicitly classing vaping as a deviant behaviour rather than encouraging their use which can provide huge benefits to public health. 23 Additional costs to the DHHS include the draft and implementation of updated legislation and appropriate guidelines and signage, this cost is likely to be high in the first year with minimal return if a penalty system for non-compliance is also implemented. I believe that the decision for the allowance of vapour products in areas where smoking is restricted should rest entirely with the premise owners, this hinges on the provision of accurate and regularly updated information provided by the DHHS. This provides a double benefit in allowing vapour product users the freedom to use the products providing visibility and encouragement to both existing users and potential new users. The ultimate benefit in allowing the product use is that it can be seen as tentative endorsement by the DHHS for use as an alternative to smoking or as a potential cessation aid. 24 20 http://ntr.oxfordjournals.org/content/early/2013/12/10/ntr.ntt203.abstract : Second-hand Exposure to Vapours From Electronic Cigarettes 21 http://www.ncbi.nlm.nih.gov/pubmed/23033998 : Comparison of the effects of e-cigarette vapour and cigarette smoke on indoor air quality. 22 http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4110871/ : Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review 23 http://www.biomedcentral.com/1741-7015/12/225 : Electronic cigarettes have a potential for huge public health benefit 24 http://www.addictionjournal.org/press-releases/e-cigarette-use-for-quitting-smoking-is-associated-withimproved-success-rates- : E-cigarette use for quitting smoking is associated with improved success rates

Concluding Statement It is clear that some implantation of a regulatory framework is needed to ensure that vapour products are generally used exclusively by current tobacco smokers seeking to reduce the known harms from tobacco. From a tobacco smoker s perspective, vapour products create a new value proposition that offers many of the experiences associated with smoking (something to hold and gesture with, sensory experience etc.) with substantially less harms (long term risk much lower, less societal disapproval, minimal odour nuisance) at lower cost. Prior to the emergence of vapour products, the alternatives can broadly be classified as quit or die, vapour products are a middle-of-the-road proposition enabling a transition from smoking to cessation at the users own pace. Vapour products can also be viewed with great potential, as a market driven by the needs of the consumer rather than the needs of commercial or Governmental interests. Analysts predict, based on the current market rates that vapour products have the potential to surpass smoking (in the US) within a decade, much of this will of course depend on any regulatory framework and whether said framework encourages or suppresses innovation. There are risks involved in either being seen as too restrictive or not restrictive enough, however careful consideration of all available evidence from all sources should lead a more flexible approach enabling the vapour product market to continue to innovate, whilst simultaneously protecting nonsmoking youth and encouraging a switch to a less harmful, middle-of-the-road alternative. 25 25 http://www.ash.org.uk/files/documents/ash 918.pdf : Action on Smoking & Health, Electronic Cigarettes: What We Know So Far