Unintended consequences: New regulations must protect youth while maintaining access to harm reduction for adult smokers

BEAMSVILLE, Ontario, Nov. 30, 2020 (GLOBE NEWSWIRE) -- On November 26^th, the Implementation Report of the Tobacco Control Act, was tabled on behalf of Health Minister Christian Dube. Upon review of the Quebec Coalition for Tobacco Control’s release regarding the report, the Canadian Vaping Association (CVA) warns that the policy changes recommended by QCTC will result in increased smoking rates and negative public health outcomes.The QCTC has recommended the following regulatory changes:

· Prohibit flavors (except tobacco) in vaping products (however, flavors may be permitted in certified versions and sold as cessation aids in pharmacies)
· Limit the nicotine content to 20mg/mL of nicotine
· Reduce financial access to these products among young people by introducing a tax on vaping liquids
· Establish a system of tariffed permits for sale, distribution and import
· Ban new tobacco outlets and vaping shops within 250 meters of a school
· Frame the appearance of devices and fluids to make them less attractive to young people
· Add warnings about health risksThe CVA has been a consistent advocate for strong youth protection measures and has worked with many governments to create a framework that balances youth protection with adult access. While our organization agrees with some of the recommendations put forward by QCTC, others will have the unintended consequence of both pushing ex-smokers back to smoking, as well as dissuading a number of current smokers from transitioning to a significantly less harmful product

There is significant data to suggest that high nicotine concentrations are a primary driver for youth use. However, as demonstrated in Ontario and British Columbia the problem is not solely high nicotine concentrations but unrestricted access to these products. There is a segment of adult smokers who rely on high nicotine products to prevent relapsing to combustible tobacco. Effective policy does not prohibit these products altogether, but instead restricts their sale to age-restricted specialty stores. Which, by the QC gov't's own admission, meet a high standard of conformity in carding and denying access to minors.

Moreover, the CVA agrees with banning new outlets from opening within 250 meters of a school. This is an appropriate measure to prevent straw buying by older students. Additionally, we agree with the recommendations for warnings, health risks, and unappealing packaging, however these policy recommendations have previously been addressed by the federal Tobacco and Vaping Products Control Act (TVPA). The TVPA has mandated that vapour products sold within Canada must contain specific health warnings and addiction statements and prohibits packaging that may be appealing to young persons. Any such warnings must be calibrated to make a distinction between the relative harms of tobacco and vaping, as stipulated in the May 2019 Quebec Superior court ruling issued by Judge Dumais. In effect, all regulated e-liquid currently available within the Canadian market is unappealing to youth.

While the CVA generally agrees the above recommendations will contribute to effective youth protection policy, it is imperative that the Government of Quebec acknowledge the ample data on flavour bans. Time and again, it has been concluded that flavours being a driver for youth use is a fallacy. The data continues to show that flavours are imperative to adult adoption and continued cessation success, while flavour bans have shown to result in an immediate increase in smoking rates and traditional tobacco consumption. 

The idea that flavoured vaping products contribute to youth vaping is a common misconception that has been discredited by the Centers of Disease Control and Prevention (CDC). According to the CDC report “Tobacco Product Use and Associated Factors Among Middle and Highschool Students”, 77.7 percent of young people indicated that they vape for reasons other than “because e-cigarettes are available in flavours, such as mint, candy, fruit or chocolate.” The most common reason for use among youth was, “I was curious about them.”

Furthermore, the study, “Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation,” conducted by Yale researchers concluded that, “adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors. More research is needed to establish the relationship between e-cigarette flavors and smoking and to guide related policy.” The researchers went on to state, “While proposed flavour bans are well-intentioned, they have disastrous outcomes. Legislation on vaping flavours must take the facts of smoking cessation and harm reduction into account, and we urge legislators against the widespread implementation of such bans.”

Flavour bans are proven ineffective for youth prevention once again, through the American Cancer Society’s study, “Flavored E-Cigarette Sales in the United States Under Self-Regulation From January 2015 Through October 2019,” published in the American Journal of Public Health. The study looked at youth vaping rates after JUUL voluntarily removed flavours from the United States. The only remaining flavours were tobacco, mint and menthol. The study concluded that removing flavours had no effect on youth use, and instead youth switch to one of the remaining options.

To understand the harm that flavour bans cause to public health, we need only look to Nova Scotia. Immediately following the province’s decision to ban flavours, traditional cigarette sales experienced an unprecedented increase. Prompting the president of the Atlantic Convenience Store Association to release a statement urging Nova Scotia to reconsider the ban considering the dramatic spike in cigarette sales. Additionally, polling from Abacus Data found that nearly 30% of adult vapers were at risk of returning to combustible tobacco.

Given the QCTC’s recommendation on taxation, the CVA must again reiterate that taxing a harm reduction product is counter productive, as it discourages improvements to public health. Vape specific taxation has the same effect on smoking rates as a flavour ban. In all cases where taxation was introduced, smoking rates increased as a result. As more global jurisdictions implement vape specific taxation, there is increasing data proving that taxation is harmful to public health.

For example, Minnesota conducted a study, “The impact of E-cig taxes on smoking rates: Evidence from Minnesota,” which found that taxing vaping products would lead to an 8.1% increase in tobacco use and a smoking cessation decrease of 1.4%. It also found that if vapour products had not been taxed an additional 32,400 adults would have quit smoking. 

Furthermore, the study by the National Bureau of Economic Research also concluded that taxing vapour products increases smoking rates. “While cigarette taxes reduce cigarette use and e-cigarette taxes reduce e-cigarette use, they also have important interactions on each other. E-cigarettes and cigarettes are economic substitutes. So, if you raise taxes on one product, you will increase use of the other," said Michael Pesko, a health economist and assistant professor at Georgia State University, in a statement.

Pesko and other researchers drew upon sales data from 35,000 retailers across the nation for a seven-year period and concluded that for every 10 percent increase in e-cigarette prices, sales of the vaping product dropped 26 percent. The higher tax on e-cigarettes resulted in an 11 percent increase in sales of traditional cigarettes, the researchers concluded. "We estimate that for every one e-cigarette pod no longer purchased as a result of an e-cigarette tax, 6.2 extra packs of cigarettes are purchased instead," Pekso said. "The public health impact of e-cigarette taxes in this case is likely negative."

The CVA respects the QCTC’s mission to protect youth from nicotine experimentation and addiction. Yet, it is crucial that Canadian governments and QCTC alike understand that the CVA shares this goal. Independent vape businesses were created to solve the problem created by tobacco. Although often wrongfully viewed as an extension of tobacco, the sole purpose of the independent vape industry is to help adult smokers reduce their harm. 

As it stands, the policy recommendations proposed by QCTC would serve to benefit Big Tobacco and harm adult smokers. Contrary to the rhetoric, the industry is not an adversary to youth protection. In fact, prior to regulation the vape industry self imposed measures to protect youth. 

“The data from Nova Scotia demonstrates the province’s failure to regulate in the interest of public health. As a result, Nova Scotia has failed its citizens. We urge Quebec not to follow this disastrous path. The CVA calls on the Government of Quebec to ensure the industry is included in the regulatory process. Collectively we can ensure policy is effective and science driven,” said Darryl Tempest, Executive Director of the CVA.

For more information, please contact: 

Darryl Tempest
Executive Director
647-274-1867