Recommendations: Will the Tobacco and Vaping Products Act go far enough?

Abstract

E-cigarette use among adolescents and young adults in Canada is increasing. Potvin's (2016) editorial outlined the need for more evidence on e-cigarettes as a gateway to combustible cigarettes and their toxicity. Since then, new evidence has emerged supporting the gateway effect and establishing toxicity. Health Canada has reviewed the evidence and recently opted to regulate e-cigarettes, including prohibiting brick-and-mortar retail access for youth under 18 years of age. However, many online e-cigarette retailers exist, which increases adolescents' access to e-cigarettes and currently unregulated nicotinecontaining refills. Recent evidence on the toxicity of particular compounds in e-cigarette refills has demonstrated how these compounds may be amplified by certain types of e-cigarette devices. The toxicity of e-cigarettes is not only of concern to the user but potentially a concern to the public as well. The message that e-cigarettes have a benign effect on users and the public needs to change and should be reflected in Health Canada's future regulations concerning the Tobacco and Vaping Products Act.KEY WORDS: Electronic cigarettes; smoking; vaping; public health; health policy La traduction du résumé se trouve à la fin de l'article.

Association of E-cigarettes with adolescent alcohol use and binge drinking-drunkenness: A systematic review and meta-analysis

“…Other harmful aspects of ECIGs include their ability to cause inflammation throughout the body with the possibility of negatively affecting the immune system, the brain, cardiovascular system, and most other tissues (1,(57)(58)(59)(60)(61)(62). Independent of ECIG harm, ECIG users are three to four fold more likely to initiate the use of conventional cigarettes compared to NON-ECIG users further increasing the lifetime risk of harm from smoking (10,63,64). Because of the unhealthy nature of ECIGs and their link to conventional cigarettes, experts recommend screening all youth for ECIG use with the referral of smokers to nicotine addiction treatment.…”

“…As of February 2020, 100 countries had E-cigarette sale bans or strict regulations for sale to minors, advertising, promoting, sponsorship, and product regulation (e.g. content, concentration, ingredients/flavors, safety) (64,79,80). In December 2019, sale of all tobacco products to individuals under the age of 21 years was banned in the United States (81).…”

Electronic cigarettes in Italy: a tool for harm reduction or a gateway to smoking tobacco?

“…There is also concern that e-cigarettes may undermine efforts to ‘denormalise’ smoking 20. Finally, non-smokers trying e-cigarettes can succumb to nicotine addiction, particularly young people 1 21 22…”

Sensory attributes of e-cigarette flavours and nicotine as mediators of interproduct differences in appeal among young adults

“…Flavour and nicotine concentration in electronic cigarettes (e-cigarettes) are focal targets for regulatory policies 1–5. To guide such policies, evidence of mechanisms mediating differences in e-cigarette appeal across products varying in flavour and nicotine is needed, particularly among young adults who more likely vape non-tobacco flavours (eg, fruit, menthol) 6.…”