Non-Smokers Rights Association/Smoking and Health Action Foundation

cartomizer + battery Non-Smokers Rights Association/Smoking and Health Action Foundation

Adjustable voltage Adjustable smoke volume Improved battery life Consistent charge Non-Smokers Rights Association/Smoking and Health Action Foundation

Refillable cartridge Refillable tank/clearomizer Replaceable cartridge Non-Smokers Rights Association/Smoking and Health Action Foundation

US sales have doubled every year for past 3-4 years; 2013 sales estimated at $1.7B Big Tobacco is buying e-cigarette companies Major multinational tobacco companiesBAT, Imperial, Japan Tobacco–buying e-cigarette companies or developing their own products Major US tobacco firms also getting involved (Lorillard bought Blu; Reynolds American launched Vuse; rumour of Altria takeover of NJOY) Non-Smokers Rights Association/Smoking and Health Action Foundation

Awareness and use of e-cigarettes (Ayers et al, American Journal of Preventive Medicine, April 2011) Internet Searches: E-Cigarettes, Snus, NRT, Champix Non-Smokers Rights Association/Smoking and Health Action Foundation

Two large US surveys in 2010: national online study (n=2650) and Legacy Longitudinal Smoker Cohort (n=3650) (Pearson et al, AJPH, July 2011) Ever-use = 11.4% current smokers; 2% former smokers; 0.8% for never smokers Current use = 4.1% current smokers; 0.5% former smokers Two large UK surveys in 2010 and 2012 (n=12,500 adults, incl 2,100 smokers) (Dockrell et al, N&TR, May 2013) Ever use = 22% smokers; 0.5% non-smokers (2012) Current use = 7% smokers (2012) Non-Smokers Rights Association/Smoking and Health Action Foundation

Little Canadian data; ITC 4 country survey, n=1500 (Adkison et al, AJPM, Mar 2013) 40% Canadian smokers aware of e-cigs 4% smokers ever use; 1% current use 64% believe e-cigs are less harmful than cigarettes E-cig users in all 4 countries: 85% use to help them quit; 80% use because they are less harmful; 75% use to cut down; 70% use when cant smoke Questions added to 2014 CTADS and next YSSQuebec only Non-Smokers Rights Association/Smoking and Health Action Foundation

Canada: 1211 respondents, age 16-30; 456 smokers, 755 non- smokers (2012) (Czoli et al, SRNT 2013) Ever use = 33% smokers; 6% non-smokers Current use = 14% smokers; 1% non-smokers France: 3400 students, age (2012) (Dautzenberg, Open Journal of Respiratory Disease, 2013) Ever use = 33% daily smokers, 16% non-daily, 4% non-smokers Poland: 13,700 students, age 15-19/20-24 (2012) (Goniewicz et al, Pediatrics, Oct 2012) Ever use = 23% youth; 19% young adults; 3% non-smokers Current use = 8% high school; 6% young adults US: 24,000+ students, grades 6-12 (2012) (MMWR, Sept 2013) Ever use, high school = 10% (4.7% in 2011) Current use, high school = 2.8% (1.5% in 2011) Non-Smokers Rights Association/Smoking and Health Action Foundation

E-cigs for nicotine useIllegal E-cigs not for nicotine use that make a health claim Illegal Nicotine cartridges/liquidIllegal E-cigs not for nicotine use that do not make a health claim Legal

While electronic cigarettes are technically a "smoking alternative" rather than a smoking cessation device, the range of nicotine strengths offers some obvious potential as an aid in ones attempts to quit smoking…. (Wister Oct 2012) Non-Smokers Rights Association/Smoking and Health Action Foundation

( ( Non-Smokers Rights Association/Smoking and Health Action Foundation

Retailers are openly selling and promoting e- cigarettes and related paraphernalia Head shops Flea markets Mobile sales at workplaces Kiosks in malls Convenience stores Gas stations Specialty e-cigarette stores Pharmacies Internet Non-Smokers Rights Association/Smoking and Health Action Foundation

Superstore, southern ON, 2011 Non-Smokers Rights Association/Smoking and Health Action Foundation Rexall PharmaPlus, Ottawa, Jan 2013 Website, London ON, retailer Sept 2011,

Many forms of e-cigarette promotion Countertop displays Retail signage & billboards Newspaper ads Retail trade journal ads/articles Company brochures Celebrity endorsements E-cig company sponsorships Price discounting Fax blasts + mass s Internet Websites Blogs Testimonials YouTube videos Non-Smokers Rights Association/Smoking and Health Action Foundation

Opponents Proponents E-cigarettes are unproven cessation devices; should be required to undergo same rigorous testing for safety/efficacy as other NRTs E-cigarettes have potential to undermine major tobacco control gains E-cigarettes are clean drug delivery device that can satisfy smokers addiction to nicotine and to smoking behaviours Even if untested, health risks of e- cigarettes could not come close to those of cigarettes Non-Smokers Rights Association/Smoking and Health Action Foundation

Long-term health risks of inhaling PG not known Lack of quality controls, manufacturing standards Misleading, false, incomplete labellingingredients not fully disclosed Unproven cessation claims Risks from nicotine e-liquid Tobacco control successes may be undermined Will increased social exposure and promotion of smoking re-normalize smoking? Will e-cigs lead to smoking/nic addiction among youth? Will dual use increase tobacco consumption? Will e-cig use complicate enforcement of smoking bans? Non-Smokers Rights Association/Smoking and Health Action Foundation

Substantially lower health risks than cigarette risks must be compared to cigarette Exposure to all tobacco smoke toxicants significantly reduced TSNAs in e-cigs are at levels are comparable to those in NRTs Main ingredient (propylene glycol) safe for oral consumption; used as solvent in medications Only 1 death, 1 hospitalization ever reported Effective in helping smokers cigarette use Effective in helping smokers quit smoking Non-Smokers Rights Association/Smoking and Health Action Foundation

Evidence-based Balancedminimize risks, acknowledge potential benefits E-cigarettes are almost certainly much safer than tobacco cigarettes, and to date there has been little real- world evidence of harm from e- cigarettes. E-cigarettes have tremendous potential to help smokers reduce their cigarette consumption and to quit smoking altogether. Non-Smokers Rights Association/Smoking and Health Action Foundation

All e-cigaretteswith and without nicotine should be subject to the same legal framework E-cigarettes should be subject to the same regulatory controls as tobacco products: cannot be sold to minors cannot be displayed in retail stores cannot be sold wherever tobacco sales are prohibited cannot be promoted except in adults-only venues and in direct mail to a named adult cannot be used in indoor public places & workplaces cannot be used on school grounds Non-Smokers Rights Association/Smoking and Health Action Foundation

Early stage issue; much work remains to be done Interests of smokers/tobacco control best served by providing balanced, accurate information Health organizations and practitioners have role to play in advancing e-cigarette policy research public opinion surveys public education local voluntary policies local bylaws advocacy for legislation Non-Smokers Rights Association/Smoking and Health Action Foundation