October 2019 Board Meeting - The Harms of Vaping and Next Steps for Regulation Resolution

ISSUE

Recent increases in the popularity of electronic cigarette (vaping) products among youth and young adults has led the United States Food and Drug Administration to declare their use an epidemic among young people (U.S. National Academies of Sciences, Engineering and Medicine, 2018). E-cigarettes heat liquid (e- juice) producing an aerosol that e-cigarettes users inhale. The liquid in e-cigarettes or vapes as they are more commonly referred to can include nicotine, cannabinoid (CBD) oils, tetrahydrocannabinol (THC) or other substances. In Canada student use of vaping products increased by 30% each year between 2015 and 2017 (University of Waterloo, 2017), and a recent study by Hammond et al. (2019) noted vaping rates among 16 to 19 year olds in Canada increased 74% between 2017 and 2018. These nationwide trends are reflected in Ontario where 21.6% of students in Grades 7-12 reported use of a vaping product in their lifetime (Boak et al, 2017).

There are two pieces of legislation which regulate the promotion and sale of vaping products in Ontario. The federal Tobacco and Vaping Products Act (TVPA) aims to address the rising popularity of vaping products among young people by placing restrictions on how they can be advertised. At the provincial level, the Smoke-free Ontario Act (SFOA) 2017 further regulates these products by restricting their sale to minors, regulating how they can be displayed in storefronts, and restricting their use in certain public spaces. The Smoke-free Ontario Act 2017 is enforced locally by the Tobacco Enforcement Officers (TEOs) at the Windsor-Essex County Health Unit (WECHU) who inspect spaces proactively, ensure the region’s 223 e- cigarette vendors are operating in compliance, and conduct youth access test shopping inspections to discourage the sale of these products to minors. In spite of these protective measures their remains a lack of adequate safe-guards against promotion of vaping products in places where they may be observed by young people and other vulnerable populations. Promotions are commonly seen at point-of-sale in many convenience and grocery stores, as well as in locations like gas pumps, or parking lots associated with the places where vaping products are sold. As well, newer generation vaping products produced by companies such as JUUL©, VYPE©, STLTH©, or SMOK© are designed to be discrete and efficient nicotine delivery systems which in some cases deliver higher concentrations of nicotine per puff than tobacco cigarettes (American Cancer Society, 2019).

There is currently little research on the long-term health impacts of e-cigarette use and second-hand exposure, although, preliminary research has shown a positive association between use of vaping products and the risk for the uptake and intensity of tobacco smoking (Ontario Agency for Health Protection and Promotion (Public Health Ontario), 2018). This is complemented by the finding by Hammond et al. (2019) that after several decades of decline, tobacco smoking rates among Canadian adolescents have recently increased. Outside of the risk for nicotine addiction and susceptibility for tobacco uptake, the long term health effects of vaping products are unknown. The potential for more acute implications of chronic use have recently been realized with the approximately 1,080 cases of severe respiratory illness and 18 deaths associated with the use of vaping products in the United States (Centers for Disease Control and Prevention, 2019). In September of 2019, Health Canada issued a warning to Canadians that use vaping products to monitor themselves for symptoms of pulmonary illness, which has resulted in Ontario’s health minister ordering all public hospitals to report vaping-related cases of severe pulmonary illness to the Ministry of Health.

BACKGROUND

The Windsor-Essex County Health Unit has been working with municipalities, business, and school administrators to ensure these groups are prepared and educated around the harms of vaping and the existing regulations around vaping in public spaces. Since February of 2019 WECHU Tobacco Enforcement Officers have engaged in enhanced proactive inspections to ensure compliance with both municipal Bylaws and the provincial SFOA 2017. Since the passing of the SFOA 2017 in October of 2018 these efforts have resulted in 25 charges issued to high school students for vaping on or within 20 metres from school property, several verbal and written warnings to both high school and elementary students, 11 charges issued to vaping product vendors for selling vapour products to a person who is under the age of 19 years old, and multiple charges being issued to vaping product retailers for improper display or promotion of their merchandise.

Additional efforts were further described in an information report provided to the Board of Health on June 20, 2019 in which existing and planned activities to address vaping among young people were detailed, including:

• Distribution of School Vaping Prevention Toolkit to school administrators
• Participation in a provincial vaping working group
• WECHU staff education and policy development for clients using vaping products
• Secondary school proactive enforcement inspections in partnership with local Police Services
• School and school board presentations for students, teachers, and administrators
• Policy support offered to school boards
• Under 25 Electronic Cigarette Vendor Education program
• Smoke/Vape-free Spaces media campaign

The Windsor-Essex County Board of Health has passed a series of resolutions beginning in 2014 encouraging action at the provincial and local level to curb the potential for harms of vaping particularly among young people and people who do not smoke. The WECHU has since been instrumental in developing and passing local regulations to further protect residents from exposure to smoking and vaping products in public spaces. Since 2014, eight municipal bylaws have been passed which build upon and surpass the existing provincial regulations for smoke/vape-free indoor and outdoor spaces. Support was also provided to the Essex Regional Conservation Authority in their development, passing, and subsequent revisions to include more public spaces in which smoking and vaping were not permitted. A summary of the Board of Health Resolutions which have supported this and future work related to vaping is provided below:

In their consultation process, Health Canada and the Ontario Ministry of Health (formerly, the Ministry of Health and Long-term Care) provide public health units, other health organizations, stakeholders, and the general public with the opportunity to provide feedback into new regulations related to public health matters. The WECHU has responded with feedback at every opportunity provided by these levels of government in their consultations related to vaping. A summary of the feedback provided can be referenced below:

PROPOSED MOTION

Whereas, the WECHU Board of Health has passed three previous resolutions related to vaping to encourage further regulation at the federal, provincial, and local levels of government;

Whereas, the WECHU has submitted feedback independently and through regional collaborations for the increase in regulations related to vaping products;

Whereas, there is evidence that vaping products have short-term negative health effects and contain harmful chemicals like nicotine;

Whereas, the restrictions on the promotion and display of tobacco products and the removal of tobacco flavouring from the retail marketplace has contributed to the reduction of tobacco smoking among young people;

Whereas, Individuals who do not smoke should not start vaping, especially youth, young adults, pregnant women, and those planning on becoming pregnant;

Whereas, vaping rates among young people have increased 74% between 2017 and 2018;

Whereas, Vaping products have the potential to re-normalize smoking and lead to tobacco use among youth;

Now therefore be it resolved that the Windsor-Essex County Board of Health supports the ban on the promotion of vaping products in the retail setting and online, and

FURTHER THAT, the provincial government further restricts the sale of flavoured vaping products to include only tobacco flavours targeting current smokers who are looking to quit, and

FURTHER THAT, all regulations related to protecting youth and young people from the harms of tobacco smoke be applied to vaping products.

References

• American Cancer Society. (2019). What do we know about e-cigarettes? Retrieved from American Cancer Society
• Boak, A. Hamilton, H. A., Adalf, E. M., & Mann, R. E. (2017). Drug use among Ontario students, 1977-2017: Detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS) (CAMH Research Document Series No. 46). Toronto, ON: Centre for Addiction and Mental Health.
• Centers for Disease Control and Prevention. (2019, 10 08). Smoking and Tobacco Use. Retrieved from Centers for Disease Control and Prevention
• Hammond, D., Reid J. L., Rynard, V. L., Fong G.T., Cummings K. M., McNeill A., et al. (2019).Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys.
• BMJ; 365 :2219. Retrieved from https://doi.org/10.1136/bmj.l2219
• Margolis, K. A., Donaldson, E. A., Portnoy, D. B., Robinson, J., Ne, L. J., & Jamal, A. (2018). E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students. Preventive Medicine 112(September 2017), 119–125
• National Academies of Sciences, Engineering, and Medicine. (2018). Public health consequences of e- cigarettes.Washington, DC: The National Academies Press. Retrieved from https://doi.org/10.17226/24952
• Ontario Agency for Health Protection and Promotion (Public Health Ontario). (2018). Current evidence on e- cigarettes: a summary of potential impacts. Toronto, ON: Queen's Printer ofr Ontario.
• Smoke-Free Ontario Scientific Advisory Committee, Ontario Agency for Health Protection and Promotion (Public Health Ontario). Evidence to guide action: Comprehensive tobacco control in Ontario (2016). Toronto, ON: Queen's Printer for Ontario; 2017.
• The Ontario Tobacco Research Unit. (2019). Promotion of Flavoured Vaping Products that appeal to Youth. Available here.
• University of Waterloo. (2017). Canadian student tobacco, alcohol and drugs survey. Retrieved from Canadian Student Tobacco Alcohol Drugs Survey
• U.S. National Academies of Sciences, Engineering and Medicine. (2018). Public Health Consequences of E-cigarettes.