More evidence that cigs are bringing low risk kids into the nicotine addiction/cigarette market; Canadian govt needs to close the ecig advertising loophole in Bill S-5

Sarah Aleyan and her colleagues from the University of Waterloo just published “Risky business: a longitudinal study examining cigarette smoking initiation among susceptible and non-susceptible e-cigarette users in Canada” in BMJ Open.  This longitudinal study followed Canadian high school students for two years and found that never cigarette smoking kids who used e-cigarettes at baseline were much more likely to be smoking cigarettes two years later. 

Most important, the gateway effect was nearly twice as big for low risk kids (adjusted odds ratio of 5.28 for the low risk kids compared to 2.78 for kids who were susceptible to smoking at baseline).  In addition, never smoking kids who used e-cigarettes who had not started smoking yet because became susceptible to future smoking.  These findings, which are consistent with all the earlier studies that looked at this question, shows that the argument by e-cig enthusiasts that “kids who use e-cigs would smoke anyway” is wrong.  E-cigarettes are supporting and expanding the nicotine addiction and smoking epidemics.

There have been so many studies documenting the gateway effect between e-cig and cigarettes that I have lost count.  Every single one of them has shown a statistically significant gateway effect, with the biggest effect by far in e-cig friendly England.

Meanwhile, Canada, which just passed its Bill S-5 law mandating plain packaging for cigarettes – a good thing that further embarrasses the US FDA for not even having graphic warning labels on cigarettes -- gave e-cigarettes a pass. Look at the beautiful packages that Imperial Tobacco (a wholly owned subsidiary of BAT) just launched for its Vype (c/o Stan Shatenstein).  Such ads for cigarettes have been illegal in Canada for years. 

This is another example of government looking backward rather than forward.  Based on the new Aleyan study, I read “switching” in these ads as “switching to cigarettes.”

The rules for advertising cigarettes and e-cigarettes are almost diametrically opposed.  Tobacco advertising and sponsorship long prohibited, but Bill S-5 (cite1, cite2) gives e-cigs carte blanche beyond these bogus ‘lifestyle/youth’ restrictions, that BAT and the other tobacco companies are skilled at skirting:

DIVISION 2 

Vaping Products

Advertising appealing to young persons

30.‍1 No person shall promote a vaping product, a vaping product-related brand element or a thing that displays a vaping product-related brand element by means of advertising if there are reasonable grounds to believe that the advertising could be appealing to young persons.

Lifestyle advertising

30.‍2 No person shall promote a vaping product, a vaping product-related brand element or a thing that displays a vaping product-related brand element by means of lifestyle advertising.

Sponsorship promotion

30.‍3 (1) No person shall promote a vaping product-related brand element or the name of a vaping product manufacturer in a manner that is likely to create an association between the brand element or the name and a person, entity, event, activity or permanent facility.

By giving e-cigarettes this exception, Canada is joining England and the US in conducting a giant experiment on their population.  By letting tobacco companies advertise again, even if 'only' for vape products, they not only are allowing the industry to chase after kids for e-cigarettes, but they are opening the door for the tobacco companies to move their ads closer and closer by color, style and suggestion to promoting tobacco products.  Indeed, a national study using the NIH/FDA PATH dataset showed that receptivity to e-cigarette advertsing was associated with subsequently smoking conventional cigarettes and a new study from USC shows that advertising of any tobacco product helps sell cigarettes to kids.

Here is the abstract for the Aleyan paper; hopefully Canadian authorities will pay attention and close the huge loopholes they opened in Bill S-5:

Objectives. Given that many adolescent e-cigarette users are never-smokers, the possibility that e-cigarettes may act as a gateway to future cigarette smoking has been discussed in various studies. Longitudinal data are needed to explore the pathway between e-cigarette and cigarette use, particularly among different risk groups including susceptible and non-susceptible never-smokers. The objective of this study was to examine whether baseline use of e-cigarettes among a sample of never-smoking youth predicted cigarette smoking initiation over a 2-year period.

Design.  Longitudinal cohort study.

Setting 89 high schools across Ontario and Alberta, Canada.

Participants A sample of grade 9–11 never-smoking students at baseline (n=9501) who participated in the COMPASS study over 2 years.

Primary and secondary outcome measures  Participants completed in-class questionnaires that assessed smoking susceptibility and smoking initiation.

Results  Among the baseline sample of non-susceptible never-smokers, 45.2% of current e-cigarette users reported trying a cigarette after 2 years compared with 13.5% of non-current e-cigarette users. Among the baseline sample of susceptible never-smokers, 62.4% of current e-cigarette users reported trying a cigarette after 2 years compared with 36.1% of non-current e-cigarette users. Overall, current e-cigarette users were more likely to try a cigarette 2 years later. This association was stronger among the sample of non-susceptible never-smokers (AOR=5.28, 95% CI 2.81 to 9.94; p<0.0001) compared with susceptible never-smokers (AOR=2.78, 95% CI 1.84 to 4.20; p<0.0001).

Conclusions  Findings from this large, longitudinal study support public health concerns that e-cigarette use may contribute to the development of a new population of cigarette smokers. They also support the notion that e-cigarettes are expanding the tobacco market by attracting low-risk youth who would otherwise be unlikely to initiate using cigarettes. Careful consideration will be needed in developing an appropriate regulatory framework that prevents e-cigarette use among youth.

The full cite is Aleyan S, Cole A, Qian W, et al.  Risky business:  a longitudinal study examining cigarette smoking initiation among susceptible and non-susceptible e-cigarette users in Canada.  BMJ Open 2018; 8:e021080. doi:10.1136/bmjopen-2017-021080.  It is available for free here.