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Proposed Regulations in Canadian Marketplace

Electronic cigarettes (or “e-cigarettes”) are devices that are battery operated to mimic the use and at times the taste and appearance of conventional cigarettes. They do not include tobacco in their contents and when used, they produce vapour rather than smoke.

In the first few years since its appearance, the use of e-cigarettes has propagated North America, which includes Toronto, Canada. Several concerns though have been identified regarding e-cigarette’s safety, impact on initiating youth smoking, and tendency to normalize smoking behaviour and its probability to undermine existing legislation on tobacco control. These are based on Toronto Public Health’s (TPH’s) review on existing evidences on electronic cigarette use, health effects, safety, cessation aid potentials, as well as other jurisdiction actions and regulatory variance at the municipal, provincial, and federal levels. To address these concerns, a number of Canadian as well as international jurisdictions have already proposed and/or taken action. As a result, Toronto Public Health (TPH) has published a position statement about e-cigarettes and relation to health, which outlines current concerns with a summary of relevant policy and regulatory approaches to help address them.

The TPH report recommends that the Minister of Health and Long-Term Care creates amendments to include electronic cigarettes to the Smoke-Free Ontario Act (SFOA), in such that the Act would also prohibit the use of e-cigarettes wherever cigarette is prohibited in Ontario, Canada. The report also recommends prohibition of the sale of e-cigarettes to underage minors (kids under 19 years old). If by February 2015 the provincial action is still not taken, the Medical Officer of Health will further consult with the City Solicitor as well as other City Divisions and appropriate stakeholders, and then send a municipal measures report to the Board of Health in order to prohibit e-cigarette use wherever smoking is prohibited under the SFOA Act and/or under City by-laws.

The Medical Officer of Health, in the interim, will also work with the City Manager to look at developing some internal policy that would prohibit electronic cigarette use in City workplaces. The report also recommends amendments to the SFOA to provide more youth-friendly (non-addictive) e-cigarette flavors, as well as proposes amendments to federal legislation that would help ensure consistency in the manufacturing and labelling of e-cigarettes.

 

MEDICAL OFFICER OF HEALTH RECOMMENDATIONS:

 

The TPH report recommends...

  1. The Board of Health to endorse TPH’s public position statement on e-cigarettes

  1. The Ontario Minister of Health and Long-Term Care to amend the Smoke Free Ontario Act and poses regulations to:

  • a) prohibit use of e-cigarettes wherever smoking is prohibited;

  • b) prohibit displays of e-cigarettes in retail stores

  • c) prohibit sales of e-cigarettes to minors; and

  • d) prohibit sales of all flavored e-cigarette products

  1. If so the provincial government has not acted upon regulating e-cigarettes within 6 months in Toronto, the Medical Officer of Health, in consultation with the City Solicitor and other municipal officials, to report as appropriate on municipally regulating the prohibition of e-cigarette use wherever smoking is currently prohibited under provincial or local legislature;

  1. The Medical Officer of Health to work with the City Manager in the interim to engage in developing an administrative policy that would prohibit e-cigarette use in the workplace;

  1. The Federal Minister of Health to amend federal legislation to:

  • a) regulate all e-cigarettes, liquids, and cartridges to ensure consistent manufacturing and accurate labelling;

  • b) regulate the maximum dosage/quantity of nicotine in e-cigarettes;

  • c) require e-cigarette liquids to be sold in child-proof bottles; and

  • d) restrict e-cigarette advertising, marketing, and promotion as consistent with existing tobacco use legislations;

  1. Health Canada to:

  • a) enforce current prohibitions on e-cigarettes that make any health claims without appropriate evaluation, assessment, and market authorization; and

  • b) monitor research on the adverse health effects of using e-cigarettes and the effects of second-hand exposure;

  1. This report to be forwarded to the 4 Toronto School Boards, Toronto Hospitals, and Toronto Universities and Colleges to encourage them to adopt the policies prohibiting the use of e-cigarettes in all indoor/outdoor properties;

  1. This report to be forwarded to the Toronto Association of Business Improvement Areas and the Ontario Restaurant Hotel and Motel Association in order for them to encourage their own members to develop in-house policies addressing proper use of e-cigarettes in their property;

  1. This report to be forwarded to the Parks & Environment Committee for information; and

  1. This report to be forwarded to the Municipal Licensing & Standards Division Executive Director; to the Parks, Forestry and Recreation Division General Manager; the Ontario Chief Medical Officer of Health; the Minister of Health and Long Term Care; and the Public Health Ontario - for information.

  

Financial Impact

 

No direct financial impacts whatsoever arise from this report beyond the current year’s approved budget.

 

DECISION HISTORY

 

On October 23, 2013, the Parks and Environment Committee took into consideration a report by the Parks, Forestry and Recreation General Manager; and the Medical Officer of Health entitled “Proposed Amendment to Municipal Code, Chapter 608, Parks, to Prohibit Smoking around Playgrounds and Other Areas in City of Toronto Parks”. The Parks and Environment Committee requested that the Medical Officer of Health reports to the Committee and to the Board of Health regarding the potential impact of "e-cigarettes" in the public domain, and with it a regulatory framework suggestion.

 

ISSUE BACKGROUND

 

An electronic cigarette (or simply “e-cigarette”) is a device that is battery operated to mimic the use and at times the taste and appearance of a conventional cigarette even without containing nicotine or tobacco. When inhaled, an atomizer heats up a cartridge containing a liquid solution of water (called 'e-liquid'), flavoring, and at times nicotine- in a base of vegetable glycerine and propylene glycol. Normally, this produces a vapour (or aerosol) which resembles cigarette smoke.

Electronic cigarettes may or may not have nicotine. E-cigarettes containing nicotine are known as electronic smoking products or electronic nicotine delivery systems (ENDS). The term used in using an e-cigarette is often called 'vaping' (from the word “vape” or vapour).

First developed in China in 2004 in its current form, e-cigarettes were introduced in the North American market in the year 2007. Their availability and use has proliferated throughout the globe, including Toronto, Canada and today, even conventional cigarette manufacturers now sell e- cigarettes.

In Canada, e-cigarettes containing nicotine (or e-cigarettes making a health claim, for instance, that they can be used to help people quit smoking) are typically regulated under the Food and Drugs Act and are required market authorization through Health Canada prior to being advertised, imported, or sold in Canada. Such e-cigarettes with nicotine have no market authorization but nonetheless, they continue to be easily obtainable in Canada either online or through certain retailers. E-cigarettes without nicotine, and which do not make any health claims, on the other hand can be advertised, imported, or sold in Canada without any restrictions.

E-cigarettes are currently not subject to the labelling, packaging, sponsorship, advertising, and promotion restrictions that apply to conventional cigarettes and/or other tobacco products. It seems e-cigarettes are being increasingly marketed to youth or young adults either through enticing flavoring, event sponsorship, free product offers, and celebrity endorsements. E-cigarettes are also currently not subject to the Smoke-Free Ontario Act of 2006 (SFOA) which prohibits tobacco selling to minors and smoking in workplaces, public places, and in school and child care facilities as well as near the entrances of health care facilities. E-cigarettes are also not (yet) subject to restrictions under Toronto by-laws prohibiting smoking near public building entrances, at sports fields and other park amenities, on City playgrounds, and on public squares.

Many people have become interested in using e-cigarettes with nicotine content to help them quit smoking, or to help reduce their cigarette use, although the efficacy of these e-cigarettes as a cessation aid has no sufficient proof yet. Concerns exist that promotion of e-cigarettes and its use in places where regular smoking is prohibited could undermine quit attempts and tobacco control legislation, as well as serve as instigation to nicotine addiction and initiation of smoking among the youth. Furthermore, new emerging evidences raise concerns about the safety of e-cigarettes for users and for those exposed to its second-hand vapours.

 

COMMENTS

 

Toronto Public Health (TPH) developed policy recommendations on e-cigarettes. So as to inform it, TPH had conducted a series of review on the following:

  • available scientific evidence on the health and safety concerns related with using e-cigarettes and second-hand exposure to its produced vapours (this includes 3 recent systematic reviews);

  • available scientific evidence on the ability of e-cigarettes to help smokers quit smoking;

  • data on the youth’s use of e-cigarettes and its potential to act as an initiator to tobacco use;

  • existing regulations applying to e-cigarettes as well as regulatory gaps; and

  • actions up-taken by other jurisdictions

The following sections include a summary of the findings of TPH’s review and recommendations in order to help address them.

 

E-cigarette – Health, Safety Concerns

 

In a survey conducted from 2010 to 2011, about 64 percent of Canadians who have awareness of e-cigarettes perceived e-cigarettes to be less harmful than regular conventional cigarettes. Though still a relatively new area of study, an emerging body of scientific evidence reveal that e-cigarettes could pose serious health risks to its users and also to those exposed to its vapours. E-cigarette liquid, vapour, and parts may include harmful ingredients and varied levels of cancer-inducing chemicals. These may include several types of tobacco-exclusive nitrosamines, volatile organic compounds, and carbonyl compounds (e.g. acetaldehyde, aldehyde, acrolein). Although these chemicals are in significantly lower dosages in e-cigarettes compared conventional cigarettes, its long-term health effects are still unknown.

Studies have also uncovered minute particles that contain heavy metals (e.g. chromium and nickel) in e-cigarette vapours probably originating from the heating elements of e-cigarettes. The particles have been detected in levels similar to those found in the smoke of traditional cigarettes. Because of the very small size of these metal particles, they can be deposited deep in the human lungs, therefore increasing a person’s risk to respiratory diseases. The size of the particles also means they can penetrate the blood stream and be transported and absorbed into the tissues of the body. A base ingredient in e-liquids, Propylene glycol, was also identified as an irritant. When heated and vaporized, it can create formaldehyde, which is a cancer-causing compound. Aside from this, a recent study that had been published also found that propylene glycol and high-battery (higher temperature yielding) output voltage in e-cigarettes are also associated with significant increases in formaldehyde and acetaldehyde levels in the e-cigarette’s vapours.

Short-term studies have also revealed several negative health results associated with the active inhalation of e-cigarette’s aerosols. These include throat, mouth, and airway irritations, potential respiratory inflammation, allergic reactions, and decreased lung function. Ingestion of e-liquids and other improper uses of e-cigarettes are also accountable for such cases as nicotine poisoning and other related injuries, most especially among younger children.

Recently, the Centers for Disease Control and Prevention has reported a tremendous increase in e-cigarette-related phone calls to the United States poison centres from one (1) call/month in September 2010- to 215 calls/month in February 2014. Most of these reported cases of poisoning were caused by inhalation or ingestion of nicotine-containing e-cigarette vapours and liquids, and via eye or skin contact. Fifty one percent, or more than one-half of these calls involved children less than five years of age.

The German Federal Institute for Risk Assessment also reported that ten (10) cases of nicotine poisoning among e-cigarette users were due to their overuse of e-cigarettes (as e-cigarettes’ nicotine content do not extinguish naturally as regular conventional cigarettes). Moreover, e-cigarettes have also been linked to various cases of fires and/or explosions. 

Exposure to exhaled or second-hand e-cigarette vapour may also pose health risks. Although second-hand e-vapour does not seem to increase carbon dioxide (CO2) and carbon monoxide (CO) levels in the air while indoors, it has been found to contain dangerous and cancer-causing chemicals (e.i. fine particles and volatile organic compounds. A recent study also revealed that individuals exposed to electronic cigarette emissions had demonstrated nicotine absorption in their blood in levels comparable to those individuals exposed to conventional cigarette smoke. Published literature that study second-hand e-cigarette vapour remains scarce and the evidence concerning its health effects are still inconclusive. More in-depth studies that will further assess the health risks of people’s exposure to second-hand e-cigarette vapours are much needed.

Due to the health risks and concerns involved with e-cigarettes, Health Canada has issued an advisory to Canadians in the year 2009 advising them to avoid use of e-cigarettes and its related products up until their safety and quality have already been proven.

 

Youth E-cigarette Use

 

One of the primary concerns associated with the use of e-cigarettes is its potential to promote youth smoking uptake. In 2013, about 99,800 students in grades 9 to 12 (approximately 15% of Ontario's youth) used e-cigarettes, and nearly 5% of these youth use e-cigarettes containing nicotine. In the USA, the NYTS (National Youth Tobacco Survey) found that youth e-cigarette experimentation as well as current use had doubled among middle school and high school students between the years 2011 and 2012. In estimation, about 1.78 million students have used electronic cigarettes as of year 2012.

Although there is still a lacking data on whether or not e-cigarette use actually acts as an initiator to youth tobacco use, its rising trends are becoming much concern. According to the NYTS, approximately 160,000 US American students who have reported themselves to have ever used e-cigarettes had never smoked traditional cigarettes before. In Canada, 10 percent of non-smoking adolescents (aged 16 to 18 years old) have tried electronic cigarettes. E-cigarettes could introduce young adolescents to nicotine addiction and further lead them to smoking conventional cigarettes, which suppress nicotine cravings more effectively (i.e. they feel more rewarding in providing nicotine).

Even if youth e-cigarette use does not lead to initiating youth tobacco use, still, e-cigarette use among young people, particularly their use of nicotine containing e-cigarettes, continues to pose serious concerns. Overuse of e-cigarettes or high doses of nicotine from e-cigarettes may cause nicotine poisoning and improper handling or inhalation of their e-liquid can cause serious physical injuries. Nicotine also has been found to have potentially negative brain effects on adolescents’ mental development.

Currently, e-cigarettes are not included in the Smoke-Free Ontario Act (SFOA), which outlines a number of measures discouraging youth smoking uptake. These include a minimum age to allow tobacco purchase and a prohibition on the display of cigars or cigarettes in retail stores.

The SFOA and its associated Smoke-Free Ontario Strategy have both been linked to helping to reduce Ontario youth smoking rates impressively. It is a much needed task to restrict the availability of e-cigarettes to adolescents or younger people to help further this progress instead of to undermine it. Additionally, restrictions on e-cigarette advertising and promotion are needed urgently. It seems- e-cigarettes are marketed in ways similar to how conventional cigarettes were promoted before federal tobacco legislation prohibited most tobacco promotion and advertising. These include attractive product packaging, free product offers, lifestyle advertising, and celebrity endorsements.

Restrictions on e-cigarette flavors are also needed. Tobacco companies have traditionally used candy flavors to attract adolescents and young adults. A recent study in Canada found that more than one-half of cigarette users in grades 9 to 12 use flavored cigarette products, thus demonstrating the youth's preferences for flavors. The Ontario and federal governments in the recent years have created an amendment to the tobacco control legislation to prohibit flavored small cigars and cigarillos to help limit youth use of these flavored cigarette products. Now, similar legislation is also needed for e-cigarettes. Furthermore, candy and fruit flavored e-liquids as well as those sold in attractive packaging may also encourage younger children to swallow them. As mentioned above, the US Centers for Disease Control and Prevention has reported several cases of e-cigarette-related poisonings that involved children under 5 years of age.

 

E-cigarettes – Federal Regulation

 

E-cigarettes (electronic cigarettes) are subject to different regulations depending on whether or not they have nicotine contents. Under Canada's Food and Drugs Act, e- cigarettes containing nicotine and/or those that make a certain health claim require a new drug approval before they can be marketed or sold legally in Canada. To date, no electronic cigarettes have been authorized (yet) for sale. Nonetheless, e-cigarettes containing nicotine appear to have permeated the Canadian market to a large extent. In March 2009, Health Canada released a notice to stakeholders noting that some e-smoking products had been marketed and sold in Canada even without market authorization. This notice demanded the persons who were advertising, importing, or selling e-smoking products without authorization to discontinue doing so, otherwise be faced with enforcement actions. Nevertheless, e-liquids containing nicotine still continue to be easily obtainable online and through certain retailers.

E-cigarettes without nicotine and those that do not make any health claims have NO restrictions on marketing, selling, or importing them, which has led to confusion among the general public and health professionals about the legal status of electronic cigarettes in Canada. Moreover, it appears that some e-cigarette manufacturers, most especially those who sell products containing nicotine, have exploited these regulatory gaps. Studies show that some e-cigarette cartridges labelled “nicotine free” actually contains nicotine and remarkably, the Canadian Cancer Society Quebec Division’s study of 13 e-cigarette products revealed that about two-thirds of e-cigarette products labelled "nicotine free" contains nicotine.

E-cigarette use could act as a first step to nicotine addiction for both youth and adults without the user possibly realizing it. Moreover, as e-cigarettes containing nicotine cannot be marketed or sold legally in Canada, there exists no regulatory restrictions on the amounts of nicotine they can contain, nor do they have any requirements disclosing their nicotine contents on their product labels. Whether or not they do contain nicotine, e-cigarette cartridges, parts, and e-liquids are not subject to the manufacturing standards, quality control, and/or labelling and packaging requirements of conventional cigarettes. In conclusion, there is probably limited consistency in the components and quality of many e-cigarette brands, thus there is no safety assurance for its user and/or those exposed to its second-hand vapours.

 

E-cigarettes and Smoke-Free/ Non-Smoking Public Areas

 

E-cigarettes (and e-cigarette use or “vaping”) are not included in the in the SFOA’s definition of smoking, which prohibits smoking in workplaces, public places, on schools and daycare properties, and near health care facility entryways. E-cigarette use is also not regulated by Chapters 608, 636 and 709 of Toronto's Municipal Code, which prohibits smoking near the entrances of public buildings, on public squares, and on or nearby City playgrounds and other park amenities including sports fields.

E-cigarette use in places wherein smoking is prohibited brings up several concerns. As mentioned above, there are possible health risks linked with exposure to e-cigarette second-hand vapour – for instance second hand vapours from e-cigarettes containing nicotine can cause nicotine absorption in people (or children) exposed to it. Moreover, because e-cigarette vapours look like smoke and its devices also often resemble conventional cigarettes, their use in public places wherein smoking is strictly prohibited makes it difficult to tell whether regular cigarettes are being used or not. Businesses, organizations, and City divisions concerned about cigarette and e-cigarette use on their property frequently send such inquiries to the Toronto Public Health's Tobacco Enforcement Officers and the City Public Health Nurses.

Indoor e-cigarette use may also undermine people’s attempts to quit smoking. Two studies, including one conducted on Canadian young adults (ages 16 to 30 years old), have found that some smokers use e-cigarettes as replacement in places wherein smoking regular cigarettes are strictly prohibited. This dual use of regular cigarettes and e-cigarettes could undermine smokers' efforts to quit tobacco smoking, since vaping could, in actuality, help sustain their addiction. (An analysis of e-cigarette websites found that most advertising claims of e-cigarette manufacturers state that electronic cigarettes can be used anywhere including non-smoking or smoke-free places.) In addition, the sight of using e-cigarettes in public could also trigger tobacco-use in former smokers as well as in current smokers trying to quit smoking. Compared to non-smokers, former smokers are more likely to try e-cigarettes, hence the possibility of leading them back to cigarette smoking, or to start vaping instead of maintaining their total abstinence from using nicotine.

Finally, vaping (or using e-cigarettes) in places where regular smoking is prohibited adds a contributing factor to the social visibility of the act of smoking in public places. In turn, this influences people’s perceived acceptability of smoking (be it e-cigarettes or regular cigarettes), especially among youth. Restrictions on e-cigarette usage in public places are necessary to ascertain that youth and/or children are exposed to both smoke-free environments and role models. This, particularly, is necessary in places wherein youth and children frequently stay such as schools, recreational facilities, restaurants, or shopping malls or retail stores.

 

Ontario and Canada (Actions in Other Jurisdictions)

 

Several municipalities in Ontario, Canada have focused their strategy response to e-cigarettes on advocacies to the federal and provincial government. Particularly, the Association of Local Public Health Agencies (or alPHa) recently adopted a Peterborough County-City Health Unit and Board of Health sponsored resolution- requesting Health Canada and the Ontario Ministry of Health and Long-Term Care to control the use, display, sales, manufacturing, and promotion of e-cigarettes. Some jurisdictions however have already taken local action to restrict the places where electronic cigarettes can be used. By January 2014, Innisfil Ontario has added e-cigarettes to their smoke free outdoor sports/recreational spaces by-law, and Peel Region's policy on Smoking in the Workplace prohibited employee, visitors, and contractors’ e-cigarette use in Region of Peel workplaces. In York Region, e-cigarettes have also been included in tobacco-free policies at schools, while in Toronto, the Toronto Transit Commission (TTC) board is set to consider amending their smoking by-law in Fall 2014 to prohibit the use of e-cigarettes on TTC property. The Centre for Addiction and Mental Health (or CAMH) also prohibits using e-cigarettes anywhere on CAMH property to help eliminate tobacco-related triggers for patients trying to control their addiction to nicotine or tobaccos.

Apart from Innisfil, at least 2 other municipalities in Canada include e-cigarettes in their local by-laws restricting smoking in public places: Nova Scotia, Alberta, Red Deer, and Hantsport. Furthermore, Edmonton, Alberta school boards have also prohibited e-cigarette use on school properties after police reported students using e-cigarettes to vaporize marijuana oil. The Nova Scotia provincial government is set to introduce legislation prohibiting e-cigarette sales to minors, e-cigarette point of sale advertising, and use in places wherein regular smoking is strictly prohibited. Recently, Montreal Public Health made a series of recommendations for e-cigarette federal regulation, which would include marketing e-cigarettes as a Canadian tobacco product, limiting its sponsorship and advertising, and setting its minimum quality standards. Ideally, it should only recommend e-cigarette use as an aid to quit smoking under doctor supervision, making e-cigarettes available only for smokers trying to quit before they are made available to the Canadian public.

Several health organizations throughout Canada are united towards the need for e-cigarette regulation in order to address public the health concerns in relation to e-cigarette availability and use. These include the Canadian Public Health Association, the Ontario Campaign for Action on Tobacco, and the Non-Smokers Rights Association.

 

In Other Countries

 

Several U.S. states and municipalities prohibit use of e-cigarettes where smoking is prohibited, and/or prohibit its sales to minors. These include Los Angeles, Chicago, New York City, King County (Washington State includingn Seattle), San Francisco, New Jersey, Utah, and North Dakota.

In April of 2014, the U.S. Food and Drug Administration (FDA) issued a proposed statute that would carry on its tobacco mandate to e-cigarettes. This proposed regulation would specify marketing, reporting, and labelling requirements for electronic cigarette manufacturers, and prohibit its sales to minors amongst some of its requirements. Currently, the statute is posted for public comments.

Similarly, the European Union included e-cigarettes recently in a revised version of the European Union Products Directive, mandating reporting and labelling requirements for e-cigarette manufacturers, maximum volumes and nicotine concentration levels for containers and cartridges of e-liquids, and advertising and packaging requirements. Member states are given allowance till year 2016 to arrange the rules into federal law, which will apply to all e-cigarettes with nicotine but with the exception of those e-cigarettes that have been approved as a medication.

 

E-cigarette Smoking Cessation

 

Smokers use e-cigarettes mostly with the goal of helping them reduce or quit their cigarette smoking. Likewise, some public health experts approve of e-cigarette as a better alternative to cigarette use. On the other hand, only limited research exists examining the effectiveness of e-cigarettes as a tool for smoking cessation. Existing research on this subject remains inconclusive. A New Zealand randomized controlled trial in 2013 for instance concluded that e-cigarette use may be as effective as nicotine patches for people trying to quit smoking. These findings though were found to be statistically insignificant.

A 2013 study conducted in the US revealed that despite that tobacco quitting was the most common reason reported for e-cigarette use for state line callers trying to quit tobacco, e-cigarette users were found to be less likely than non- e-cigarette users to be abstinent from tobacco 7 months after initial evaluation. Several studies have also identified high rates of e-cigarette dual use with cigarettes, which means- smokers still tend to continue smoking even while using e-cigarettes. E-cigarettes then on the contrary, may sustain smokers’ nicotine addiction, and undermine their efforts to quit as it draws them away from other quitting aids that have already been proven effective and safe.

People interested in using e-cigarettes (with nicotine content) for quitting smoking send regular inquiries to Toronto Public Health. TPH on the other hand currently does not recommend e-cigarettes for quitting smoking as Health Canada has not approved e-cigarettes for this purpose. As mentioned above, e-cigarettes containing nicotine or those that make a health claim (for instance, that they can be used as a smoking cessation aid) need market authorization before they can be advertised, sold, or imported legally. For consideration of their e-cigarette product as a health product, manufacturers can apply to Health Canada. Health Canada grants market authorization to health products only after following a successful scientific evidence review demonstrating the quality, safety, and efficacy of the health product with respect to its intended purpose. As of today no e-cigarettes containing nicotine or that which claim to be as effective smoking cessation aid have yet received any market authorization in Canada.

While Health Canada has not approved e-cigarettes as a cessation aid, Health Canada has authorized several products that could aid people trying to quit smoking. These smoking cessation aids include nicotine patch, spray, gum, lozenge, inhaler (NRTs- Nicotine Replacement Therapies) and nicotine-free medications. Along with Toronto Public Health, Community Health Centres, family physicians, and community partners such as the Nicotine Dependence Clinic at CAMH, Canadian Cancer Society’s Smokers’ Helpline, and Leave The Pack Behind can help provide access to these smoking cessation aids and other self-help materials, as well as counselling services for individuals who need any help in quitting smoking.

 

Recommended Approach and Next Measures

 

As this report demonstrated, e-cigarette use (whether with or without nicotine content) is a Canadian public health concern for the reasons that follow:

  1. Emerging evidence exists on the health and safety risks of vaping, use of e-cigarette devices, and exposure to its second-hand vapour;

  2. Youth e-cigarettes use could lead to smoking initiation or nicotine addiction;

  3. Manufacturing standards and quality control for e-cigarettes remain lacking; and

  4. E-cigarette use may hinder efforts to denormalize smoking behaviour and may promote smoking lifestyle to children and youth as well as former or current smokers trying to quit.

This report suggests that the Ontario Minister of Health and Long-Term Care creates amendments to the SFOA to prohibit e-cigarette use or ‘vaping’ wherever smoking is prohibited, to prohibit the display of e-cigarettes in retail stores, and to restrict its sales to minors. This recommendation will address concerns regarding the health risks of e-cigarette use and exposure to its second-hand vapour, its potential to undermine current tobacco control legislations, and its tendency to re-normalize smoking. Furthermore, such action would help ensure a more consistent approach to tobacco control policies and enforcement, specifically in communities across provinces.

If within 6 months the provincial government has not yet acted to regulating e-cigarettes, the Medical Officer of Health shall report on municipally regulating use of e-cigarettes in Toronto, prohibiting it wherever smoking is presently prohibited under provincial or local legislation.

In the interim, organizations as well as businesses are encouraged to adopt internal policies prohibiting e-cigarette use on their properties (or wherever smoking is currently prohibited). The Medical Officer of Health with the City Manager will also work together to discuss development of an administrative policy that would also prohibit e-cigarette use in workplaces.

Finally, the Medical Officer of Health further recommends amending federal legislation to guarantee consistency in the manufacturing of e-cigarettes, to require e-liquids to be sold in child-proof bottles, to stipulate reporting requirements and labelling, and to restrict promotion and marketing of electronic cigarettes.

 

Note: CanCigs follows the current rulings of Health Canada in that we do not sell to minors nor do our electronic cigarettes contain nicotine.