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What we know so far.
What are e.cigarettes?

*An e-cigarette is a battery-powered device

that converts liquid nicotine into a mist, or
vapour, that the user inhales.
*There's no fire, no ash and no smoky smell.
*An e-cigarette has three main parts:
1. a rechargeable lithium battery
2. a vaporisation chamber
3. a cartridge
Types of e.cigarettes
There are three main types of electronic cigarettes or vapourisers:

1. Disposable products (non-rechargeable)

2. An electronic cigarette kit that is rechargeable with replaceable pre-filled


3. An electronic cigarette that is rechargeable and has a tank or reservoir

which has to be filled with liquid nicotine
Usage of E.cigarettes amongst smokers in GB
Aids used in most recent quit attempt
45of smokers trying to stop
30 E-cigs
20 NRT Rx
15 Champix
10 Beh'l supp

N=10411 adults who smoke and tried to stop or who stopped in the past year; method is
coded as any (not exclusive) use
Tobacco Harm Reduction:
& electronic cigarettes

The best thing a smoker can do is quit completely, immediately and forever

*Tobacco harm reduction is nothing new.

*Toxicants in e-cigarettes? Other than nicotine, what else do e-cigarettes

deliver? A number of studies have looked at this, with at least 8 toxic
compounds identified .However all of these were at significantly lower levels
than in conventional cigarettes

*PHE Review e.cigarettes are 95% less harmful to health than normal
Proportion of smokers believing e-
cigarettes less harmful than cigarettes

Only a minority of current smokers believe e-cigarettes

are less harmful than cigarettes


40 37.9

Percent 30



E-cigarette user Non user Total
N=2596 current smokers from Nov 2014
What regulation is needed?

* The quality and safety of the range of products

available vary between brands

* EC must be made to comply with consumer protection

legislation to ensure products are safe, fit for purpose
and as-described

* Product regulation allows specific directives for

particular risks: Child-proof e-liquid, sales to minors,
regulation of advertising

* The issue is whether e-cigs should be regulated as

medicinal devices
E.cigarettes regulation
Current regulation
UK &EU: Consumer product regulated under General Product
Safety Directive
October it will be an offence to sell e.cigs to under 18s,
including proxy purchasing.

E.C containing up to 20mg/ml come under the EU Tobacco
Products Directive
Products will carry health warning
Above 20mg/ml manufactures would have to apply for them to
be a licensed medicine
Proposes a ban on all print and broadcast advertising
EU Tobacco Products
It will not regulate domestic only advertising (e.g. billboards and PoS)


Marketing of flavours

Permit advertising on TV, but prohibit promoting smoking or any imagery

that might be reasonable be associated with tobacco brands

Advertisements are prohibited from encouraging non smokers or non

nicotine users to use e.cigarettes
What can happen if we cripple
EC by over-regulation

*We will protect the market monopoly of conventional cigarettes

*Product innovation will reduce/ possibly stop
*Product prices would increase, possibly to the point at which
switching to a low-risk e-cigarette would be much more
expensive than continued smoking
*We will contribute to disease and death of millions of smokers
prevented from moving on to safer nicotine products

*The TPD rules are a progressive step to reduce the promotion

of e.cigarettes to non smokers and young people. However
they do not address all the concerns about the marketing of
Celebrity endorsements are not prohibited

Warrington Wolves have a partnership with

UK electronic cigarette brand TRUVAPE.

e-cigarettes and Children
*The e-cigarette market is evolving rapidly
*Current use among adults is confined to current
and ex-smokers
*Current use among children is rare and found
mostly among older children and the most
frequent smokers
*1% of children expect to try e-cigarettes soon
*It is vital to continue to monitor changing patterns
of e-cigarette use to inform policy
* Currently regulated by the Committee on Advertising
Practice (CAP) and Broadcasting Committee on
Advertising Practice (BCAP) rules.
* Are not covered by the same regulations that bans
advertising of tobacco products
* Cannot be co branded with tobacco (brand sharing ban)
Marketing by E-cigarette companies

Safer (healthier)
Smoking anywhere / beat smoke-free
Lifestyle (sociable, social status)

Four core functions

Promotion - Recruit new users

Product - Get them to use more
Price - Keep them brand loyal
Place - Keep them using

Plus: Leverage stakeholders

*Relative harm is back: its not what you do its the

way that you do it
*The TI is regaining its voice
*and reaching for a halo MRHA have licensed
Voke - A nicotine vapourise produced by BAT will
be selling a prescription medicine and being paid to
do so by the NHS
*The TI will use e-cigs and HR to support its core
business: tobacco
*Children will be key
The case for e-cigarettes
The new Lancet paper has established them as effective as nicotine
replacement therapy.

Smokers like inhaling nicotine: Smokers say e-cigarettes are helpful because
they still have the sensation of inhaling and lifting a cigarette to their mouth to
take a drag.

They dont give you lung cancer: Experts have estimated e-cigarettes could
save the lives of millions of smokers.

They could replace tobacco cigarettes one day: Some experts predict many
smokers may switch to e-cigs, with huge benefits for public health.

They are safer than tobacco: Whatever the concerns about e-cigarette
safety, no cases have been reported of anyone being killed by an e-cigarette
unlike tobacco, says Professor Peter Hajek, director of the Tobacco
Dependence Research Unit at Queen Mary University, London
Concerns of e.cigs
Potential to glamorise the image of smoking (again) A study published in
the journal Nicotine and Tobacco Research shows that some children who
have never smoked may be drawn to smoking through e-cigarettes and
therefore it could be a gateway device.

Quality control is a concern: For others the main objection is that quality and
contents of e-cigarettes can vary widely.

They still contain nicotine: Although nicotine doesnt cause cancer it can raise
blood pressure, cause palpitations and is highly addictive, and little is known
about the long-term effects of inhaling the vapour.

They circumvent smoking bans in public places: Some people get annoyed
by people smoking e-cigarettes in restaurants seeing them as flouting the
law even though it is not illegal to smoke them.
*Issues to consider
*Risks of e-cigarettes What if
*Marketing and use Renormalise smoking?
*A gateway to smoking?
*Defers quit attempts?
*Undermines quit attempts (less effective than NRT)?
*Accidental poisonings?
*Big Tobaccos Trojan Horse?

*Opportunities of harm reduction What if

*Marketing and use denormalise smoking?
*As effective as NRT, just much more popular?
*Even smokers who dont intend to quit, just do?
*Smoking is denormalised because more smokers quit?
*They replace smoking?
* E.cigarettes/NCDs have the potential to help people who are
heavily nicotine dependent

* There are concerns about their effectiveness, safety and

potential to renormalise smoking.

* Concerns that they are introducing adolescents to nicotine


* Taken attention away from other known effective TC measures

e.g. plain standardise packaging.