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October 28, 2019
There is a lot of talk in the news and among legislators of reducing the use of e-cigarettes by youth. Talks have included measures to prevent uptake including restricting point of sales, limiting flavours or types of devices, limiting nicotine amounts, and taxing products. We have to be careful in what is proposed, and what we suggest will be accomplished with these proposals. The old adage, “under promise and over deliver” is not for nothing. Try the inverse and watch the reaction. We need to clearly define our goals and how we intend to get there and it is best if those goals are within reason. Let’s examine the proposal to restrict sales of vape products to specialty vape shops and the impact it may have on youth uptake.
Before we begin, we should look at who we’re talking about when we speak of youth uptake of e-cigarettes. “Youth” is a term that itself can be a bit confusing, as its use varies depending on who is using it and why. Many in the general public take it to mean under the age of 18 (the age of majority in most Canadian provinces and voting age in all) but that is misleading. People attending high school are generally classified as youth, though many are 18 and above by the time they reach grade twelve. Similarly, Health Canada occasionally talks about the developing brain in youth and in those cases is talking about people up to the age of 25. So for the purposes of this particular discussion and the primary study referenced, we’ll use the term “student” as it more accurately defines the group that we’re talking about: those persons who are still in attendance at high school.
According to Summary of results for the Canadian Student Tobacco, Alcohol and Drugs Survey 2016-17 there was an increase of 3% in students who had ever tried an e-cigarette from the 2014-15 survey (23% compared to 20%). There was also an increase in the percentage of students who reported having used an e-cigarette in the previous 30 days (10% as compared to 6%). “Among students who used an e-cigarette in the past 30 days, 57% had used an e-cigarette on three or fewer days, while 11% reported daily use.” Among those students who did report having used an e-cigarette in the past 30 days, 17% were current smokers, 12% were former smokers, 35% were experimental/occasional smokers. Only 36% reported having used an e-cigarette without ever having previously tried a combustible cigarette (put another way, of the 23% who tried an e-cigarette only 8% had not previously smoked).
By comparison, 18% of students (grades 7 to 12) had ever tried a cigarette. Alcohol remains the substance with the highest rate of use among students at 44% (down from 53% in 2008-09 but up from 40% in 2014-15). Cannabis use by students is reported at 17%, a figure that remains unchanged from the previous survey. Interesting side note, the 2016-17 survey asked about methods of cannabis consumption and while the most common method remains smoking, 34% also reported using edibles and 30% reported vaping- both of which were not legal for any age in Canada at the time of this study and so were being obtained, whether directly or indirectly, from the grey/black market.
Another interesting portion of the survey examined how easy students felt it was, or would be, to obtain prohibited substances (e-cigarettes, tobacco, alcohol, cannabis, etc) and most reported that they felt it was fairly easy to very easy. This in spite of some of these products already being restricted to adult only points of sale or only available on the black market. This lines up with findings by Health Canada that students are most likely to obtain substances, such as tobacco, from a social source. In fact, “Nearly three quarters (72%) of students, representing approximately 108,000 youth in grades 6 to 12, who smoked in the past 30 days reported usually getting their cigarettes from a social source.”
Also reported in the survey was that, “Less than one quarter (22%) of students in grades 7 to 12 who used an e-cigarette in the past 30 days got their e-cigarette from a retail source. Retail sources include purchases made in store and/or online. Accessing e-cigarettes through retail sources was higher among students in grades 10 to 12 (24%) than those in grades 7 to 9 (16%) and higher among males (28%) than females (12%).” There is no further breakdown along age lines here: that’s important to note. For all we know most of the grade 10 to 12 students who purchased e-cigarettes from a retail outlet were 18 and over.
This lines up with what we are hearing from our neighbours to the south as well. SD county supervisor and youth advocate Kristin Gaspar delivered a compelling statement, reminding many of us that we simply don’t understand the way that young people are using technology to access the black market and restricted substances.
So what can we take away from these reports and what we know about the way in which young people access restricted substances? One takeaway would be that prohibiting substances does not entirely prevent youth uptake of any substance, nor does restricting access to adult only points of sale. Retail outlets- be they vape shops, convenience stores, or gas stations- are not responsible for youth uptake. The numbers couldn’t be more clear: 78% of students accessing vape products do so through non retail (primarily social) channels.
That tells us a lot about whether restricting sales to specialty vape shops will solve the youth uptake problem: namely, that the effect will be minimal at best. But what of the unintended consequences?
One unintended consequence of restricting sales to adult only vape shops would be that specialty vape shops will shoulder all of the blame for any remaining youth uptake and use of e-cigarettes in the coming years. No more pointing fingers at convenience stores or gas stations (who, we can see from the numbers cited, aren’t to blame either).
The very shops supporting or lobbying for restricting sales and for full responsibility would, in effect, reap what they sow- full responsibility for a problem not of their making or within their control. Unfortunately, so would the rest of the shops who don’t support the proposal as all eyes are on industry to make good on its promise that restricting sales will reduce youth uptake. This would probably lead to the suggestion of further restrictions or outright prohibition as the proposition has been put forward that restricting sales will eliminate (or vastly reduce) youth uptake. Those legislators and activists with a prohibitionist bent would already prefer to see vape products removed from the market entirely and a failure will only fuel their push for more restrictions or outright bans.
It also, as suggested above, divides the community at a time we can least afford it. We currently have two major industry advocacy groups in Canada lobbying for opposing sides and a community equally divided. (It’s worth noting that we do not have a Canadian consumer advocacy group similar to CASAA in the U.S. though we do have specialized advocacy groups Rights 4 Vapers and THRA, whose members also hold opinions.)
Another dire consequence of restricting sales of e-cigarettes to adults only vape shops would be to limit adult access in rural and remote areas (where vape shops are not prevalent but cigarette sales are). As smoking rates are already higher in rural and remote areas, and health outcomes in these areas substantially impacted by this, we would have to be satisfied with the status quo in order for this to be an acceptable outcome. That’s a status quo that shouldn’t be acceptable to anyone. Successive governments, in numerous reports spanning many years, have suggested that it isn’t and as tobacco harm reduction (THR) advocates we shouldn’t be either. Especially in pursuit of a flawed strategy.
It would also limit impulse purchases. The ability to buy a THR device on the spot, in lieu of or addition to the purchase of cigarettes is a great opportunity to potentially reach a current smoker who perhaps woke up that morning with no intention to quit. The more opportunities a smoker has to choose an alternative, the better. Eliminating the ability to reach them where they are, where they are buying their cigarettes, cuts us off from a vital point of connection. It is critical that we don’t lose sight of the over five million smokers in Canada.
We ought to very carefully examine the question we are being asked and whether the proposed solution makes any sense. We don’t want to be goaded into an action and set ourselves up for failure, particularly when all eyes are on us and the rhetoric is so hot. In this case, the proposition that restricting sales of vape products to specialty vape shops will eliminate or greatly reduce youth uptake makes no sense, according to the government’s own data. With the added consequence of requiring us to sacrifice the health and well being of a large segment of the adult smoking population, the question should be rejected out of hand and our attention turned to initiatives that might prove successful.
We’ll examine whether restricting flavours or setting nicotine limits would impact youth uptake in our next article.
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