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E-cigarettes – a healthier option to smoking?

Smoking and exposure to second-hand smoke increases your risk of cancer and other chronic diseases including heart disease. To address this risk, government and community partners joined forces, developing and launching a provincial tobacco control strategy in 2001. As a result of this collaborative and comprehensive approach, there was a significant reduction in tobacco use in this province.

Today *18.1 per cent of Nova Scotians smoke, down from *20.8 per cent in 2010 and 33 per cent in the early 1990s. These efforts are paying off, but a realization that the work was not complete prompted the development and launch of a renewed tobacco control strategy in 2011. Towards a Tobacco-Free Nova Scotia identifies a number of directions and priorities to build on previous success. Continued commitment is also necessary as new tobacco-related nicotine delivery products are being developed and marketed - among them, e-cigarettes.
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The introduction of electronic cigarettes or e-cigarettes in Canada is troubling for those involved in tobacco control. An e-cigarette is made of stainless steel or plastic. It looks like a cigarette, but may contain liquid nicotine versus nicotine in tobacco. As a result, some manufacturers market the e-cigarette as a way for users to get their ‘nicotine fix’ without the toxic chemicals in tobacco or tobacco smoke. The implication is that it is a healthier alternative to smoking cigarettes. E-cigarettes are also being promoted by some manufacturers as supporting smoking cessation efforts.

“As someone committed to continuing our work in tobacco control, I’m very concerned about the introduction of e-cigarettes,” said Sharon MacIntosh, Health Promotion Coordinator, Public Health Services, Capital Health. “A major concern is that e-cigarettes will undermine tobacco control policies, especially workplace and public place smoking bans that protect people from second-hand smoke and promote quitting.

“The use of e-cigarettes where smoking is not permitted increases social exposure to smoking and may contribute to the ‘renormalization’ of cigarette use. These are two important factors in influencing youth to start smoking. Public use of e-cigarettes also provides visual cues to smoke, which undermine quit attempts and promote relapse. As well, e-cigarettes are often promoted in the same ways that cigarettes were before most tobacco marketing was banned and these promotions may serve to make smoking ‘cool’ again.”

At present, scientific evidence does not show that e-cigarettes are effective in helping people stop smoking. Also, little is known about their potential health risks. Manufacturers have not yet submitted the appropriate market authorizations and establishment licenses to Health Canada, which are needed to ensure their products meets consumer safety standards. For people wanting a safe source of nicotine, Health Canada has authorized the sale of effective smoking cessation aids, including nicotine gum, patches, inhalers, and lozenges.

A typical e-cigarette has three components: a cartridge containing nicotine, water and flavouring in a base of propylene glycol, vegetable glycerin or polyethylene glycol 400; an atomizer with a heating element which turns the liquid nicotine or flavouring into a vapour; and a battery to power the atomizer and the indicator light that glows red like a lit cigarette when the user inhales. Both refillable and pre-filled disposable cartridges are available. Not all cartridges (nor e-liquid/e-juice solutions) contain nicotine.

In Canada, currently it is illegal to sell e-cigarette cartridges that contain nicotine, but the e-cigarette device can be legally sold. This allows vendors to sell e-cigarettes with nicotine-free cartridges and for liquid nicotine to be sold ‘under the table’ or via the internet in disposable or refillable cartridges.

The storage and handling of the nicotine used in e-cigarettes is a also a cause for concern. One distributor in London, Ontario, mixes the e-liquid in his basement and asks customers to return the vials for refilling or recycling. Refill bottles of e-liquid can be purchased that contain over 1,000 mg of nicotine, when a lethal dose of nicotine for adults is 30-60 mg and 10 mg for children.

While great strides have been made in Nova Scotia in the area of tobacco control, too many Nova Scotians still smoke. The introduction and promotion of new tobacco-related products such as the e-cigarette is proof of the need for a sustained and comprehensive approach to tobacco control.

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*prevalence of Nova Scotians who smoke, published in the Tobacco Use in Canada 2013.

Special thanks to the Non-Smokers’ Rights Association I Smoking and Health Action Foundation for granting CCNS permission to use content and a diagram of an e-cigarette from their bulletin, The Buzz on E-Cigarettes: March 2012. This bulletin is available at http://www.nsra-adnf.ca/cms/file/files/e-cig%20Brochure%20FINAL.pdf  
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