Thursday, 12 December 2019

What the research says about young people and e-cigarette flavours

Many researchers are focusing on the role played by e-cigarette flavourings in encouraging young non-smokers to use these products.

Earlier this year, the Nordic Welfare Council produced a report intended to inform public health efforts by governments in the Nordic Region (Iceland, Sweden, Denmark, Norway, Faroe Islands, Finland, Aland, and Greenland).

Their report - The significance of flavour additives in the use of moist snuff and e-cigarettes – with a focus on young people and the Nordic region - provides a readable summary of the evidence as well as a summary of e-cigarette and oral tobacco (snus) use in those countries.

Their conclusions are pasted below, with links to the research on which they based their findings. Because this report is already 11 months old, further studies are also identified at the end of this blog post.

CONCLUSIONS OF THE NORDIC WELFARE COUNCIL:

  • "Flavour additives are a leading cause of young people trying tobacco products or e-cigarettes."
  • "New users have a preference for the particularly sweet flavours, such as those of sweets, fruit, chewing gum, soft drinks, etc."
  • "Young people also have a perception that e-cigarettes with the flavour of fruit, for example, are less harmful to health than e-cigarettes with the flavour of tobacco."
  • " If the product also contains nicotine, this may lead to dependence and potentially interest in trying other, more harmful tobacco products."
  • "Restrictions and regulations on flavour additives in e-cigarettes and e-liquids will therefore most likely have an impact on the use of these products by young people."

ARTICLES REVIEWED BY THE NORDIC WELFARE COUNCIL:

Never, current, and former smokers had distinct reasons for e-cigarette use and discontinued use and differed in flavor preferences.
Never, current, and former smokers (n=1,567; age 18-34)

Several reasons for first trying e-cigarettes predicted continued e-cigarette use, including good flavors, does not smell bad, can hide from adults, low cost, friends use, can use anywhere, to quit smoking regular cigarettes, and because they are healthier than cigarettes.
Longitudinal surveys. Middle and high school students (n=340)

Smokeless tobacco susceptibility was greatest among tobacco never-users who perceived flavored ST as easier to use.
2013-2014 Population Assessment of Tobacco and Health study (PATH) Tobacco never-users (n=7,718; age 12-17)

Ever and current e-cigarette users had higher odds of reporting that flavored ecigarettes were "less harmful" than nonflavored e-cigarettes, compared to youth who did not use e-cigarettes.
Data from a rapid response surveillance system. Students (sample [n]=3,704 from a population of students [N]=434,601; grade 6, 8, and 10)

The popularity of flavors across the range of tobacco products e.g. e-cigarettes and hookah suggest that flavoring might have broad appeal to young tobacco users.
2014 National Youth Tobacco Survey (NYTS). Middle and high school students (n=22,007).

Participants associated flavored smokeless tobacco with appealing non-tobacco products, such as chewing gum and alcohol. Availability of different varieties and flavors stimulated interest and curiosity in sampling or switching between smokeless tobacco products.
Interview. Adolescent males and smokeless tobacco users (n=23)

Dai, 2016 Flavored Electronic Cigarette Use and Smoking Among Youth.
Use of flavored e-cigarettes was associated with higher odds of intention to initiate cigarette use, lower odds of intention to quit tobacco use, and a lower prevalence of perception of tobacco's danger.
2014 National Youth Tobacco Survey (NYTS). Middle and high school students (n=21,491).

Dai, 2018 Single, Dual, and Poly Use of Flavored Tobacco Products Among Youths.
Use of flavored tobacco products is prevalent among youths. E-cigarettes were the leading flavored product and often concurrently used with other flavored tobacco products.
2014 National Youth Tobacco Survey (NYTS). (n=21,926)

Evans-Polce, 2018 Reasons for Vaping Among U.S. 12th Graders.
Three distinct classes of vapers were identified: adolescents who were Vaping for Taste + Entertainment, Vaping to Experiment, and Vaping to Replace Cigarettes.
2015 and 2016 Monitoring the Future study. Students, 12th graders.

Harrell, 2017 Flavored Tobacco Product Use among Youth and Young Adults: What if Flavors Didn't Exist?
 Most of the youth and young adult tobacco users reported using flavored tobacco. Three-fourths of flavored product users said they would no longer use the product if it was not flavored. This was highest for e-cigarettes and hookah and lowest for cigarettes.
Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS). Youth (n=2,483) and Marketing and Promotions across Colleges in Texas (MPACT). Young adults (n=4,326)

Hoffmann, 2016 Flavour preferences in youth versus adults: a review.
Tobacco products in flavours preferred by young people may impact tobacco use and initiation, while flavours preferred by adults may impact product switching or dual use.
Review study. (n=59 studies)

 Kong, 2015 Reasons for Electronic Cigarette Experimentation and Discontinuation Among Adolescents and Young Adults.
The top reasons for experimentation with e-cigarettes were curiosity, appealing flavors, and peer influences.
Focus group and survey. Students (n=1,302; age 12- 22)

Kowitt, 2017 Perceptions and Experiences with Flavored NonMenthol Tobacco Products: A Systematic Review of Qualitative Studies.
Positive perceptions of flavored tobacco products and flavors led to experimentation and/or initiation of flavored tobacco products.
Review study. (n=20 studies)

Miech, 2017 What are kids vaping? Results from a national survey of US adolescents.
Among students who had ever used a vaporiser, 65-66% last used 'just flavouring' in 12th, in 10th and in 8th grade, more than all other responses combined. Nicotine use came in a distant second, at about 20% in 12th and 10th grade and 13% in 8th grade.
Survey. Students (n=44,892; grade 8, 10, and 12)

ModestoLowe, 2017 E-cigs . . . Are They Cool? Talking to Teens About E-Cigarettes.
Electronic cigarettes have gained wide acceptance among adolescents, especially those with sweet flavors such as bubble gum and cheesecake. This article outlines the basics of e-cigarettes and potential health hazards.
Motivational interviewing

Morean, 2018 Preferring more e-cigarette flavors is associated with e-cigarette use frequency among adolescents but not adults.
Compared to adults, a larger proportion of adolescents preferred fruit, alcohol, and "other"-flavored e-liquids, whereas adults disproportionately preferred tobacco, menthol, mint, coffee, and spiceflavored e-liquids.
School-based survey. Adolescents (n=396), and MTurk survey. Adults (n=590). 25

Patrick, 2016 Self-reported reasons for vaping among 8th, 10th, and 12th graders in the US: Nationally-representative results.
Overall, results suggest that decisions to vape are based on curiosity, taste, and pleasure, rather than for reasons such as quitting regular cigarettes or substituting for regular cigarette smoking.
2015 Monitoring the Future study. Students (n=4,066; grade 8, 10, and 12)

Pepper, 2016 Adolescents' interest in trying flavoured e-cigarettes.
 Adolescents were more likely to report interest in trying an e-cigarette offered by a friend if it were flavoured like menthol, candy or fruit compared with tobacco. Adolescents believed that fruitflavoured e-cigarettes were less harmful to health than tobacco-flavoured e-cigarettes. Perceived harm mediated the relationship between some flavours and interest in trying e-cigarettes.
Phone survey. Adolescents (n=1,125; ages 13-17)

Schiffman, 2015 The Impact of Flavor Descriptors on Nonsmoking Teens' and Adult Smokers' Interest in Electronic Cigarettes.
The e-cigarette flavors tested appealed more to adult smokers than to nonsmoking teens, but interest in flavors was low for both groups. Online survey. Non-smoking teens and adult smokers (n=648; age 13-80)

Shang, 2018 The impact of flavour, device type and warning messages on youth preferences for electronic nicotine delivery systems: evidence from an online discrete choice experiment. Fruit/sweets/beverage flavours significantly increase the probability of choosing ENDS among youth and flavour has the most pronounced impact among three attributes.
Online survey.

Tsai, 2016 Reasons for Electronic Cigarette Use Among Middle and High School Students - National Youth Tobacco Survey, United States, 2016.
Among students who reported ever using e-cigarettes, the most commonly selected reasons for use were use by "friend or family member", availability of "flavors such as mint, candy, fruit, or chocolate"; and the belief that "they are less harmful than other forms of tobacco such as cigarettes". Availability of flavors as a reason for use was more commonly selected by high school users than by middle school users.
2016 National Youth Tobacco Survey (NYTS). Student U.S. middle school (grades 6-8) and high school (grades 9-12).

Villanti, 2017 Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013-2014).
Flavor was a primary reason for using a given tobacco product, particularly among youth. Eighty-one percent of youth and 86% of young adult ever tobacco users reported that their first product was flavored versus 54% of adults aged ≥25 years.
2013-2014 Population Assessment of Tobacco and Health study (PATH) Adults and youth (n=45,971; age >12)

Zare, 2018 A systematic review of consumer preference for ecigarette attributes: Flavor, nicotine strength, and type.
Consumers preferred flavored e-cigarettes, and preference varied with age groups and smoking status. Several flavors were associated with decreased harm perception while tobacco flavor was associated with increased harm perception.
Review study. (n=66 studies)

STUDIES PUBLISHED SUBSEQUENT TO THE NORDIC COUNCIL REVIEW

Chen-Sankey, 2019. Perceived ease of flavored e-cigarette use and e-cigarette use progression among youth never tobacco users,
Perceiving flavored e-cigarettes as easier to use than unflavored e-cigarettes may lead to e-cigarette use progression among youth never tobacco users.
Path Study 2013-2014 and 2014-2015 (n=6,983).

Goldenson 2019 A Review of the Use and Appeal of Flavored Electronic Cigarettes
Nontraditional-flavored e-cigarettes are popular among youth, but may be less common among older adults and combustible cigarette smokers. Further research is needed to determine whether use of e-cigarettes in nontraditional flavors affects smoking cessation.
Review study

Meernick. Impact of non-menthol flavours in e-cigarettes on perceptions and use: an updated systematic review
Non-menthol flavours in e-cigarettes decrease harm perceptions (five studies) and increase willingness to try and initiation of e-cigarettes (six studies). Among adults, e-cigarette flavours increase product appeal (seven studies) and are a primary reason many adults use the product (five studies). The role of flavoured e-cigarettes on smoking cessation remains unclear (six studies).
Review Study (n=51 studies)

Schneller 2019. Use of Flavored E-Cigarettes and the Type of  E-Cigarette Devices Used among Adults and Youth in the US—Results fromWave 3 of the Population Assessment of Tobacco and Health Study (2015–2016)
Adults were far more likely to report using tobacco flavor alone, compared to any other individual flavor category or flavor category combinations (OR: 21.08, 95%CI: 5.92, 75.12). Whereas, youth were more likely to report using multiple flavor categories (OR: 2.03, 95%CI: 1.55, 2.65), with the most reported pairing being fruit and candy (36%).
Path Study (n=28,148 adults, 11,814 youth)

Soneji 2019. Use of Flavored E-Cigarettes Among Adolescents, Young Adults, and Older Adults: Findings From the Population Assessment for Tobacco and Health Study
The leading e-cigarette flavor types among adolescents were fruit, candy, and other flavors; among young adults were fruit, candy, and mint/menthol; and among older adults were tobacco or other flavors, fruit, and mint/menthol.
Path Study 2014-2015 (n=3086)


Monday, 2 December 2019

The FDA's ground rules for IQOS may have lessons for Canada

Last month, Philip Morris began selling the heated tobacco IQOS devices and sticks in the United States. This is almost 3 years after they were marketed in Canada.

The reason for the delay was that the US Food and Drug Administration would not permit the sale of this or any other new tobacco product until it was satisfied that doing so was in the public interest. In granting authority, the FDA imposed market restrictions and reporting requirements that were designed to limit harmful unintended consequences - like initiating use by non-smokers or former smokers.

As the industry trade magazine Tobacco Reporter describes, the impact of FDA requirement is significant:
Access to the IQOS store is strictly controlled. Customers have to show identification and declare whether they currently smoke cigarettes. Nonsmokers and those under 21 are turned away, according to Altria.
The IQOS marketing authorization requires Altria to keep detailed records and send the FDA quarterly reports on its sales, including details like demographic data on its customers and how many have switched to IQOS from cigarettes or use both products.
The company must also send an annual report with more granular information, including any reports of adverse experiences.
In this post, we summarize some of the different regulatory approaches that have been taken with respect to next generation tobacco products and ways to prevent post-market problems.

DIFFERENT COUNTRIES, DIFFERENT REGULATORY APPROACHES

Canada:  Post market reporting required (for tobacco)

In Canada, manufacturers can begin marketing new tobacco or vaping products without having first to seek the permission of federal or provincial governments. As long as they meet the many requirements of federal and provincial laws - taxes, packagign, ingredient restrictions, sales displays - they are allowed to be sold. After products are on the market, companies are required to file monthly or annual reports on certain marketing activities. Different types of nicotine products (eg cigarettes, e-cigarettes, oral tobacco, cigars) trigger different requirements.

Over the past decade tobacco companies have introduced Canadian consumers to new styles of cigarette filters (Aqua and Activate), oral tobacco (Snus), of heat-not-burn (IQOS, glo), of e-cigarettes (JUUL, Vype, Logic, Blu). On no occasion was Health Canada required to assess whether the marketing of these products was in the public health interest, or authorized to take action if this was not the case other than through the enforcement of pre-existing laws and regulations or the development of new ones. The structure of our tobacco regulatory system is one that leads to a perpetual game of catch-up.

The Canadian approach applies the same rules to all products within a certain category. Heat-not-burn tobacco products (like IQOS) and oral tobacco are treated as tobacco products under federal health and tax law, and subject to the same advertising restrictions as cigarettes. Vaping products and oral nicotine are subject to lesser restrictions. Reporting requirements for vaping products, for example, have not been developed although the products have been on the market now for 18 months.

European Union: Premarket notification required for e-cigarettes

In other parts of the world, rules have been put in place to limit the capacity of companies to take government by surprise when they launch new nicotine-carrying products. When the European Union Directive on tobacco was amended in 2014, it included requirements for manufacturers to give governments a six month 'heads-up' before marketing any novel tobacco product or electronic cigarettes. The directive also authorizes member states to establish authorization systems for such products. Many countries impose a notification fee to help defray the costs of processing or review.

Some of the challenges of this approach have recently been documented - including the volume of premarket authorizations that can result. Finland received more than 19,000 premarket notifications within a 3 year period. 

With this approach, governments are still playing a game of catch-up, but the industry has a little shorter head start than in Canada.

USA:  Premarket authorization required for next generation products

The U.S. has gone further than any other country in ensuring a review of products before they are marketed.

All tobacco products introduced to the market or modified after 2007 are required to submit a Premarket Tobacco Application  (PMTA) to the U.S. Food and Drug Authority. (Minor changes to cigarettes, however, can be introduced without this process if they are 'substantially equivalent' to a product already on the market).

In 2016, this requirement was extended to e-cigarettes. Those which were already on the market were given until May 2020 to submit an application for approval. (BAT's subsidiary recently did so for some of its vaping devices).  A little over a year from now, the FDA will be granting approval and setting the conditions of sale for JUUL, Logic, VYPE/VUSE and the hundreds of products sold by large and small manufacturers, or it will be ordering them them off the market.

Essentially that means that all of the "next generation products" must eventually be approved by the FDA or removed from the market.

In the USA, the government has the power to tell the companies to wait at the starting line until the regulations are ready and to expect that some will be sent off the field - even if they are well down the track.

Getting authorization is a privilege that comes with conditions 

Unlike Europe or Canada, the U.S. health regulators are obliged to assess whether or how allowing any of these new products will contribute to the health of Americans. As the FDA describes it:
A PMTA must provide scientific data that demonstrates a product is appropriate for the protection of public health. In order to reach such a decision and to authorize marketing, FDA considers, among other things:
  • Risks and benefits to the population as a whole, including people who would use the proposed new tobacco product as well as nonusers;
  • Whether people who currently use any tobacco product would be more or less likely to stop using such products if the proposed new tobacco product were available;
  • Whether people who currently do not use any tobacco products would be more or less likely to begin using tobacco products if the new product were available; and
  • The methods, facilities, and controls used to manufacture, process, and pack the new tobacco product.
So far, the FDA has approved two products under this process: The IQOS heat not burn cigarette (2019) and Swedish Match snus (2015). It recently authorized Swedish Match to inform consumers that their products pose lower health risks than cigarettes.

FDA Permission to sell Next Generation Products comes with strings attached:

The FDA process permits the regulator to apply specific rules to specific products. It allows them to permit some vaping device designs, but not all. It allows them to put different conditions on some manufacturers than on others.

The FDA's authorization for IQOS illustrates how a product-specific, company-specific authorization can be constructed. In the 122-page review made public this spring, the FDA transparently explained its reasons for issuing the authorization, including the reasons that the advice of some its own experts were rejected and over ruled. It set the constraints that Philip Morris must follow, including the guidance that it is to take measures to prevent new uers, former smokers or dual use:
 Limiting youth exposure and initiation and use of the products as you have indicated in your PMTAs (i.e., complete switching to IQOS by adult cigarette smokers) are important components of consideration for the marketing of these products to continue to be appropriate for protection of the public health.
The level of detail in the reporting requirements greatly exceed those currently in place in Canada. Under these requirements (page 102 to 110 of the authorization decision), PMI must report on past activities and give notice of future ones. The first four (of several dozen) of these obligations reflect how much more detail is required than in Canada.
  • A summary of U.S. sales and distribution of the tobacco products, including total U.S. sales reported in dollars, units, and volume, and broken down by U.S. census region, major retail markets, and channels where the products are sold (e.g., convenience stores, food and drug markets, big box retailers, digital platforms, tobacco specialty shops, company-owned stores). 
  • Data on product purchasers. Report any data collected about new purchasers, those who have switched tobacco products, and/or multiple product users. The results must be broken down by purchaser demographics (e.g., age, gender, race/ethnicity, geographic location) and must not include personally identifiable information.
  • An analysis of the actual delivery of advertising impressions, by channel, by product, and by audience demographics (e.g., age, gender, race/ethnicity, geographic location), including a breakout by age-group (i.e., adults, ages 25+; young adults, ages 18-24; and youth, ages 12-17 and ages 11 and under). This analysis must be verified against post-launch delivery-verification reports submitted to you from an accredited source. 
  • A summary of media tracking and optimization, by channel, by product, and by audience demographics (e.g., age, gender, race/ethnicity, geographic location), including a summary of realtime digital media monitoring to identify, correct, and prevent delivery of advertising impressions to youth, ages 17 and under, and including a summary of implementation of any corrective and preventive measures. 
The cost? Born by the tobacco industry

The FDA approach comes with a cost, as it takes a large infrastructure to manage approvals and post market surveilance. The FDA's budget for its tobacco control office is more than $660 million this year.  Importantly, these activities are not funded by the general taxpayer, but through a special assesasment of "Tobacco User Fees" charged to manufacturers on the basis of their market share in certain product categories.

The benefit? Greater transparency and more science behind decision-making

The FDA review process provides a tranparency that allows for independent scientists and public health contributors to participate knowledgeably in the regulatory process. Much of the companies' application, the FDA decision and the opinion of its critics and supporters become a matter of public record. (A year ago, Tobacco Control published a supplement of independent assessments of PMI's application).

The FDA invested more than US$180 million last year to outside researchers (Tobacco Centers of Regulatory Science) to participate in building the science to inform tobacco regulation. That's more than 4 times Health Canada's entire tobacco control budget!


Monday, 25 November 2019

Big tobacco funds and controls the new Vaping Industry Trade Association (VITA)

[NB: On December 4th, VITA issued a statement objecting to and correcting some of the information provided in this blog. The original blog appears below, but is now annotated with reference to their objections and corrections.]

Last week the first webinar was held between the Vaping Industry Trade Association (VITA) and its membership. Unexpectedly, one of the participants made the slides and other information available to us. With this confirmation that this organization is funded by and operating in the interests of tobacco companies, governments should ensure that their relationships with this entity meet Canada's international treaty obligations.

Tobacco companies are the "founding directors" of  VITA

The Vaping Industry Trade Association (VITA) was established in the summer of 2019 to replace the Electronic Cigarette Trade Association (ECTA). It was incorporated on September 19th. Whether the choice of the acronym VITA - the latin word for life - was made with a sense of irony or denial is not known at this point.

All but one of the "founding directors" of the new organization are identified as the PR-directors of 3  "tobacco-affiliated" e-cigarette producers active in Canada: Imperial Tobacco Canada (VYPE), JTI-Macdonald (Logic) and JUUL. "Tobacco-affiliated" is the term used by VITA. There is a 4th tobacco company which sells e-cigarettes in Canada (Imperial Brands, Blu), but it is not a member of the Canadian cigarette oligopoly and we are informed that it is excluded from becoming a member of VITA.
(VITA says that 2 other founding directors are on the board as chairman and treasurer and that Imperial Brands is not banned from joining the organization)



Tobacco interests provide 100% of VITA's funding.

It was confirmed to us that these "tobacco-affiliated" organizations have provided a 3-year funding commitment to the organization. Other members do not have to pay dues during this period.
(VITA says that "tobacco-affiliated" organizations pay 50% of the $600,000 annual contribution by founding directors, and that other members pay when joining.)

Tobacco companies control key activities of VITA

Of the 5 operating committees of VITA, three are chaired by "tobacco-affiliated" employees:
  • The Technical Committee is chaired by the director of scientific and regulatory affairs at Imperial Tobacco, Richard Voisine.
  • The Communications Committee is chaired by Imperial Tobacco's Manager of Government Relations and Regulatory Affairs, Amee Barber
  • The Government Relations Committee is chaired by JUUL's Director of Federal Affairs (and former MP and Ontario Minister of Energy), Glenn Thibeault.
The committees that are chaired by vape shop owners are the governance committee and the programs committee. 


VITA has engaged well-connected public and government relations consultants

In addition to Glenn Thibault, VITA has engaged other former politicos to influence opinion and regulation. Among those presenting at the webinar were:

* Gordon Taylor Lee of National Public Relations supports the Commications Committee. From 2004 to 2012, he had senior positions in Health Canada and the Public Health Agency, including in the office of the Minister of Health. 
* Terrence Oakey at One Persuasion. Prior to working as a lobbyist, he advised on health policy for Stephen Harper. 

VITA's planned advertising campaign is aimed at discrediting public health voices.

Charcoal Marketing has been hired to roll out a social media campaign, focusing first on British Columbia and then in other provinces where the industry feels vulnerable to increased regulation (British Columbia, Quebec, Ontario, Alberta and Nova Scotia). 

The key messages for this campaign combine promotion of the product class as "safer" and also re-deploy familiar tobacco industry campaign themes. 1) virtue-signalling of intent to protect children and 2) discrediting of public health concerns. (The traditional third arm of argument is to predict dire unintended consequences of regulations). 


(Vita says this is not their campaign's goal).


VITA has hired a controversial physician to plead its case.

On November 19, VITA announced that they had hired Dr. Mark Tyndall. The press release says that he was hired to advise and help interpret new evidence. But VITA members were told last week that his job is also to promote vaping to the medical community.

On the same day that his appointment was announced, Dr. Tyndall tweeted in support of the rights of vapers. His twitter profile does not yet acknowledge that he is a paid influencer.


(VITA says Dr. Tyndall "has been brought on as theharm reduction advisor, and health related spokesperson to VITA, as referenced in this publicly available pressrelease. Dr. Tyndall will advise VITA on how to promote vaping as a harm reduction strategy for people who smoke cigarettes and help with the interpretation and application of emerging scientific evidence on vaping ..."_

VITA and the Framework Convention on Tobacco Control

How should governments, the media and the public manage their relationships with this new  industry group? Guidelines for interaction with tobacco interests are provided by the Framework Convention on Tobacco Control. As a party to the Framework Convention on Tobacco Control, Canada (including provincial governments) are committed "to protect these [public health] policies from commercial and other vested interests of the tobacco industry."

Among the guidance given to government in implementing these guidelines are the following:
(1) Raise awareness about the addictive and harmful nature of tobacco products and about tobacco industry interference with Parties’ tobacco control policies. 
(2) Establish measures to limit interactions with the tobacco industry and ensure the transparency of those interactions that occur. 
(3) Reject partnerships and non-binding or non-enforceable agreements with the tobacco industry. 
(4) Avoid conflicts of interest for government officials and employees. 
(5) Require that information provided by the tobacco industry be transparent and accurate.  


Thursday, 21 November 2019

Health Canada consumer research on vapers' attitudes to flavours

Last February, 2,027 Canadian vapers sat down at a computer and answered a questionnaire prepared by Environics Research on behalf of Health Canada. Six months later, the report summarizing their answers has been available at the Library of Canada. (Link: POR 083-18 Vapers Panel Survey to Measure Attitudes and Behaviours Regarding Vaping Products).

The results provide some data for discussions about vapers' use of flavours and what impact restrictions on flavours might have. The text below is reprinted verbatim from the Environics report. Excel tables are also available for people who wish to dig deeper into the findings - or into the other attitudes that were reviewed.

And there is more to come! Federal government reports on consumer research identify that a follow on study (POR 141-18) was commissioned, although it has not yet been released.

--------------------------------------------------------------------------------

Environics Research
POR 083-18


Flavours are important to vapers
The feature regular vapers like most about their device is their ease of use, although flavours, device colours and the ability to do tricks is of relatively greater importance to youth vapers.




Flavour preferences of young people differ from those of older vapers
The preferred flavour choice for regular vapers is fruit (30%), followed by tobacco flavour (15%), mint/menthol (13%) and candy/confectionary (9%). Preference for fruit flavour is particularly pronounced among youth vapers (45%) and young adult vapers (39%), while preference for tobacco flavour skews to vapers aged 25 and older.

[P]reference for fruit flavours is relatively higher among never smokers (42%), while preference for tobacco flavour is relatively higher among current and former smokers (19% and 15%, respectively, versus 3% of never smokers).



Younger vapers switch flavours more often
The majority (59%) of regular vapers say they tend to stick to a single flavour of vape liquid, compared to four in ten (39%) who use multiple flavours throughout the day or week. Regular vapers in Quebec in particular show a preference for using a single flavour (66%).


Tendency to switch between multiple flavours varies by age. Close to half (48%) of youth vapers use multiple flavours throughout the day or week, whereas only one-third (36%) of vapers aged 25 years or older do so.



One-quarter of vapers relate flavour choice to quitting
Those who have used different flavoured vaping liquids were asked about their main reasons for switching flavours. The most common reason is to experiment with the flavours (53%). Others say it depends on their mood (35%) or on price (25%). Some also say flavour switching helps them gradually quit or reduce smoking cigarettes (24%). This reason is more commonly given by adult vapers (27%) and by current (31%) and former (22%) smokers. Otherwise, reasons given for flavour switching do not vary significantly by age.


Flavours are the main reason cited by never-smokers for vaping.
Reasons for vaping depend on smoking history, with dual users and former smokers most commonly using it for smoking cessation. Never smokers - of whom most (70%) are youth or young adult vapers - choose to vape because they like the flavours/smells, as a social activity, or for emotional reasons (e.g, it's fun, reduces boredom).

• Among dual users, adult vapers are more likely than others to cite the desire to reduce the number of cigarettes (53%), while young adult and adult vapers are both more likely to cite the desire to quit outright (46% each). Youth and young adults who are dual users are relatively more likely to say they vape because of the flavours/smell (41% and 39%), for fun (23% and 19%), to reduce boredom (25% and 17%), or when they are in certain social settings (22% and 20%).

• Among former smokers, the number one reason for vaping among all age groups is to help them quit smoking.

•Among never smokers, the top reason for vaping among all age groups is the flavour/smell. Youth and young adults are more apt to give multiple reasons, including the excitement of vaping (48% and 42%), doing tricks (39% and 27%), and because their friends and family vape (35% and 23%).


Those who have used vaping to quit think flavours are important
Both former smokers and dual users currently trying to or planning to quit believe it is at least somewhat important to have a range of vaping flavours available to them.



Sunday, 17 November 2019

How cheap will vaping products get before we see price as part of the youth vaping problem?

Vaping Product
Retail signs
Montreal & Ottawa
Nov 5-9, 2019
A price war is underway among the four main manufacturers of the pod-style vaping products that are sold in convenience stores. Over the fall, each of the companies which sell these JUUL-type products has reduced its retail and/or on-line prices.

The cost of a tellingly-labelled "starter kit" for JUUL imitators (Logic and Vype) is now less than $10. The JUUL starter kits are more expensive (as low as $30), but are half the price they were this summer. It is now cheaper to vape all day than than to buy a specialty coffee.

With this latest round of price cuts, convenience store prices for vaping prodpucts have fallen by 45% to 75% over the past year.
  • British American Tobacco's Vype ePod was launched in January to compete with JUUL at a price of $40.00. This week it is being sold in mainstream convenience outlets, like Circle K/Couche-Tard for $10.00, tax included. (The online-price without tax is $8.99). 
  • JUUL was launched in Canada last summer with a starter kit priced at $64.99. This week it is for sale at $29.99 in Couche-Tard (a somewhat higher price of $39.99 is listed on JUUL's  web-store).
  • Logic Compact was launched by Japan Tobacco's Canadian subsidiary this winter at a lower price than its competitors - $19.99. It is now for sale in stores at $10.99. (Logic does not sell products through its web-site).
The price of the nicotine pods used in these devices has also fallen. A package of 2 Vype e-pod cartridges was selling in Montreal this week for $6 (half the original listed price), and 2 Logic cartridges could be bought for $5. (One pod is loosely understood to be the equivalent of a package of 20 cigarettes).

Lower prices can be expected to result in more young people vaping

Decades of research have shown that low tobacco prices lead to higher rates of children and young adults smoking (and higher tobacco prices reduce it!). It stands to reason that the well-established economic principle of higher-prices-reduce-use would apply to e-cigarettes.


Price discounts are now the tobacco industry's major marketing tool.

Pricing is a key component of all marketing strategies, and has become increasingly so with tobacco. The U.S. Federal Trade Commission is unique among governments in demanding and make public the aggregate promotional budgets of the tobacco industry. Earlier this year it reported that 85% of the advertising budget of U.S. companies ($7.3 of $8.6 billion) was spent on price discounts. As traditional advertising has been banned or fallen out of favour, the companies are focusing their efforts on the sticker price.

Tobacco companies with deep pockets are well-positioned to engage in a long-term price war, and there are reasons that their shareholders will be happy to endure the short-term losses that could result:
* low prices allow them to expand their long-term (addicted) customer base, on which they can make future profits.
* low prices allow them to undercut vaping businesses that sell through vape shops, and may drive these these small-business competitors out of the market.

This year tobacco companies can afford to spend even more on promotions

Last March, Canada's 3 large tobacco companies sought protection under Canada's insolvency laws (the Companies' Creditors Arrangement Act), including the manufacturers of Vype and Logic. As a result, the profits that they would normally send back to their multinational owners has been frozen with the expectation that this will be handed over to the provinces and others who are suing them. The court did not, however, freeze their promotional budget for tobacco or vaping products. Deep spending in Canada on vaping promotions (even if it exhausts their Canadian cigarette revenues) will not affect the overall profitability of their multinational owners -- and it may enhance their long term profits.

Regulatory experience with affordable addiction

1)  Tax officials can use excise and sales taxes to ensure a minimum price. 

Taxes are one of the most highly recommended public health strategies to reduce youth use of harmful substances like alcohol and tobacco. Evidence shows that taxes are very effective at protecting young people (and others!) from tobacco use. In Canada, the federal government currently imposes a tax of $2.44 on each package of 20 cigarettes, and provincial government taxes on the same package range from $2.98 to $5.90.

Many jurisdictions are moving to implement vaping taxes, and 2 Canadian provinces are also taking this important step. This week British Columbia announced that as of the new year, the provincial sales tax on these goods would increase from 7% to 20%. This was one component of a larger set of reforms to address what health minister Adrian Dix described as an "addictions trap for our youth". Three weeks ago the Alberta government promised that would impose a tax on vaping products next year, but has not yet set the amount or the style of tax.

Taxes can reduce affordability - but only if they are set at a high enough level. 

Even with B.C.'s new tax, vaping will still be twice as cheap as smoking cigarettes. A JUUL nicotine cartridge that is priced at $5.25 before tax will cost $6.56 after tax (up from $5.88 today). The after-tax cost of a $10 starter kit will increase from $11.20 to $12.50. (In B.C., the cheapest advertised price for a package of 20 cigarettes is around $12.)

As a World Bank report recently pointed out, there are additional ways to address affordability through taxes. Available structures include taxing the devices, imposing a tax per ml of nicotine fluid, or per mg of nicotine, or per pod. Sales taxes alone encourage price competition because reducing the price also reduces the tax, whereas using excise taxes to set level of tax per unit helps ensure a minimum price.

This is illustrated by comparing the current situation (A) with the impact that B.C.'s upcoming sales tax increase will have (B) and also with the impact that would result if each pod of nicotine were taxed at 75% the rate of the current taxes on a pack of 20 cigarettes (C)

2) Health regulators can use price regulation to reduce experimentation. 

Canadian governments have used other regulatory means to prevent manufacturers from using price to increase the consumption of harmful products"
* minimum unit pricing of alcohol is a measure adopted by many Canadian provinces (including Ontario).
* minimum package size is a measure used in tobacco control to prevent companies from selling "kiddy packs" of fewer than 20 cigarettes.
* Quebec has combined minimum pricing with minimum package sizes to implement a de facto minimum price for little cigars of $10.00.

Other countries have managed prices in ways that prevents price wars among manufacturers or retailers for tobacco products.  In France, Brazil and Japan, for example, retailers can only charge the price for cigarette brands that are on a government-approved list. (Although France does not impose a price list for e-cigarettes, Japan and Brazil ban these products altogether).

Federal regulatory changes which facilitate tobacco and nicotine price wars can be undone.

Tobacco companies have established distribution structures which give them greater control over retail pricing. A decade ago, tobacco products were distributed through wholesalers, and each retailer paid the same price. But after changes to the federal Competition Act in 2009, manufacturers were given the right to use "discriminatory pricing" to give special discounts to selected retailers. The contracts under which retailers gain this advantage commit them to using lower mark-ups, and passing the saving on to consumers.

The result is that in some stores cigarettes (and vaping products )are much cheaper than in others, even in the same neighbourhood. 

The challenging road ahead

With deep pockets, a well-established route to market, decades of experience and a loyal (addicted) consumer base to maintain revenues, tobacco companies can afford to use vaping products as a lost leader for nicotine use.

Amazon and Uber have shown how sacrificing profits can be used to expand a market footprint and to both create and dominate a new market category. There is no reason to think that "Big Nicotine" would not do the same.

Monday, 11 November 2019

ICYMI: How e-cigarettes can break your heart

Last week yet another publisehd study raised concerns about health impact of e-cigarettes.

Much of the attention this fall has been on injuries to the lung, especially the Ee-cigarette or vaping product associated lung injury (EVALI) that has been experienced by thousands of American vapers and a much smaller number in Canada. Less reported have been papers exploring risks to other parts of the body, or which look at longer-term health effects.

One helpful study considered past studies on animals and humans to explore the various ways in which long-term cardiovascular damage might arise from using e-cigarettes. The paper Cardiovascular risk of electronic cigarettes: a review of preclinical and clinical studies was commissioned from 6 researchers associated with the Ohio State University. It was written last spring, and published last week in the journal Cardiovascular Research.

The authors (Nicholas D Buchanan, Jacob A Grimmer, Vineeta Tanwar, Neill Schwieterman, Peter J Mohler and Loren E Wold) note that there is a significant knowledge void to fill, as the the long-term effects of vaping on the cardiovascular system were "essentially unstudied".

To address that gap, they considered the state of knowledge about the individual constituents found in the emissions from vaping products, such as  (a) nicotine, (b) particulate matter and metals, and (c) carbonyl compounds (produced by the solvents used to hold the nicotine) and flavourings. While there are many designs of e-cigarettes, virtually all result in users inhaling these subtances.

The authors located several dozen studies made of the effects of these substances on animals and tissues (preclinical studies) and also on humans (clinical studies). They considered what the results of these studies implied for the cardiovascular health of an individual who was exposed to these substances through vaping for an extended period.


Potential adverse cardiovascular effects induced by various constituents of e-cigarette aerosol.

Each of these components of e-cigarette vapour has been demonstrated to pose a risk to the cardiovascular system:  a) nicotine can increase blood pressure and heart rate, or cause inflammation or stiffness in the arteries; b) fine particles find their way into the blood stream and directly affect the cardiovascular system, c) flavouring ingredients, even if they are considered safe to eat, can cause harm when they are inhaled, by triggering inflammation or other reactions.

This review identified many mechanisms by which e-cigarette use could increase cardiovascular risk, individually and in combination with each other. "As a result, great caution and hesitation should remain concerning e-cigarette use until its health risk profile is better established."



Mechanisms of e-cigarette induced cardiovascular dysfunction.


After completing this review, the researchers conclude that, with respect to cardiovascular disease, the risks from e-cigarettes cannot be said to be less than they are from smoking cigarettes until more research can show this to be the case. "While the current but still limited literature suggests that e-cigarette use may lead to fewer negative cardiovascular effects than conventional cigarettes, our review supports that there is not sufficient data to conclusively make these resolutions."

They urge that e-cigarettes be subject to the kind of pre-market scientific reviews that are required of other drugs. With this kind of "clinical trial data determining the general safety profile of e-cigarettes, regulatory guidelines defining their proper use and public perception can be better formulated."

Enough evidence of harm to implement protective measures

Already several comprehensive scientific reviews have been conducted about the health effects of vaping on behaviour of major health authorities like the World Health Organization (2015), Public Health England (2015, 2018), the National Academies of Science, Engineering and Medicine (2018),  Public Health Ontario (2018) and others. These reviews have provided regulators and practitioners with inconsistent and sometimes conflicting advice on the regulatory approach that should be taken with respect to e-cigarettes.

The contributions of recent papers, like the one cited above, increasingly call for regulators and practitioners to insist on more evidence before acting as if e-cigarettes were less harmful. Last month, for example, a study lead by Jeffrey Gotts looking into the question "What are the respiratory effects of e-cigarettes?" This team also cautioned that it is not possible at this time to "determine whether the respiratory health effects of e-cigarette are less than those of combustible tobacco products."

These recent papers and other key research findings are summarized in our new fact sheet, The Health Effects of Vaping.

Tuesday, 5 November 2019

Yet another novel nicotine product on the Canadian horizon: tobacco-less oral tobacco

"An exciting new space"

That's how BAT's category director Vincent Duhem described Oral Tobacco products to investors earlier this spring.

Unlike vaping products, he pointed out, Oral tobacco had assets that other next generation products did not. Unlike vaping products, no device was required and it can be used in places where vaping is not allowed (he showed a picture of an airplane). Even more - it offered additional "sensorial stimulations" and could be successfully marketed to women too. (Slide 8)

The "Modern Oral" product Mr. Duhem was promoting was designed to span the gap bewteen between tobacco products and pharmaceutical grade nicotine products. BAT has developed three branded products cover that space: EPOK (white tobacco), LYFT (no tobacco)  and VELO (no tobacco). (Slide 11)


Everything Old is New Again

Oral tobacco is older than cigarettes, and is still a common form of nicotine use in some parts of the world - including the United States, Scandinavian countries and much of the Indian subcontinent.

The challenge for BAT and other companies wanting to rehabilitate this traditional practice is to convince people to put a small bag in their mouth several times a day and hold it there for half an hour. For many, this will seem an odd way to spend their time.

The companies' strategy to accomplish this seems to have focused on reducing the "yuck" factor, and making a mouth full of 'stuff' look less gross and less dangerous. They seem to have approached the task of whitewashing oral tobacco quite literally: both the product and packaging have been purified in white.
* In EPOK, the tobacco was bleached white, and then flavoured and adjusted to be less unpleasant tasting. (One of the patents involved can be found here).
* In LYFT, the nicotine was embedded in bleached fibers from pine trees, as well as other flavouring agents and stabilizers. (The process is described here)

Another major step to making this product palatable to new users is to make it, well, palatable. With LYFT, the sharp tingle of nicotine in the mouth is masked with no fewer than 9 fruity and minty taste and strength options. Is this the alcopop of nicotine? (Slide 20)



Forget ugly-brown, taxed tobacco. Instead, try some pure-white, tax-free nicotine-infused pine.

Taking nicotine out of the tobacco and then putting it into a different plant fiber may seem like a peculiar manufacturign process, but getting consumers to re-think oral tobacco is only one of the advantages to tobacco companies.
  • Nicotine pouches circumvent the EU ban on oral tobacco (see later)
  • Nicotine pouches aren't taxed like tobacco is. No excise tax revenue going to the treasury leaves more pricing room for manufacturers' profits. Mr. Durhem told investors that BAT made 3.1 times the profit on LYFT compared with factory made cigarettes. (Slide 16)
  • Nicotine pouches don't face the same advertising restrictions. 
BAT may not be able to give its cigarettes away for free, but it can offer free samples LYFT nicotine pouches.

"Welcome to a new world of stimulation," beckons the LYFT web-site. "Anytime. Anywhere. Are you in? Click here for a free sample."

Subsequent packs, of course, are not free. The price of a can with 24 pouches is £7.99 - cheaper than the over £10 price tag on a package of UK cigarettes.

Other tobacco companies are also eager to fill that space.

Similar products made by other tobacco companies are already on the market:

Catching regualtors off-guard.


Exposing cracks in Canada's tobacco regulatory system:
The "exciting new space" that these new nicotine products are designed to fill is not one that has yet been addressed in Canada or in many other countries. The federal Tobacco and Vaping Products Act regulates tobacco products and nicotine products which "produces emissions in the form of an aerosol." Tobacco-free nicotine pouches are not embraced by this law, and would not be subject to any of its provisions.

The other federal Canadian law which would apply is the Food and Drugs Act. Last year, the rules for non-prescription nicotine were 'clarified', and it now appears that these new tobacco company products would be exempt from prescription drug controls as long as they contain 4mg or less of nicotine. The newly clarified exemption applies to "in a form to be administered into the oral cavity by means of a non-active device (one that operates on energy generated by the human body or by gravity) that delivers 4 milligrams or less of nicotine per dose for buccal absorption."

Its not clear how long before such products may be offered for sale in Canada. As of November 1, 2019, neither LYFT nor VELO were registered in Canada as trademarks for nicotine products, although Zyn was registered  in Canada last February and ON! was registered in August.

Benefitting from the cracks in EU tobacco regulation:
The marketing of these novel oral product in the U.K., Austria, Germany and other parts of the EU shows similar cracks in their tobacco and nicotine control systems. The EU tobacco directive bans oral tobacco, and requires warning labels on all tobacco products. (Sweden is the singular exception to this ban, and Norway and Switzerland are not members of the EU). Nicotine pouches are now sold by tobacco companies in EU countries without package health warnings.

Seeking approval in US tobacco laws:
The U.S. Food and Drug Administration has determined that oral nicotine can is deemed to be a tobacco product, and has asserted its authority over the marketing. Its rules include the ability of the companies to ask for permission to market these as less harmful products.

Last month General Snus became the first tobacco product allowed by the FDA to make reduced risk claims. Altria is asking for the same right for its Copenhagen brand of snuff. Last week, in a presentation to investors, it illustrated how it intends to use this authority.

As the FDA processes similar applications for nicotine pouches, one might presume that similar authority will be given to these more recent products too.

A product for every consumer 

Tobacco industry marketing plans used to revolve around finding a brand image that they could match to every consumer group. Tough macho brands for people who wanted to be thought of as touch and macho (Export A), urban sophisticated brands for people who aspired to that lifestyle (du Maurier, Benson & Hedges), etc.

Recent investor presentations (like slide 6 on a presentation made by BAT last October) show the development of this integrated range of nicotine systems. Some (cigarettes) are for people who love the taste of smoking, others (Oral) for those who feel the social pressure to not smoke or (vaping) who don't like the smoking experience.

With the increased presence of these next generation products, the need is growing for next generation regulatory approaches.





Friday, 1 November 2019

How much has vaping reduced cigarette sales? Not much, says Altria to its investors

Yesterday Altria made a regularly-scheduled presentation to investors, giving them an update on their business results for the first 9 months of their fiscal year.

Altria sells that country's most prominent cigarette brand (Marlboro), but there was very little interest in its report of the cigarette marketing.

Instead, investors' focus was on Altria reports on the value of the 'strategic investment' it made last December when it spent $12.8 to get a one-third stake in JUUL.Because JUUL is not a publicly traded company, this is as close to insider information on the vaping market that investors will get. (Altria reported that JUUL is now worth about $12 billion less than it was at the beginning of the year - losing one-third of its market value.)

Under the hood

Altria's main business is cigarettes, but it is looking to increase sales in new forms of Oral Tobacco (ON!), Heated Tobacco (IQOS) and to profit from investments in E-vaping (JUUL), wine, beer and cannabis.

In yesterday's slide presentation to investors (the web-cast script is not available at this time), Altria focused investors' attention on the shifting patterns of nicotine use.

Three slides from that presentation are worth a second look.

#1: Vaping among adults (21 years and over) is not growing fast.

With the push for age 21 rules, the industry's definition of adult smoker has changed. Altria's estimates of the number of vapers (including those who do and who do not also smoke cigarettes) shows that the number of adult vapers is not much different than it was 5 years ago, although the proportion of those who also smoke cigarettes is falling somewhat.




#2: Cigarette sales are dropping:
- for every 20 cigarettes smoked last year, this year there are only 19.


Volume sales of cigarettes in the United States are down more than 5% this year compared with last -- a greater dip than in any other of the past 5 years. That's the equivalent of 1 less cigarette in every package in 2019, compared with 1 less cigarette in every carton in 2015.

The reason? Altria says it is because smokers are substituting some cigarettes with e-cigarettes and because some smokers have completely switched to vaping. "We continue to believe that increased adult smoker movement to e-vapor and increased exclusive e-vapor category usage are the primary drivers of the accelerated decline."

But when Altria looks more closely at the 5% decline, vaping is only half of the  reason ....



#3: Vaping and other nicotine products have reduced cigarette sales:
- for every 48 cigarettes smoked last year, 1 has been replaced with an e-cigarette.


Altria "decomposes" the 5.5% decline in cigarette smoke and attributes the decline as follows:
  • 45% of the decline (2.5% of total cigarette volume) is a result of the ongoing drop in tobacco use, which it refers to as "secular decline".
  • 20% of the decline (1.1% of the total cigarette volume) is the result of cigarettes being too expensive
  • 38% of the decline (2.1% of the total cigarette volume) is attributed to "cross category movement"... i.e. smokers getting their nicotine from other products. 
It also reassures investors that at this time there is no reason to think that vaping will lead too many smokers to quit any time soon. "We reaffirm our 2019 U.S. cigarette industry volume decline estimate of 5% to 6% and maintain our compounded annual average U.S. cigarette industry volume decline estimate through 2023 of 4% to 6%."


Can we trust these numbers?

Credibility is an ongoing challenge for tobacco companies, and the health sector has good reason to avoid using industry data as the basis of any public health decisions. Nonetheless, this Altria presentation shows ways in which the factors that might influence the tobacco market can be disentangled.

Grist for the mill! 

Wednesday, 30 October 2019

Finland's strong controls on e-cigarettes include a ban on flavours.

Recently the academic journal Tobacco Control published a new study on Finland's experience with banning flavours in e-cigarettes. In this paper, Eeva Ollila of the Cancer Society of Finland analyzed the legal challenges and defiance to the law by manufacturers and retailers, and identified the need for greater controls at the EU and other levels. See you in court: obstacles to enforcing the ban on electronic cigarette flavours and marketing in Finland.

Canadians reading her research may be forgiven for thinking 'we should be so lucky'.

Despite the enforcement challenges, Finland has largely succeeded in protecting its young people from e-cigarette uptake. This is shown in the results from its annual school health survey which were reported in Eeva Ollila's paper. Colour was added for ease of reading.

This data show that, unlike Canada, after Finland legalized e-cigarettes (in 2016), use by early high school students went down (green lines). (Snus - which is illegal in Finland - may be a different issue!).


Finland’s tobacco endgame includes lowering e-cigarette use.

Finland has embedded a tobacco end-game in its national public health strategies and also in its tobacco laws.


Finland puts limits on nicotine, flavours and ingredients:Under Finland’s 2016 Tobacco Act manufacturers of e-cigarettes must:
  • Not use any flavourings in e-cigarette liquids other than tobacco flavour. (s. 24)
  • Comply with other aspects of EU Directive (i.e. maximum nicotine concentration of 20 mg/ml) (s. 52)
  • Restrict the size of nicotine liquid containers to 10 ml. (s.24)

Finland requires manufacturers to file extensive reports to government.
  • Six months before putting a product on the market, manufacturers must  provide comprehensive information on the ingredients and their toxicological profile, as well as a description of other manufacturing processes. (s. 26) A modest (150 euro) fee is required for each notification. 
  • Manufacturers must provide annual reports on sales volume, by brand name and type of product, on preferences of various consumer groups, on market surveys (s. 27)
  • Manufacturers must maintain a record of any suspected adverse effects on human health, and provide this to government. (s. 28)

Finland requires manufacturers to provide information to consumers.
Manufacturers must provide health-related information on and in packages.
  • In addition to the health warning required by the European Union directive, manufacturers must include a leaflet with “instructions for use and storage (including statement that product is not recommended for use by young people and non-smokers), information on illnesses and other health-related circumstances preventing the use of the product, warnings for specific risk groups, information on the product’s possible adverse effects, information on the addictiveness and toxicity of the product.”

In Finland, tobacco and e-cigarette retailers pay high licensing fees.
Retailers of tobacco and/or nicotine-containing liquids are regulated by Valvira, the National Supervisory Authority for Welfare and Heath. Retailers must:
  • Have a retail licence issued by the local authority.
  • Submit an annual payment at a rate set by local authorities. The maximum is EUR 500 per point of sale (i.e. for each cash register). The maximum for retailers who sell both tobacco products and nicotine-containing liquids is EUR 1,000. 
  • Refrain from displaying tobacco or nicotine products in their stores. Tobacco specialty stores may do so, but not if the displays are visible from outside. Retailers are permitted to show purchasers a catalogue of available products and price list, if they have been asked. Standards for this material is set by regulation.
  • Have one employee designated as a monitor of the store’s compliance with regulations. 

A public register of retail licences and wholesale notices for tobacco and nicotine products is maintained by Valvira. (There are about 7,250 tobacco and nicotine retail licences in Finland (because each point of sale or cashier must be licensed, this means there will be fewer than 7,250 retail outlets). Of these, about 340 sell nicotine liquids. About 2,750 annual visits are made by municipal inspectors to licensed tobacco/e-cigarette retailers.

Finnish health authorities do not promote the use of E-cigarettes as part of a harm-reduction strategy.
The Finnish Institute for Health and Welfare (a government agency) does not promote using e-cigarettes or identify harm reduction as a goal of e-cigarette regulation. The first messages on its web-page on e-cigarettes caution:
  • The nicotine in electronic cigarettes is highly addictive and has its own health effects.
  • The use of electronic cigarettes impairs the normal functioning of the lungs and reduces the function of the lungs.
  • Experimental studies have shown that the use of electronic cigarettes can contribute to the development of cardiovascular changes.
  • cigarette liquids and vapors contain a number of harmful substances, such as PAH and VOC (volatile organic compounds). Some of the compounds are the same, carcinogenic compounds, as in tobacco smoke, but generally in smaller amounts.
  • Silica and metal particles and drug residues have been found in some e-cigarette liquids.
  • Some e-cigarette fluids have caused toxic effects on cells in laboratory tests.

Finland monitors of youth and adult tobacco use on an annual basis.
Finland’s public health monitoring includes annual surveys of school health behaviours, and adult smoking behaviours.

Finland imposes a tax on e-cigarettes (at about one-tenth of that on cigarettes).
Finland's tax on e-cigarettes is EUR 0.30 per ml of liquid. The tax on a typical 2 ml/200 puff pod of nicotine fluid is thus about EUR 0.60 or CAD $0.80. This is equivalent ot the Finnish tax on 2 cigarettes (EUR 0.27 or CAD 0.40 per cigarette).

This information - and references - are available in a downloadable fact sheet.