As a cultural hub, Montreal is always quick to adopt the newest trends. It comes as no surprise, then, that when the coolest thing since smoking became ‘smoking,’ Montrealers began using e-cigarettes.
Cigarette smoking is one of the leading causes of death, killing nearly six million people globally every year, as estimated by the World Health Organization (WHO) in May 2014. Individuals are not only constantly looking for ways to quit, but also for safer alternatives to cigarettes. Consequently, the market for smoking cessation aids is colossal, the U.S. alone has had sales reaching over $1 billion this year, according to a new report from Mintel on smoking cessation aids.
E-cigarettes are electronic cigarettes that use heated water vapour to give its user a dose of nicotine. As a cessation aid, they are supposed to be delivered in smaller and smaller amounts until the smoker is no longer addicted. The rapid rise of e-cigarettes has been prompted by widespread aversion towards- the taste and feel of nicotine patches and gum. E-cigarettes, which are remarkably similar in shape to real cigarettes, thus serve as a saving grace for many smokers.
While the concept appears sound, problems have arisen recently due to a lack of market regulation. Unlike most cigarette smokers, e-cigarette users don’t really know what they are actually inhaling.
“There’s no control of the manufacturing process,” stated Christopher Labos, a cardiologist from the division of Epidemiology, Biostatistics, and Occupational Health at McGill University. “[Tobacco companies] are not conspiring to put something in the e-cig. The process [for e-cig producion] is just not up to par, and contaminants [during manufacturing] are leeching in unintentionally.” Traces of diethylene glycol, a component of antifreeze and nitrosamine, a known carcinogen, have been found in e-cigarettes.
Montreal’s Public Health Department is now calling for new sanctions and regulations of e-cigarettes—similar to the current approach towards regular cigarettes.
However, Cynthia Callard, the executive director of Physicians for a Smoke-Free Canada, voiced her concerns over the lack of regulation. Presently, the risk for e-cigarettes overshadow the benefits, in a statement released by Santé Montreal.
“The potential benefits of these products […] are not realized and the downfalls are exacerbated,” Callard said.
The main issue facing North American public health officials is non-smokers’ interest in e-cigarettes and primarily, the younger population. According to Labos, a lot of the marketing for e-cigarettes focuses on the sex appeal of the product.
“The danger is that without regulation, people can use e-cigs indoors and in public areas,” Labos said. “We risk re-normalizing smoking and making it cool.”
These marketing tactics come as no surprise when considering the fact that major tobacco companies own the majority of e-cigarette subdivisions. Altria, Vuse, and Blu are owned by Philip Morris USA, the country’s largest tobacco company; R.J. Reynolds, the second largest; Lorillard, the third largest, respectively.
The tobacco industry has a notorious history of using deceptive techniques to sell cigarettes, including the usage of labels such as light, low, and mild to sell ‘safer’ cigarettes. It wasn’t until the Tobacco Act in 1997 that tobacco companies in Canada could not purport a healthier cigarette.
Concerns have continued to rise in recent years over the marketing of e-cigarettes, as a new study has shown an increasing number of people under the age of 18 trying e-cigarettes.
A study from the New England Journal of Medicine published in Jan. 2014 showed that from 2011 to 2012, e-cigarette usage increased from 3.3 per cent to 6.8 per cent among students from grades six to 12. Among high school e-cigarette users, 7.2 per cent reported never even smoking conventional cigarettes.
“All the people I know who tried e-cigs just went back to regular [cigarettes],” said Camille Testard, U3 Management. “It’s actually really easy to switch [between the two].”
The use of e-cigarettes is tied to higher-than-ever odds of cigarette smoking. A cross-sectional study published in the Journal of American Medical Association (JAMA) Paediatrics showed that among experimenters, e-cigarette use would encourage the smoking of conventional cigarettes among U.S. adolescents. The same study found that advertising for e-cigarettes marketed to young adults increased by 32.1 per cent from 2011 to 2012.
A randomized controlled trial published in The Lancet compared the e-cigarette, nicotine patch, and a placebo control for quit-rates. The study of 657 participants showed rates of 7.3 per cent, 5.8 per cent, and 4.1 per cent respectively—a minimal difference.
And yet, e-cigarettes continue to dominate the market.
“Even if e-cigs are ‘safer,’ it doesn’t mean they’re safe,” said Labos. “Less risk does not equal zero risk.”
The long-term effects of nicotine and propylene glycol, the solvent in which nicotine is dissolved in, on the body are unknown. Nicotine, albeit addictive, has yet to demonstrate any negative long term physiological effects.
What we know, however, is that a lot of the advertising and claims of benefits made by e-cigarette companies are rarely grounded in science. Their nebulous claims that e-cigarettes can prevent heart disease and cancer paint them as the next panacea. Consumers fall victim to these claims, and consequently try to remedy very real problems with a very fake solution. To prevent the propagation of misinformation, regulation is a must, states Labos.
The city of Montreal’s proposed sanctions include: marketing e-cigarettes as a Canadian tobacco product, setting quality standards, subjecting e-cigarettes to the Tobacco Act, and requiring e-cigarettes to be approved by a doctor.
Without these checkpoints and safety measures, the threat that e-cigarettes pose to normalizing smoking again and the potential for long-term problems outweigh any benefit that can be obtained from using them, states Santé Montreal.
The number of studies done on on e-cigarettes is still very low and makes it difficult to draw any real conclusions, ultimately highlighting the necessity for sanctions.
Quitting smoking is difficult and Labos urgest that those trying to quit should keep trying.
“[Those trying to quit] should know that they didn’t fail,” he said. “It takes most people multiple attempts to quit.”
The McGill University tobacco cessation program is available to all McGill students looking to quit smoking. Co-Directors Dr. Gaston Ostiguy and Dr. Sean Gilman can be contacted for more information.