Charles Gardner MD CCFP MHSc FRCPC Medical Officer of Health Simcoe Muskoka District Health Unit October 2016 Relationships with Commercial Interests GrantsResearch Support none ID: 1043559
Download Presentation The PPT/PDF document "E-cigarettes: What Providers Need To K..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. E-cigarettes: What Providers Need To Know Charles Gardner, MD, CCFP, MHSc, FRCPCMedical Officer of HealthSimcoe Muskoka District Health UnitOctober, 2016
2. Relationships with Commercial Interests:Grants/Research Support: none Speakers Bureau/Honoraria: provided to SMDHUConsulting Fees: noneClinical Trial: none Other: OMERS pension fund content
3. E-cigarettes should always be considered in the context of the tobacco epidemic.
4. Smoking: Still one of the top preventable causes of deathSource: SEVEN MORE YEARS: The impact of smoking, alcohol, diet, physical activity and stress on health and life expectancy in Ontario. Institute for Clinical Evaluative Sciences, Public Health Ontario
5. the arrival of e-cigarettes – the “wild west”
6. Potential for resurgence of youth smokingE-cigs prevalence of use increasing from 15% to 22.6% - 2013 to 2015, Ont.Smoking and Health Foundation / Association of Local Public Health AgenciesThe two competing perceptions of E-Cigarettes – Potential Threat
7. The two competing perceptions of E-Cigarettes – Potential BenefitDisruptive innovation that aids in the tobacco end gameDavid Sweanor, Legal Council, Nonsmokers’ Rights Association“Can the rise of the e-cigarette… do what the refrigerator did for stomach cancer – by making the cigarette and perhaps all forms of combusting of tobacco obsolete?”
8. Public Health England: “95% less harmful than smoking.”Duncan Selbie, Chief Executive
9. Chemical exposuresFirsthand Tobacco smoke levels between 40 to 2800 fold higher than E-cigs for:Formaldehyde, acetaldehyde, acrolein, VOCs, Nitrosamines - Laugesen 2015, Goniewicz et al. 2014 Exposure to the ‘butter’ flavor chemical (diacteyl) causes lung scarring E-cigarette vapour and cigarette smoke comparable for five metals (copper, magnesium, lead, chromium, manganese) - Williams et al (2013) SecondhandNicotine from smoking tobacco cigarettes 10 times higher than from e-cigarettes - Czogala et al. 2014 Particulates 13-fold higher from tobacco use than e-cigs - Saffari et al. 2014
10. Gateway for youth smokingSource: Barrington-Trimis J, et al. E-Cigarettes and Future Cigarette Use. Pediatrics, June 13, 2016.
11. Possible Benefits? Cochrane Collaboration, Sept 2016: No evidence emerged that short-term EC use is associated with health risk.Low certainty of benefit:Cessation 2 RCTs compared with placebo / EC without nicotine: increased the chances of stopping smoking in the long termLow confidence due to small numbers of studies and wide confidence intervals1 RCT compared with nicotine patches found no difference in cessationLow confidence for similar reasonsReduced cigarette consumption - 2014 (compared with placebo ECs and nicotine patches), Same limitations as above Lack of biochemical assessment. A further 15 ongoing RTCs
12. Where do we go from here? Public HealthOverall Approaches:Prevent youth / nonsmoker initiation of use Possible cessation / harm reduction benefit for smokers (low certainty)More research neededPublic health approachesRegulation options:Prohibit sales to minors – in placeProhibit use in indoor public places and work places – not yet in placeRestrictions on marketing – not in placeProduct restrictions – flavouring, content disclosure – not in place
13. Where do we go from here? Clinical PracticeAdvise to patients: Counsel against use for nonsmokers – particularly youthContinue full range of smoking cessation supportsInformed consent approach re limited research on cessation / reduction