Transcript Update in Simcoe Muskoka,and E

UPDATE IN SIMCOE MUSKOKA,
AND E-CIGARETTES
SMTCC – Who’s Who & What’s New in Smoking Cessation
December 9, 2014
Lisa Simon, MD, MPH, CCFP, FRCPC
Associate Medical Officer of Health
Simcoe Muskoka District Health Unit
OVERVIEW
• Local epidemiology
• Current topics:
 New provincial legislation
 Ontario Smoking Cessation System proposal
 Smoke-free housing
• E-cigarettes
OVERVIEW
•
TOBACCO USE
• Epidemiology – prevalence trends?
CURRENT TOPICS
NEW: SMOKE-FREE ONTARIO ACT (SFOA)
REGULATION, EFFECTIVE JAN 1, 2015
• Prohibit smoking on all bar and restaurant outdoor
patios.
• Prohibit smoking on playgrounds, publicly owned
sporting areas, and adjacent spectator areas.
• Prohibit tobacco sales on post-secondary education
campuses.
NEW: PROPOSED SFOA AMENDMENTS
• Ban the sale of flavoured tobacco products, with delayed
implementation date for menthol-flavoured tobacco products.
• Increase maximum fines for those who sell tobacco to youth.
• Strengthen enforcement to allow for testing of substances used
in waterpipes (e.g. hookahs, shisha) in indoor public places.
• [Ontario also intends to amend regulations to further restrict
smoking on outdoor grounds of hospitals.]
NEW: PROPOSED MAKING HEALTHIER CHOICES
ACT, 2014
• E-cigarettes legislation:
 Ban the sale and supply of e-cigarettes to anyone under the age of
19.
 Prohibit the use of e-cigarettes in certain places where the smoking
of tobacco is prohibited.
 Ban the sale of e-cigarettes in certain places where the sale of
tobacco is prohibited.
 Prohibit the display and promotion of e-cigarettes in places where
e-cigarettes or tobacco products are sold, or offered for sale.
ONTARIO SMOKING CESSATION SYSTEM
(OSMOSYS) PROPOSAL
• Initiative of CAMH, Canadian Cancer Society, and U of Ottawa
Heart Institute
• Goal: integrated system for tobacco cessation in Ontario
• Key elements:
 Coordinated protocol with shared language, procedures and linked
processes for interacting with health care organizations, health care
professionals, and people who smoke;
 Centralized data capture, data management, and treatment routing;
 Combined and integrated training platform and service provider network.
• Status: proposal currently being submitted to province
SMOKE-FREE HOUSING
• Multi-unit dwellings (MUDs) still routinely site of
SHS exposure
• Smoke-free MUDs protect non-smokers, and like
other smoke-free policies may → ↑ quitting and
↓ initiation of tobacco
• 70% of non-smoking adults living in MUDs in Simcoe Muskoka
support smoking ban (RRFSS, 2011-13)
• Progress in Simcoe Muskoka:
 Building awareness, and supporting transitions to smoke-free MUDs
 Have had many units transition to smoke-free, beginning with social housing
E-CIGARETTES
Cartridge – Atomizer – Battery
HEALTH CANADA’S POSITION
E-cigarettes for nicotine use
Illegal
E-cigarettes not for nicotine use that
make a health claim
Illegal
Nicotine cartridges/liquid
Illegal
E-cigarettes not for nicotine use that do
not make a health claim
Legal
SFOA: DOES NOT APPLY
PREVALENCE OF E-CIGARETTE USE
• Canadians aged 16-30 yrs. (Czoli, Hammond, & White, 2014):
 16% tried an e-cigarette
 Current and former smokers more likely than non-smokers to
have tried (OR 10 and 4, respectively)
 Smokers tried in order to: help quit smoking (80.4%), longterm replacement for cigarettes (77.8%), use in places where
cannot smoke (80.9%)
E-CIGARETTES AS CESSATION AID
• 1 RCT (Bullen et al, Lancet, 2013):
 No sig diff in verified abstinence from quit day to 6-month f/u between 3 trial
arms: 7·3% with 16 mg nicotine e-cigarettes, 5·8% with 21 mg patches, and
4·1% with no-nicotine e-cigarettes
(risk difference for nicotine e-cigarette vs patches 1·51 [95% CI –2·49 to 5·51]; for
nicotine e-cigarettes vs placebo e-cigarettes 3·16 [95% CI –2·29 to 8·61])
• 5 observational studies (4 longitudinal, 1 cross-sectional) and 3
clinical trials without control group
• Overall:
 Evidence limited and inconclusive
 E cigarette use associated with reduction in cigarette use rather than
quitting - high levels of dual use with cigarettes
HEALTH RISKS
• Less harmful than conventional cigarettes, but not risk-free
• Adverse effects of nicotine exposure
• Particulates
 Passive vaping
• Potential for nicotine poisoning
• Unknown: harms of long term use?
RISKS TO TOBACCO CONTROL
• Gateway to nicotine addiction and/or smoking for youth?
• Re-normalize smoking behaviours?
• Undermine smoking bans?
• Dual Use: undermine quitting?
THE ROLE OF BIG TOBACCO
MARKETING AND SALES
SMDHU’S ACTIONS
• SMDHU Position: Electronic cigarettes should be prohibited
anywhere smoking is currently prohibited, whether provincially
or municipally mandated, including public places and
workplaces.
• Have advocated accordingly to provincial and federal gov’ts
• Supporting e-cigarette policy work by municipalities, school
boards, post secondary, and others, before and after provincial
legislation comes into force
WHEN YOUR PATIENTS ASK YOU ABOUT USING
E-CIGARETTES…
• What do you say?
• Grana et al, E-cigarettes: A scientific review, Circulation 2014:
“If a patient has failed initial treatment, has been intolerant of or
refuses to use conventional smoking cessation medication, and
wishes to use e-cigarettes to aid quitting, it is reasonable to
support the attempt.” Caveats:
 Fully informed
 Don’t use indoors or around children
 Set a quit date for e-cigarette use
 Quit smoking entirely
ACKNOWLEDGEMENTS - SMDHU
• Penny Rush, Chronic Disease Prevention - Tobacco Program,
Public Health Nurse
• Rebecca Harbridge, Chronic Disease Prevention - Tobacco
Program, Public Health Nurse
• Lee Zinkan-McKee, Chronic Disease Prevention - Tobacco
Program, Manager
• Non-Smokers Rights Association
THANK YOU