May 24, 2018 Rendez-vous #10
with David Hammond
David is Professor in the School of Public Health at the University of Waterloo in Canada.
Thank you David for accepting our rendez-vous.
May I ask you to introduce yourself by sharing a little bit about yourself and when, how, why you became involved in tobacco control? Maybe an update from our previous rendez-vous of June 13, 2006 (sorry that the recording was lost).
David Hammond: I am a Professor in the School of Public Health at the University of Waterloo in Canada. I’ve been conducted research on tobacco control policies for almost 20 years, including health warnings, product regulation, tobacco marketing, and e-cigarettes/vaping. As part of my work, I often advise regulatory agencies and I’ve served as a Expert Witness on behalf of governments around the world when tobacco companies challenge tobacco control laws.
Q1. You are a specialist of plain packaging, how do you assess the policy enacted by the new Bill S-5 in Canada? How does it compare with Australia, France and the UK? How many smokers do you think could be influenced to quit? Are you concerned by eventual unintended consequences, like an increase of smuggling?
David Hammond: The Australian precedent –and the subsequent legal rulings—were critically important to other countries that have followed with plain packaging legislation. Plain packaging represents an important marketing restriction and represents the logical extension of restrictions on other marketing channels. I’m often asked ‘how many smokers will quit’; in fact, plain packaging is likely to have a greater impact on smoking initiation than smoking cessation, in the same way that removing tobacco advertising takes a decade or two before the full impact can be evaluated, as new generations of young people enter the age of smoking initiation without these inducements to smoke. Having said that, Australia experiences substantial reductions in smoking prevalence very soon after plain packaging was implemented, along with other notable policies, including new health warnings and large tax increases. Although similar impacts are possible in other countries, the tobacco control community should be careful not to judge the impact of plain packaging in the immediate years following implementation.
Q2. How do you assess the status of the e-cigarettes in the new legislation? What do you think of the concerns expressed by David Sweanor in his submission to the Senate Committee (pdf): is the new policy too restrictive to incite smokers to switch to non combustible products?
David Hammond: The new vaping framework in Canada arguably goes further than any other country: not only will nicotine containing e-cigarettes be legal, but the government will likely allow regulated claims indicating that vaping is less harmful than smoking. In addition, at the current time, there are relatively few restrictions on advertising and promotion: e-cigarette companies will be allowed to advertise their products on TV and in other mass media channels.
Q3. According to the data of the Smoking Prevalence in Canada 2016 (released September 2017) there is a very significant income disparity: "The proportion of smokers in Canada decreased as household income increased. Among households within the lowest income quintile, almost 1 in 4 Canadians were smokers (23.4%). In households in the highest income quintile, just over 1 in 10 were smokers (12.0%; Chart 3)." Does the new bill take in consideration this growing health social inequality? What should be done about it?
David Hammond: Like most other countries, disadvantaged Canadians are more likely to smoke, as has been the case for several decades. However, it is also important to note that smoking prevalence among lower income Canadians has been falling at a similar rate as higher income Canadians. This is a good news, bad news store: while the disparities have not narrowed, progress in reducing smoking has been made across all income groups. The one very notable exception is among First Nations and Indigenous Canadians, where smoking prevalence remains above 50%: one of the highest rates among any population worldwide. There are, however, some encouraging signs that smoking may be declining among First Nation youth.
Q4. You are part of the Health Canada Scientific Advisory Board on Vaping Products that held its first Meeting of November 20-21 2017, and it's second meeting May 15 (as twitted by Linda Bauld). How do you see the role of this Advisory Board? What influence can it have on the implementation of the new bill?
David Hammond: Yes. The Advisory Board is intended to assist Health Canada as they develop the regulatory framework for vaping products.
Q5. Your study about e-cigs and youth smoking initiation in Canada (2 provinces surveyed, Ontario and Alberta) was published in October 2017. How high do you estimate the risk for young people to become smokers of cigarettes because they have tried e-cigarettes? What new studies should be developed to have a better knowledge of what's happening?
David Hammond: Many Canadian youth are trying e-cigarette, including non-smokers. However, most trial stops at experimentation: it is extremely rare to find any ‘never smokers’ who use e-cigarettes weekly or daily. We published one of the largest longitudinal cohort study, in which we found that trying e-cigarettes was positively associated with smoking initiation at baseline. However, most of this association is likely attributation to ‘common’ risk factors: the kids that are likely to try one product are more likely to try another one. This is supported by the fact that overall smoking rates have decreased at the same time as e-cigarette use has increased dramatically. Overall, there is significant interest and experimentation with vaping products among youth, but to date, it appears to have little impact on smoking rates. Of course, that could change as product design evolves over time; for example, it is unknown whether products such as Juul—which delivers very high concentrations of nicotine with novel nicotine salt technology—are more likely to promote regular use among non-smokers.
Q6. Is there anything you would like to add?
David Hammond: That’s it!
Thank you David for having taken the time for this rendez-vous.
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