The introduction of e-cigarettes has rocked the foundation of the tobacco industry and has led to a new set of health issues for the Alberta government. Alberta medical officer of health Dr. Brent Friesen spoke to the Calgary Journal to discuss e-cigarettes, tobacco and their impacts on young people in Alberta.
What kind of trends have you seen in the number of youth smokers in Alberta within the last few years?
Well the surveys that have been done are showing an increasing use of e-cigarettes — particularly among youth. If we look at Alberta from 2014-15, the rate of ever having tried e-cigarettes is 23 percent, so roughly one in four of grade 10-12 students have tried e-cigarettes. Of that 23 percent, eight per cent of them had indicated that they used e-cigarettes within the past 30 days.
What effects have you seen in the introduction and use of e-cigarettes on the number of tobacco smokers in Alberta?
The studies that have been done are limited in that regard, but the ones that have been published show youth who have tried e-cigarettes that do not contain nicotine appear to be more likely to experiment with [regular] cigarettes. If you look at the students who say they’ve never used e-cigarettes and compare them to students who report having tried e-cigarettes, those that report having tried e-cigarettes are more likely to report also smoking cigarettes. That’s part of the reason why we’re concerned [about] exposure of youth to e-cigarettes, even ones that don’t contain nicotine may be a risk factor for them to pick up smoking later on.
That’s part of the reason why we’re concerned [about] exposure of youth to e-cigarettes, even ones that don’t contain nicotine may be a risk factor for them to pick up smoking later on.” – Dr. Brent Friesen
In terms of health effects, how do e-cigarettes compare to regular cigarettes?
In terms of the amount of toxins produced by e-cigarettes, they’re generally much reduced compared to regular cigarettes. There is debate in terms of the degree of risk that somebody has from smoking e-cigarettes compared to smoking combustible tobacco. It appears to be much lower, and some studies have suggested that there is a 90-95 per cent reduction in the risk, however, these studies are lacking in the information to indicate that e-cigarettes are safe. This is due to the current lack of regulation of what may be contained in the e-cigarette liquid juice, as well as the lack of long-term studies of e-cigarette users to see what, if any, health effects may develop over prolonged use of e-cigarettes.
What do you think is the main driving force behind youth smoking?
The current major sources of promotion of cigarette smoking to youth are in movies and video games where the portrayal of smoking is desirable behaviour. There is also the design and packaging of cigarettes, which is done in such a way to gain appeal to youth, so the proposed federal regulations on plain packaging are going to be very important. Australia found the introduction of their plain packaging requirements allowed them to decrease smoking among youth by just under one per cent, which if you’re talking in terms of going from 13 per cent to 12 per cent then it is a significant improvement. So the plain packaging would be an important measure to take. Other factors that influence youth smoking are peer behaviours. What we’re seeing is that among students in junior high, grades six to nine, roughly eight per cent of students indicate that they’ve ever tried using tobacco. By the time we get to high school, grades 10 to 12, roughly a quarter of students are reporting having ever tried tobacco. Alongside these factors is our concern with e-cigarettes, because they will re-normalize smoking, and the concern of water pipe smoking being exposed to youth. A number of the herbal tobacco products can actually contain tobacco or nicotine in them and are addictive, so youth that use these products will be more likely to start using cigarettes in order to get their nicotine fix. There’s also a number of misconceptions that exist around the safety of water pipes. Many people think that inhaling the smoke through the water removes the toxic products in the smoke, but that’s not the case. All the water does is cool the smoke, so it actually allows people to inhale more deeply and intake the toxins into their bloodstream easier.
Smoking culture continues to evolve across the country. According to Dr. Brent Friesen, the current Alberta Tobacco Reduction Strategy has a goal of reducing the current rate of smoking in the general population by 12 per cent. Photo Courtesy of Wikipedia Commons user Deutschlandreform.
With all the changes in smoking recently, where do you think the culture of smoking is headed in Alberta within the next few years?
The current Alberta Tobacco Reduction Strategy has a goal of reducing the current rate of smoking in the general population by 12 per cent, compared to our current rate of 16 per cent. For youth, the goal would be to reach smoking rates below five per cent. There was a recent national meeting in Kingston, Ont. where they talked about reaching a rate of smoking in the general population of Canada of less than five per cent by 2035. So we’re hoping to see large reductions in smoking within the next 20 years to the point where there is only negligible amounts of tobacco use in our population.
If we reach that drastic decline of smoking in the general population of Alberta, how would that affect the province from an economic standpoint?
Well the province does get a large amount of revenue from tobacco taxes, but there are also a lot of expenditures that the province incurs as a result of healthcare costs and loss of productivity due to tobacco usage. One of the things that was discussed at the national conference was a strategy so that over the next 20 years the government could get to that level of less than five per cent tobacco use without losing the tax revenue it receives. This could be achieved by further increases to the tax of tobacco products so that while the rates of smoking are decreasing in the population, the government is receiving higher revenue per sale, and in the end the total amount of revenue that the government would receive from tobacco is the same or greater than it is now.
What steps will the province need to take to reach these lower smoking goals?
The rate of smoking in grades six to nine is low, but the rates among the older youth and young adults is still some of the highest in the province’s population. For us to see the greatest impact from a health standpoint, we’d need to focus on preventing smoking in youth. An important factor behind the reductions that we’ve seen in smokers among the general population in Alberta is the smoke-free legislation for restaurants, workplaces, and public places. This decreases exposure to tobacco smoke, protects against second-hand smoke, prevents youth from seeing smoking as a normal or accepted behaviour, and it helps support people who want to stop smoking. The majority of tobacco users indicate that they are planning to stop smoking in the near future. One of the things that is going to be most important in bringing down the smoking population in Alberta over time is the increase of the price of tobacco products, which is one of the most powerful influencers in the decision of youth to both start and stop smoking. The other important factor will be looking at ways to reduce the availability of tobacco products. Some of the things we’ve talked about doing is licensing and restricting the number of tobacco retailers, to bring it down from the current broad availability.Increasing the legal age to purchase or possess tobacco to 21 significantly reduces the use of tobacco among the 17 and 18 year olds due to a restricted access to these products.
This interview has been edited for length.
The editor responsible for this article is Nina Grossman and can be reached at ngrossman@cjournal.ca.