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Meeting Summary - May 16, 2022 & November 29, 2022: Scientific Advisory Board on Vaping Products

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Organization: Health Canada or Public Health Agency of Canada

Date published: February 2024

Virtual Meeting

Day #1: May 16, 2022

List of participants

Attendees

Regrets

Secretariat

Observers

Meeting Summary

  1. On May 16, 2022, members of the Scientific Advisory Board (SAB) on Vaping Products met virtually for the first day of their third meeting. The agenda is attached in Appendix I.
  2. The meeting opened with remarks from the Chair, Dr. Steven Hoffman, Scientific Director of the Canadian Institutes of Health Research's Institute of Population and Public Health (CIHR-IPPH). Dr. Hoffman welcomed the participants and acknowledged the board's gathering took place virtually across many Indigenous lands, including the land of the traditional unceded territory of the Algonquin Anishinaabeg People.
  3. Kendal Weber, Assistant Deputy Minister, Controlled Substances and Cannabis Branch, Health Canada, provided opening remarks on behalf of Health Canada. She thanked the board members for their time and expressed interest in new and evolving research on vaping product flavours.
  4. Nick Neeley of Health Canada provided a brief update on the legislative review of the Tobacco and Vaping Products Act. He noted that an online consultation occurred from March 16 to April 27, 2022 and Health Canada received over 3000 responses from a broad range of stakeholders, including from members of the public, public health organizations, non-government organizations, provincial and territorial governments, and industry. Additionally, submissions were received from five letter writing campaigns. Health Canada is analysing the submissions and is preparing a final report which will be tabled in Parliament in Fall 2022.

  5. The SAB Executive Secretary, Dr. Sonia Johnson, Director General of the Tobacco Control Directorate at Health Canada, introduced the session's focus on vaping product flavours, the objective of which was to discuss the evidence on the role of vaping product flavours on vaping and smoking behaviours. She provided a summary of the results from the June 2021 consultation on the proposal to restrict available flavours using a three-pronged approach:

    1. Restrict promotions;
    2. Restrict ingredients;
    3. Restrict sensory attributes.

    She concluded the presentation with an overview of the current nationally representative data on vaping rates from the 2021 Canadian Tobacco and Nicotine Survey and the 2020 Canadian Community Health Survey.

  6. The SAB engaged in a roundtable discussion on the available evidence regarding the role of vaping product flavours in vaping initiation and transitions to smoking among youth who do not smoke. The SAB confirmed that both adults and youth like flavours. However, critical evidence gaps on the role that flavours play in initiation and usage patterns remain, particularly regarding counterfactual scenarios. For example, there is a current gap in the literature regarding youth initiation trends in the context of flavour restrictions and how this would impact cessation rates among adults who smoke. The SAB discussed differences in prevalence data between provinces. The board emphasized the importance of obtaining evidence from and understanding the context of the jurisdiction in which policy decisions will be made. Lastly, the board underscored that retail access restrictions are another policy mechanism that could impact youth initiation.
  7. For the final session of meeting, the SAB was tasked with developing consensus statements on the impacts of flavour restrictions, given the current state of the evidence. To begin the session, the Chair proposed an approach to guide the discussion and presented six potential consensus statements for the board to discuss. During the discussion, the SAB walked through each statement and noted the following:
    • The consensus statements do not take into account cannabis vaping products;
    • The relative toxicity of flavours (e.g., fruit versus menthol) should be examined and considered;
    • Health statements conveying advice to the public (e.g., using the word 'should'), should be accompanied by a rationale;
    • Other factors that may impact youth vaping must also be considered (i.e., the role of peer pressure, online influence, social media, accessibility, etc.) to understand the influence that flavours have in relation to these other factors;
  8. In closing, Dr. Hoffman thanked the board for their time and confirmed that the Secretariat will be in touch to schedule the next meeting date.

Day #2: November 29, 2022

List of participants

Attendees

Secretariat

Observers

Meeting Summary

  1. On November 29, 2022, members of the Scientific Advisory Board (SAB) on Vaping Products met virtually for the second day of their third meeting. The agenda is attached in Appendix II.
  2. The meeting opened with remarks from the Interim Chair, Dr. Carolyn Baglole. Dr. Baglole welcomed the participants and acknowledged the board's gathering took place virtually across many Indigenous lands, including the land of the traditional unceded territory of the Mohawk (Kanien'kehá:ka) Nation People.
  3. The SAB Executive Secretary, Dr. Sonia Johnson, Director General of the Tobacco Control Directorate at Health Canada, provided opening remarks on behalf of Health Canada. She provided a brief update on the legislative review of the Tobacco and Vaping Products Act, and thanked the SAB members for contributing feedback to the review. She also provided updates regarding the Vaping Products Reporting Regulations, and the Consultation on Tobacco Labelling.

  4. Laura Smith, Director of the Office of Policy and Strategic Planning, provided an overview of the Directorate's public education materials, in the context of Canada's Tobacco Strategy. Previously published materials informed youth about the risks of vaping and were adapted for both in-classroom and virtual delivery. The proposal for a national smoking cessation campaign highlighting various tools for Canadians to consider to help them quit smoking (including vaping), was very well received by members.

    The SAB engaged in a roundtable discussion of public education materials about vaping and its associated health risks, as well as of its role in smoking cessation, and provided the following considerations:

    • Members emphasized the importance of content as well as context and placement in interpreting statements about the harms and benefits of vaping, and suggested that statements be considered alongside other accompanying information provided on Health Canada's website or via other public education materials;
    • Members recognized that messages could be targeted to specific subpopulations, although acknowledged that cross-exposure may occur; as a result, they emphasized the importance of consistency across messages to ensure trust and prevent confusion;
    • Members emphasized the importance of using clear and succinct language in messaging. They agreed that messaging should use terms familiar to consumers, rather than terms from clinical guidance or practice (e.g., the term 'addiction' rather than 'dependence'). Some members suggested avoiding ambiguous or confusing terms (e.g., 'may', 'some people'), although others noted the value of descriptors (e.g., 'significantly' or 'greatly');
    • Members suggested specifying the substance used when referring to vaping behaviour (i.e., specifying nicotine vaping vs cannabis vaping);
    • Members acknowledged misperceptions about nicotine among the public, and noted that this should be taken into consideration when communicating about vaping;
    • Members suggested that the risks of vaping be communicated by acknowledging the absolute harms of cigarette smoking, as well as communicating the risks of vaping in both absolute and relative terms;
    • Members suggested avoiding quantitative estimates of risk as well as statements regarding the health impacts of smoking reduction, given the complexity of factors such as specific disease outcomes, patterns of use and quantities of reduction, and behavioural compensation. Rather, they emphasized that the key message is that complete switching and smoking cessation are necessary to ensure health benefits;
    • Members supported the inclusion of vaping as one tool among many that Canadians may consider to help them quit smoking;
    • Members discussed the practical implications of presenting vaping as a tool for smoking cessation, including the lack of clinical guidance for health care professionals, although it was recognized that these will come with time and more research;
    • Alongside messaging for people who smoke, members suggested reinforcing the message that youth and people who do not smoke should not vape. They also suggested considering the evidence base for developing a message that people who formerly smoked should not vape.
  5. Dr. David Hammond and Dr. Maciej Goniewicz provided an overview of research findings in the special issue "Impact of flavour restricting policies on non-cigarette tobacco products", published by the journal Tobacco Control. Evidence to date suggests limited impact of flavour restrictions in reducing youth vaping; notable challenges included exemptions of some product types to flavour restrictions and low compliance among retailers. Studies assessing vaping product characteristics suggested some changes in product constituents, labels, and colours following the implementation of flavour restrictions in some jurisdictions. Members discussed the implications of these findings, noting the following considerations:
    • Members emphasized the importance of effective compliance and enforcement of all tobacco and vaping control policies in achieving desired outcomes;
    • Members discussed various approaches to restricting flavours and their advantages and disadvantages, and noted the importance of adapting to a continually changing market;
    • Members noted that understanding the relative importance of flavours in smoking cessation remains a key gap in the evidence.
  6. For the final session of the meeting, the SAB discussed the relative risk statements, which were considered by the previous SAB term. Members agreed that the statements, as presented, were consistent with the current scientific evidence, and identified several areas for further discussion and clarification.
  7. In closing, Dr. Baglole thanked SAB members for their time and contributions. The Secretariat will work to organize the next SAB meeting in May 2023 in Ottawa.

Appendix I – Meeting Agenda

Scientific Advisory Board (SAB) on Vaping Products

Day #1 – May 16, 2022

11:00am – 11:40am: Introduction

11:40am – 12:00pm: Legislative review critical path and next steps (Health Canada)

12:00pm – 12:30pm: Proposal to restrict flavours in vaping products (Health Canada)

12:30pm – 1:00pm: Break

1:00pm – 2:00pm: Discussion of evidence (All, facilitated by Chair)

2:30pm – 3:30pm: Closing remarks and thank-you (Dr. Sonia Johnson & Dr. Steven Hoffman)

Appendix II – Meeting Agenda

Scientific Advisory Board (SAB) on Vaping Products

Day #2 – November 29, 2022

11:00am – 11:10am: Welcome (Dr. Carolyn Baglole)

11:10am – 11:30am: Health Canada updates (Dr. Sonia Johnson)

11:30am – 12:30pm: Web communication and public education campaign materials

12:30pm – 1:00pm: Break

1:00pm – 1:30pm: Web communication and public education campaign materials (continued discussion)

1:30pm – 2:40pm: Overview of Tobacco Control special issue: Impact of flavour restricting policies on non-cigarette tobacco products

2:40pm – 2:55pm: Relative risk statements

2:55pm – 3:00pm: Closing remarks and thank-you (Dr. Sonia Johnson & Dr. Carolyn Baglole)

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