Meeting summary - November 19-20, 2018: Scientific Advisory Board on Vaping Products

Attendees
Dr. Carolyn Baglole
Dr. Linda Bauld
Dr. Geoffrey Fong
Dr. Maciej Goniewicz
Dr. Lorraine Greaves
Dr. David Hammond
Dr. Steven Hoffman (Chair)
Dr. Andrew Pipe
Dr. Rachel Tyndale
Mr. James Van Loon (Executive Secretary)

Regrets
Dr. Kenneth Warner

Secretariat
Ms. Dana Beaton
Dr. Samir Khan
Mr. Adam Doane
Ms. Fatima Mussa
Ms. Amy Wilson

Observers
Dr. Hanan Abramovici
Mr. Mathew Cook
Mr. Graham O’Brien
Ms. Megan Tam


Meeting Summary

  1. On November 19-20, 2018, members of the Scientific Advisory Board (SAB) on Vaping Products met in Toronto for their third meeting. The agenda is attached in Appendix I.

  2. On the first day, the Chair of the SAB, Dr. Steven Hoffman, welcomed participants and provided an overview of the agenda as well as the three tasks for the meeting:

    • To review and provide recommendations to Health Canada on potential authorized statements for the promotion of vaping products regarding the relative health risks of these products in comparison with tobacco products.
    • To provide recommendations to Health Canada on the proposed content of promotion restrictions for vaping products.
    • To provide recommendations to Health Canada on public messaging about vaping and vaping products.
  3. Health Canada presented on the latest national vaping surveillance and market data. The presentation included data from national surveys, including the 2016-2017 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS), as well as the findings from public opinion research, vaping market studies and product testing research. Topics of discussion included vaping behavior, risk and harm perceptions and the use of flavoured products. Health Canada will provide an update on new data sets and data analysis to the SAB at the next meeting.

  4. The SAB listened to CBC’s The Current radio program where Mr. James Van Loon and Dr. David Hammond were interviewed about vaping in Canada. The interview focused on the regulatory restrictions that were coming into effect as of that day, November 19 2018, as well as recent research by Dr.  Hammond and colleagues on the prevalence of vaping among youth in Canada.

  5. The SAB was then asked to focus on the first task of the agenda: to review and provide concurrence on draft authorized statements for the promotion of vaping products regarding the relative health risks of these products in comparison with tobacco products. Health Canada provided a refresher presentation on the purpose of creating a regulation to authorize the use of relative risk statements in vaping product promotions. Further, Health Canada presented the findings of public opinion research (POR) that had been conducted to evaluate the draft relative risk statements developed during the second SAB meeting, as well as feedback from  consultations with key stakeholders (e.g., provincial and territorial governments, health-related non-governmental organizations, representatives from the vaping industry). The SAB was asked to react to these potential authorized statements, including assessing their scientific validity and accuracy. SAB recommendations included:

    • Consideration of the relationship between individual level messaging and population level debates on vaping
    • Emphasizing the importance for smokers of completely switching to vaping
    • Consideration of the total information that needs to be conveyed to consumers of vaping products

    The SAB reached consensus on potential relative risk statements for Health Canada to consider. The SAB also suggested that future draft statements be distributed to members in advance of the next meeting and in advance of future public consultations. The SAB expressed an interest in receiving further clarification on the next steps in the regulatory process specifically the timing of the public release of relative risk statements in relation to the release of health warning statements for vaping and vaping products.

  6. Dr. David Hammond presented on recent research on youth vaping in Canada. He provided an overview of vaping prevalence among Canadian youth, aged 16 to 19 years old, particularly in relation to recent youth vaping data from the US. In addition, he presented on the use of certain vaping products (e.g., JUUL, Blu) among youth in Canada, youth perceptions on the nicotine content of vaping products and the reasons youth choose certain vaping products over others (e.g., ease of use, available flavours, exposure to marketing, etc.).  SAB members thanked Dr. Hammond for his presentation and noted the importance of understanding patterns of vaping among youth.

  7. The SAB was then asked to focus on the second task for this meeting: to provide input on promotional restrictions for vaping products. Health Canada provided a presentation on the vaping promotion restrictions already in effect federally, and across the provinces and territories (PTs). While there are restrictions on the types of promotion concerning vaping products (e.g., a ban on lifestyle advertising, endorsements and testimonials) there are no federal restrictions on the types of channels available to advertise or the physical location of advertisements. PTs however have the ability to tighten promotional restrictions at retail. For instance, several provinces have a prohibition on outdoor signage advertising vaping products while many restrict the display of vaping products at retail.  The SAB made a number of recommendations concerning the advertisement of vaping products, including:

    • Consider the perceived value of advertising vaping products and the target populations (e.g., adult smokers) versus the potential exposure to youth
    • Consider lessons learned from the marketing of other addictive substances (e.g., alcohol) that could be relevant to vaping
    • Consider incorporating warnings in advertisements for vaping products.
  8. Dr. Carolyn Baglole presented on the toxicology of e-cigarettes and insights gained from pre-clinical models on the potential mechanisms of disease in humans. Dr. Baglole highlighted the findings of a number of studies noting that while there is preclinical evidence suggesting that e-cigarettes can cause DNA damage, not all studies draw the same conclusions. In addition, she presented research on the pulmonary inflammatory response to e-cigarette exposure in animal models along with studies exploring the linkages between disease phenotype and e-cigarette exposure. Dr. Baglole noted that at this time there is wide variation in both the variables for e-cigarettes (e.g., manufacturer, flavours etc.) as well as the animal models being used (e.g., strain, age and sex) which makes comparisons between preclinical studies challenging. Dr. Baglole and other SAB members stressed the importance of moving beyond a singular focus on isolated endpoints to consider the impacts of vaping on multiple organ systems. The SAB thanked Dr. Baglole for the presentation and reaffirmed the importance of these types of mechanistic studies.

  9. The second day of the meeting opened with a reflection on the preceding day and a roundtable discussion, during which the board members expressed concerns about the marketing and promotion of vaping products, particularly in light of the emerging evidence regarding use patterns among youth. The agenda then proceeded with a presentation from Health Canada on public messaging on vaping and vaping products, as supporting information for the third task. The first round of public messaging will be a youth prevention campaign with future messaging campaigns focusing on other topics such as cessation messaging for smokers. The youth prevention campaign will feature three key messages and will be communicated using a variety of tools including online resources, social media, videos, face-to-face events and other media. The SAB reviewed the draft campaign materials and made a series of recommendations including:

    • messaging be modified to reflect that vaping is an action with an emphasis instead on the substance being consumed (e.g., nicotine)
    • consider how this campaign aligns with the messaging on cannabis consumption.  
    • incorporate images of popular vaping products (e.g., pod-based systems) into the draft iconographics to reflect devices youth are currently using.

    The SAB also emphasized the need for Health Canada to be nimble and shift messaging on vaping as new market and scientific data emerges.

  10. Health Canada then provided the SAB with an overview of the history of cannabis legalization in Canada, the proposed approach to legalization and considerations for cannabis vaping. Health Canada also shared health warnings relating to cannabis products that became available as of October 17, 2018 under the first phase of legalization (e.g., dried flower and oils). Additional public messaging is being developed for products that will become available under the second phase of cannabis legalization in October 2019 (e.g., edibles, cannabis extracts). Health Canada emphasized that it is committed to monitoring the health and safety impacts of cannabis legalization and has a number of research initiatives in progress. The SAB expressed an interest in receiving an update on cannabis and cannabis vaping at the next SAB meeting.

  11. Dr. Rachel Tyndale presented on variations in nicotine metabolism the implications for the use of certain products among vulnerable populations. Dr. Tyndale highlighted that individual differences in rates of nicotine metabolism may impact smoking rate, inhalation patterns and risk of conversion to nicotine dependence. Further, she provided data on the genetic variability in nicotine metabolism among subpopulations. Taken together, these findings have implications for smoking cessation efforts as different products may be better suited to certain populations than others given their rate of nicotine metabolism. The SAB thanked Dr. Tyndale for the thought provoking presentation and discussed the potential these insights could have for smoking cessation and personalized medicine.

  12. Dr. Maciej Goniewicz presented on nicotine salts and the characteristics of vaping pod systems with a specific focus on JUUL. Dr. Goniewicz discussed several potential reasons for the particular popularity of JUUL, including the size and design of the device appealing flavours, social media presence of this brand and the composition of JUUL products. Dr. Goniewicz provided an in depth overview of the nicotine salt chemistry, as well nicotine concentration and delivery. The SAB thanked Dr. Goniewicz for the highly informative presentation and reflected on the features and properties that could be contributing to the popularity of certain types of vaping products.

  13. In closing, Dr. Hoffman reflected on the third SAB meeting, summarized key takeaway messages, and thanked the presenters. The SAB confirmed that the fourth meeting will take place on May 13-14, 2019 in Ottawa. The proposed focus of the next meeting is the theme of cessation with potential agenda items including polysubstance use in vaping, update on the Canadian vaping market, next steps in the regulatory process and an update from Dr. Greaves on her systematic literature review on sex, gender and vaping. Dr. Hoffman adjourned the meeting and thanked the board for their willingness and efforts to guide and advise on this important area.

Appendix I – Meeting Agenda

Scientific Advisory Board (SAB) on Vaping Products

Meeting #3 – November 19 & 20, 2018

Day 1

8:30-10:00 - Introduction

  • Welcome - Chair: Dr. Steven Hoffman
  • Brief introductions/Roundtable - All
  • Health Canada vaping surveillance and research activities- Ms. Dana Beaton

10:00-10:15 - Break
10:15-12:15 - Task #1: Relative Risk Statements

  • Presentation by Health Canada
  • Review of draft statements - Guided discussion & SAB recommendations

12:15-1:00 - Lunch 
1:00-2:30 - Promotional Restrictions

  • Recent findings on youth and vaping- Dr. David Hammond
  • Presentation by Health Canada
  • Task #2: Input on promotion restrictions- Guided discussion & SAB recommendations

2:30-2:45 - Break
2:45-4:30 - Managing known/potential harms

  • E-cigarette toxicology and (potential) mechanisms of disease- Dr. Carolyn Baglole

Day 2

8:30-9:30 - Public messaging

  • Presentation by Health Canada
  • Task #3: Input on public messages- Guided discussion & SAB recommendations

9:30-10:00 - Emerging issues

  • Cannabis legalization and vaping- Dr. Hanan Abramovici

10:00-10:15 - Break
10:15-12:45 - Emerging issues continued

  • Variation in nicotine metabolism alters smoking- Dr. Rachel Tyndale
  • Nicotine salts and pod systems- Dr. Maciej Goniewicz
  • Conclusion and Next Steps
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