Item - 2019.HL12.3

The Board of Health:

1.  Requested the Government of Ontario to amend the Smoke-Free Ontario Act, 2017, such that provisions on aerosolized liquid products (vapour products) align more closely with those for tobacco products by adding a prohibition on the sale of any flavoured aerosolized liquid products (vapour products), with the exception of tobacco flavour, in stores accessible to minors.

2.  Urged the Government of Ontario to:

a.  adopt Bill 151, the Smoke-Free Ontario Amendment Act (Vaping is not for Kids), 2019, which would prohibit the promotion of vapour products, expand the prohibition of flavoured vapour products, and limit point-of-sale locations for vapour products; and
 

b.  apply the taxes that specifically apply to tobacco to aerosolized liquid products (vapour products), in line with the existing taxation framework for tobacco products.

3.  Requested the Government of Canada and the Federal Minister of Health to take prompt action to implement restrictions on the advertising and promotion, flavours, and nicotine content of aerosolized liquid products (vapour products) by enacting regulations in the Tobacco and Vaping Products Act in these policy areas.

4.  Directed the Medical Officer of Health, in consultation with Legal Services and relevant City divisions, including Municipal Licensing and Standards, Parks, Forestry and Recreation, and Corporate Real Estate Management, to report in the second quarter of 2020 on amendments to the existing City of Toronto By-laws that prohibit smoking to incorporate similar prohibitions on the use of aerosolized liquid products (vapour products).

5.  Directed the Medical Officer of Health, in consultation with relevant staff, to report in the second quarter of 2020 on the feasibility of restricting or banning the sale, consumption, and trade of aerosolized liquid products (vapour products) in Toronto.

6.  Directed that the report (November 20, 2019) from the Medical Officer of Health be forwarded to the Premier of Ontario, the Ontario Minister of Health, the Federal Minister of Health, Ontario's Chief Medical Officer of Health, the Association of Local Public Health Agencies, the Ontario Campaign for Action on Tobacco, the Council of Chief Medical Officers of Health, the Canadian Medical Association, the Heart and Stroke Foundation of Canada, the Canadian Cancer Society, the Canadian Lung Association, Physicians for a Smoke-Free Canada, and all Toronto school boards.

The Director, Strategy and Preventive Health, Toronto Public Health, and the Acting Associate Director, Strategy and Preventive Health, Toronto Public Health, gave a presentation on Update on Aerosolized Liquid Products (Vapour Products).

This report responds to a request from the Board of Health for a report on the health impacts of vapour products and potential actions for federal and provincial levels of government. Vapour products, which may include nicotine, function through the aerosolization of liquids to produce a vapour that can be inhaled. In this report, vapour products will be referred to as aerosolized products or aerosolized liquid products.

While aerosolized products, also known as e-cigarettes, are considered by some health authorities to be less harmful than combustible tobacco cigarettes, Health Canada and other health authorities have concluded that the long-term health effects from the use of aerosolized products are not yet fully known. Using aerosolized liquid products can expose the user to nicotine, an addictive substance which is associated with negative impacts on adolescent brain development, and to other chemicals that are harmful to health. Use of aerosolized liquid products has also been shown to lead to subsequent tobacco smoking among youth and young adults. This is particularly concerning as aerosolized liquid products have the potential to undermine public health gains achieved through more than a decade of coordinated, comprehensive, evidence-based commercial tobacco control work.

Aerosolized liquid products, including newer brands that contain higher concentrations of nicotine, have become widely available in convenience stores, gas stations, and other retail outlets throughout Toronto. National surveys show there has been an increase in the use of aerosolized liquid products amongst youth. The recent increase and widespread availability of popular new brands in most convenience stores in Toronto, coupled with their pervasive advertising campaigns and unlimited promotion at retail outlets, may have played a role in the increasing use of these products amongst youth. Additionally, there are a wide variety of flavours available at retail outlets, including candy and dessert flavours. Flavours were cited in a national survey as one of the main reasons youth initiated aerosolized liquid product use.

In light of current evidence, Toronto Public Health (TPH) recommends the federal government take action to prohibit aerosolized liquid product advertising and promotion where minors have access, prohibit the sale of flavours (except tobacco flavour) in retail stores accessible to minors, and set a limit on available nicotine concentrations in aerosolized liquid products. TPH also commends the province for their recent action to prohibit the in-store promotion of aerosolized liquid products and recommends the province take further action to prohibit the sale of all flavours (except tobacco) at retail stores accessible to minors. Finally, TPH recommends a report back to the Board of Health on amendments to the existing City of Toronto By-laws that prohibit smoking to also prohibit the use of aerosolized liquid products.

City Council, on November 26 and 27, 2019, adopted Member Motion Item MM12.8, and in so doing, forwarded a copy to the Board of Health.