The Royal Australasian College of Physicians' submission to the Ministry of Health Smokefree Environments and Regulated Products Act 1990 ...
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The Royal Australasian College of Physicians’ submission to the Ministry of Health Smokefree Environments and Regulated Products Act 1990 - Proposals for regulations Poutū-te-rangi 2021
Introduction
The Royal Australasian College of Physicians (RACP) welcomes the opportunity to submit feedback
on the Ministry of Health, on the Smokefree Environments and Regulated Products Act 1990 -
Proposals for regulations (the Regulations).
The RACP works across more than 40 medical specialties to educate, innovate and advocate for
excellence in health and medical care. Working with our senior members, the RACP trains the next
generation of specialists, while playing a lead role in developing world best practice models of care.
We also draw on the skills of our members, to develop policies that promote a healthier society. By
working together, our members advance the interest of our profession, our patients and the broader
community.
Overall Position on the Proposed Regulations
The RACP believes that the proposed regulatory environment for the sale and licensing of e-
cigarettes in Aotearoa NZ, as presented in the consultation document, is reasonable. However,
there are areas in which it may be strengthened to better bolster harm reduction and reduce the
number of non-smokers recruited to the use of e-cigarettes.
Finding a Balance – Harm Reduction and the Recruitment of Non-
Smokers
While the RACP continues to acknowledge the ongoing potential of e-cigarettes in reducing harm
from the smoking of tobacco, our members are concerned with the recruitment of non-smokers. As
stated in our existing Policy on Electronic Cigarettes, the College believes that the use of e-
cigarettes presents no benefits to those who do not smoke, be they never smokers or former
smokers1.
Our previous submission on the Smokefree Environments and Regulated Products (Vaping)
Amendment Bill highlights that health impacts from smoking are deeply inequitable. Tobacco
smoking in Māori and Pasifika communities contributes to nearly half of all deaths of Pasifika, and
over half of all deaths of Māori, being attributed to preventable causes, such as lung cancer2. It is
clear action is required to address this disproportionate harm.
However, in utilising e-cigarettes to alleviate this harm, it is important to avoid attracting non-
smokers to take up the use of e-cigarettes. It has been shown that 47 per cent of regular e-cigarette
users are not quitting smoking completely or avoiding returning to smoking as their main reason for
vaping, which illustrates the dangers that e-cigarettes pose in society3. The proposed regulations
must create a regulatory environment which successfully incentivises and allows the use and
1
The Royal Australasian College of Physicians. Policy on Electronic Cigarettes [Internet]. Sydney: The Royal Australasian College of
Physicians; 2018. Accessed 9 March 2021. Available from: https://www.racp.edu.au//docs/default-source/advocacy-library/policy-on-
electronic-cigarettes.pdf?sfvrsn=3a530a1a_8.
2
Walsh M, Grey C. The contribution of avoidable mortality to the life expectancy gap in Māori and Pacific populations in New Zealand—a
decomposition analysis. N Z Med J [Internet]. 2019; 132(1492): 46-60. Accessed 9 March 2021. Available from:
https://www.nzma.org.nz/journal-articles/the-contribution-of-avoidable-mortality-to-the-life-expectancy-gap-in-maori-and-pacific-
populations-in-new-zealand-a-decomposition-analysis.
3
Health Promotion Agency. E-cigarette use and perceptions among current and ex-smokers in New Zealand [Internet]. Wellington: Health
Promotion Agency; 2019. Accessed 9 March 2021. Available from: https://www.hpa.org.nz/sites/default/files/Final%20Report%20-%20E-
cigarette%20use%20and%20perceptions%20among%20current%20and%20ex-smokers%20in%20NZ_Jan%202019_0.pdf.
RACP Submission to the Ministry of Health 2promotion of e-cigarettes for smoking cessation, while also disincentivising users who do not, or
have never smoked.
Counteracting the Effects of Advertising
A prominent way in which many people originally began smoking, was through advertising,
marketing, and visibility of cigarettes in the media. Although it is reasonable for people who smoke
to be informed about e-cigarettes as a possible pathway to quitting, advertising in both retail stores
and online settings can also predict rangatahi taking up e-cigarette use4.
While the proposed regulations do not include explicit advertising as such or marketing of e-
cigarettes, the unrestricted display of vaping accessories and equipment does constitute an implicit
form of advertising. Further, if specialist vape shop displays are permitted to continue to display
products in visible windows, there is little ability to control who sees these: while shop interiors of
specialist vaping retailers are restricted to those 18 and older, the seemingly innocuous window
display is visible to people of any age. The RACP recommends that e-cigarettes and vaping
equipment and accessories are subject to window display prohibitions5.
Wording of Health Warnings on E-cigarette Packaging
While the RACP generally believes that the proposed wording of required health warnings on e-
cigarette packaging is appropriate, a further qualification should be added. This qualification should
clarify that while e-cigarettes are generally less harmful than tobacco, they are still harmful in
comparison to not smoking. Studies show that e-cigarettes generate vapour with variable amounts
of nicotine, and potentially harmful toxins, despite them being at a lower level than that of tobacco
smoking6. As evidence emerges, and is subject to ongoing analysis and testing, warning labels
should be reviewed to ensure currency.
Studies have suggested that warning labels for e-cigarettes, with messages about harms beyond
nicotine’s addictiveness are perceived as believable, informative, understandable and credible
among young adults, and may discourage e-cigarette uptake7. As such, the RACP supports
inclusion of further details such as this in health warnings for e-cigarette products, and accessories.
Geographic Location of Specialist Vape Retailers
Allowing the establishment of Specialist Vape Retailers in locations, such as those in the vicinity of
schools and major thoroughfare for rangatahi, is of concern for the RACP. If we are to protect our
4
Loukas A, Paddock E M, Li X, Harrell M B, Pasch K E, Perry C L. Electronic Nicotine Delivery Systems Marketing and Initiation Among
Youth and Young Adults. Pediatrics [Internet]. 2019; 144(3). Accessed 9 March 2021. Available from:
https://pediatrics.aappublications.org/content/144/3/e20183601.
5
Radio New Zealand. Vape shop display windows allowed under Smokefree rules [Internet]. Wellington: Radio New Zealand; 2021.
Accessed 9 March 2021. Available from: https://www.rnz.co.nz/news/national/437348/vape-shop-display-windows-allowed-under-
smokefree-rules.
6
Drummond M B, Upson D. Electronic cigarettes: potential harms and benefits. Ann Am Thorac Soc [Internet]. 2013; 11(2): 236-242.
Accessed 9 March 2021. Available from: https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201311-391FR.
7
Wackowski O A, Sontag J M, Hammond D, O’Connor R J, Ohman-Strickland P A, Strasser A A et al. The Impact of E-Cigarette
Warnings, Warning Themes and Inclusion of Relative Harm Statements on Young Adults’ E-Cigarette Perceptions and Use Intentions. Int
J Environ Res Public Health [Internet]. 2019; 16(2) Accessed 9 March 2021. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352031/.
RACP Submission to the Ministry of Health 3rangatahi from taking up vaping when they are not already smokers, we should limit their exposure
to advertising from companies engaged in the manufacture and sale of vaping products. While
evidence is mixed as to the effect of e-cigarette retailers in areas around schools, in the past, it has
been suggested that the biggest impact of tobacco retailers in areas surrounding schools is on
adolescents who are not yet addicted but are willing to try smoking opportunistically8 9 10 11.
While e-cigarettes have become more mainstream in recent years, ultimately their influence on our
society is still in its infancy, and as such, the RACP believes that we should remain on the side of
caution with regard to specialist vaping retailers, because of the previously shown effects of tobacco
retailers. In this context, we believe that further restrictions should be placed upon the approval of
Specialist Vape Retailers, including where retailers can be established (bricks and mortar sites) and
how their presence online (in terms of online retail, marketing and advertising) can be monitored and
regulated.
Sales Reporting and Statistical Breakdowns
The regulations proposed would require e-cigarette retailers to annually report, by product type and
container size, total sales amounts in dollars, so as to inform the Ministry of demand levels.
However, the RACP believes that other categories of reporting should be considered.
Consideration should be given to the collection of age data on consumers of e-cigarette products
who purchase at Specialist Vape Retailers. This could be combined with a measure of new
consumers, so that policy can be better targeted, and trends identified, to ensure that effects that
draw people who do not smoke to take up e-cigarettes, can be addressed.
Smoke Free Aotearoa
The RACP’s goal is to achieve a smoke-free Aotearoa NZ. If we are to achieve this, we need to
focus on helping people who currently smoke, away from the habit, with tailored responses focused
on wellbeing. A taxation centric approach has failed to make headway in addressing inequity of
smoking rates, with Māori continuing to smoke at a rate 2.7 times higher than non-Māori12.
Therefore the RACP appreciates the logic of New Zealand’s legislated strategy to balance tobacco
harm reduction via vaping, with avoidance of youth uptake of vaping.
8
Cole A G. Aleyan S, Leatherdale S T. Exploring the association between E-cigarette retailer proximity and density to schools and youth
E-cigarette use. Prev Med Rep [Internet]. 2019; 15. Accessed 9 March 2021. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556619/.
9
Bostean G, Crespi C M, Vorapharuek P, McCarthy W J. E-cigarette use among students and e-cigarette specialty retailer presence near
schools. Health Place [Internet]. 2016; 42: 129-136. Accessed 9 March 2021. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126978/.
10
Giovenco D P, Casseus M, Duncan D T, Coups E J, Lewis M J, Delnevo C D. Association Between Electronic Cigarette Marketing Near
Schools and E-cigarette Use Among Youth. 2016; 59(6): 627-634. Accessed 9 March 2021. Available from:
https://pubmed.ncbi.nlm.nih.gov/27720358/.
11
McCarthy W J, Mistry R, Lu Y, Patel M, Zheng H, Barbara Dietsch, Density of Tobacco Retailers Near Schools: Effects on Tobacco Use
Among Students. Am J Public Health [Internet]. 2009; 99(11): 2006-2013. Accessed 9 March 2021. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759807/.
12
Ministry of Health. Evaluation of the tobacco excise increases as a contributor to Smokefree 2025 [Internet]. Ministry of Health:
Wellington; 2018. Accessed 9 March 2021. Available from: https://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-
control/smokefree-aotearoa-2025/tobacco-excise-tax-evaluation#evaluationex.
RACP Submission to the Ministry of Health 4Conclusion
The RACP thanks the Ministry of Health for the opportunity to provide feedback on this consultation.
To discuss this submission further, please contact the NZ Policy and Advocacy Unit at
policy@racp.org.nz.
Nāku noa, nā
Dr George Laking
President, Aotearoa NZ
The Royal Australasian College of Physicians
RACP Submission to the Ministry of Health 5You can also read
