Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697634027034.pdf (Australia)
SELECT COMMITTEE ON TOBACCO HARM REDUCTION ORYGEN SUBMISSION Orygen welcomes the opportunity to provide a submission to the Senate Select Committee on Tobacco Harm Reduction.

Orygen supports efforts to reduce harm for young people from tobacco and related products.

• Tobacco smoking occurs at very high rates in young people with mental ill-health relative to their peers and causes profound health disparities.
• Available evidence indicates the potential harm from e-cigarettes is less than tobacco smoking.

• Research is needed to determine if e-cigarettes are an efficacious and acceptable smoking cessation option for young people with mental ill-health.

ABOUT ORYGEN Orygen is the world’s leading research and knowledge translation organisation focusing on mental ill- health in young people.
At Orygen, our leadership and staff work to deliver cutting-edge research, policy development, innovative clinical services, and evidence-based training and education to ensure that there is continuous improvement in the treatments and care provided to young people experiencing mental ill-health.

YOUNG PEOPLE, TOBACCO SMOKING AND E-CIGARETTES While in developed countries the rate of tobacco smoking by young people is decreasing, the use of electronic cigarettes is increasing among 15 to 24 year olds.
(1) In Australia, between 2016 and 2019 the proportion of 15 to 24 year olds ever using e-cigarettes increased from 17.1% to 22.3%.

(2) A similar rate of ever use of e-cigarettes is evident in the US (21.6%) with slightly lower rates in Canada among 16-30 year olds (16.2%).

(3, 4) The prevalence of regular use (i.e., every day or some days) is lower, at around 1 in 20 young people (5.1% in the US and 5.7% in Canada).
Experimental use of e- cigarettes is widely reported among young people including among under 18s.

(2, 4, 5) Reasons for experimentation include curiosity, appealing flavours and peer influence.

(6) Prior tobacco use is a predictor of e-cigarette use among young people.

(4, 5) MENTAL HEALTH Experiences of mental ill-health are a risk factor for young people beginning tobacco smoking.

(7) In Australia tobacco smoking rates among people experiencing mental ill-health are markedly higher.
(8) This difference emerges early, young people with mental ill-health are far more likely to smoke cigarettes, with daily smoking rates up to 77%.

(9, 10).

Given that adults with mental ill-health are estimated to account for 38% of tobacco-related deaths (11), early intervention with young people is required to prevent these very poor health outcomes.

There is also a correlation between experiences of mental ill-health and e-cigarette use.
Young people (18 to 24 years) who currently use e-cigarettes were twice as likely to report depression compared with peers who had never used e-cigarettes.

(12) Recommendation Tobacco harm reduction measures should include targeted early intervention and treatment programs to reduce tobacco smoking among young people experiencing mental ill-health.
35 POPLAR ROAD, PARKVILLE VIC 3052 | +61 3 9966 9100 | ORYGEN.ORG.AU 1 Tobacco Harm ReductionSubmission 261 SUPPORTING CESSATION E-cigarettes are increasingly being used to support a reduction or cessation in smoking including among people aged under 30 years.

(3, 4) In the US there is wide awareness among young people that e-cigarettes are used for this purpose.
(13) In Australia, young people (15-24 years) also cite smoking reduction or cessation and harm reduction as reasons for using e-cigarettes (see Table 1).

Parental approval of the use of e-cigarettes for smoking cessation has been reported by young people in the US.

(13) Despite these promising indications, there is insufficient evidence about the efficacy of e-cigarettes to support smoking cessation or reduction in young people, including those with mental ill-health.
TABLE 1 REASONS FOR USING E-CIGARETTES Reason* To help me quit smoking To try to cut down on the number of cigarettes I smoke/smoked To try to stop me going back to smoking regular cigarettes I think they are less harmful than regular cigarettes They are cheaper than regular cigarettes I think they taste better than regular cigarettes They seem more acceptable than regular cigarettes Out of curiosity Other Source: Australian Institute of Health and Welfare (2) * People could select more than one response.
Proportion of young people 15 to 24 years 12.5% 11.1% 8.9% 20.4% 10.6% 21.2% 9.5% 72.3% 10.8% PERCEPTION OF HARM Young people have more positive perceptions of e-cigarettes compared with tobacco smoking.

(14) One-in-four Australian young people report they think e-cigarettes are less harmful than smoking tobacco.

(2) Young people in the US also perceive e-cigarettes as less harmful, but there are mixed views on the addiction risk of e-cigarettes.
(13-15) Policy arguments for e-cigarettes argue that the harm reduction benefits of non-combustible tobacco, while still presenting a risk of nicotine addiction and potentially other risks, make it an important smoking cessation option.

(16) RISK OF BEING A “GATEWAY” TO SMOKING While e-cigarette use is higher among young people who smoke tobacco, there is little evidence that e-cigarette use leads causally to tobacco smoking.
(17) A longitudinal study of initiation of tobacco products among adolescents (12 to 17 years) found a pathway from tobacco smoking to a combination of e-cigarettes and combustible tobacco use was evident.

The reverse was less common.

(18) Moreover, even in cases where e-cigarette use occurs before tobacco smoking, there is little evidence that tobacco smoking was caused by the earlier e-cigarette use.
Recommendation On available evidence, tobacco harm reduction measures should include the option of e-cigarettes.

Research is urgently needed to understand how acceptable and effective e-cigarettes are as a smoking cessation approach among young people with mental ill-health.
SELECT COMMITTEE ON TOBACCO HARM REDUCTION | ORYGEN SUBMISSION 2 Tobacco Harm ReductionSubmission 261 CONTACT DETAILS For further information and follow-up relating to this submission, please contact: David Baker Principal Policy Adviser Orygen REFERENCES Halpern SD, French B, Small DS, Saulsgiver K, Harhay MO, Audrain-McGovern J, et al.

Randomized Trial of Four Green VR, Conway KP, Silveira ML, Kasza KA, Cohn A, Cummings KM, et al.

Mental Health Problems and Onset of Czoli CD, Hammond D, White CM.
Electronic cigarettes in Canada: Prevalence of use and perceptions among youth Kong G, Morean ME, Cavallo DA, Camenga DR, Krishnan-Sarin S. Reasons for Electronic Cigarette Experimentation Eastwood B, Dockrell MJ, Arnott D, Britton J, Cheeseman H, Jarvis MJ, et al.

Electronic cigarette use in young people Australian Institute of Health and Welfare.

Smoking: Data.

2020.

Volpp KG, Troxel AB, Pauly MV, Glick HA, Puig A, Asch DA, et al.
A Randomized, Controlled Trial of Financial Australian Institute of Health and Welfare.

Alcohol, tobacco & other drugs in Australia.

Canberra: AIHW; 2020.

Australian Institute of Health and Welfare.

Alcohol, tobacco & other drugs in Australia: Data.

2020.

Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, et al.

Overview of Electronic Nicotine 1.

2.

3.

Delivery Systems: A Systematic Review.

Am J Prev Med.

2017;52(2):e33-e66.

4. and young adults.


Canadian Journal of Public Health.

2014;105(2):e97-e102.

5. in Great Britain 2013-2014.

Public health.

2015;129(9):1150-6.

6. and Discontinuation Among Adolescents and Young Adults.

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

2015;17(7):847-54.

7.

Tobacco Use Among 12- to 24-Year-Olds in the PATH Study.

J Am Acad Child Adolesc Psychiatry.

2018;57(12):944-54.e4.

8.

9.


Incentives for Smoking Cessation.

New England Journal of Medicine.

2009;360(7):699-709.

10.

Financial-Incentive Programs for Smoking Cessation.

New England Journal of Medicine.

2015;372(22):2108-17.

11.

2017;38(1):165-85.

12.

Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017.

JAMA Netw Open.

2019;2(12):e1916800-e. 13.

Camenga DR, Cavallo DA, Kong G, Morean ME, Connell CM, Simon P, et al.
Adolescents' and Young Adults' Perceptions of Electronic Cigarettes for Smoking Cessation: A Focus Group Study.

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

2015;17(10):1235-41.

14. acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win.

Substance use & misuse.

2015;50(1):79-89.


Hefner KR, Sollazzo A, Mullaney S, Coker KL, Sofuoglu M. E-cigarettes, alcohol use, and mental health: Use and 15. perceptions of e-cigarettes among college students, by alcohol use and mental health status.

Addict Behav.

2019;91:12-20.

16. now: Evidence for harm minimization.

Prev Med.

2018;117:88-97.

17. with e-cigarette use in young adults.

medRxiv.

2020:2020.06.10.20127464.


18. tobacco products across 3 years among youth, young adults and adults in the USA: findings from the PATH Study Waves 1-3 (2013-2016).

Tob Control.

2020;29(Suppl 3):s178-s90.

Abrams DB, Glasser AM, Villanti AC, Pearson JL, Rose S, Niaura RS.

Managing nicotine without smoke to save lives Prochaska JJ, Das S, Young-Wolff KC.

Smoking, Mental Illness, and Public Health.

Annual Review of Public Health.


Khouja JN, Wootton RE, Taylor AE, Davey Smith G, Munafò MR. Association of genetic liability to smoking initiation Obisesan OH, Mirbolouk M, Osei AD, Orimoloye OA, Uddin SMI, Dzaye O, et al.

Association Between e-Cigarette Stanton CA, Sharma E, Seaman EL, Kasza KA, Edwards KC, Halenar MJ, et al.

Initiation of any tobacco and five Berg CJ, Stratton E, Schauer GL, Lewis M, Wang Y, Windle M, et al.
Perceived harm, addictiveness, and social SELECT COMMITTEE ON TOBACCO HARM REDUCTION | ORYGEN SUBMISSION 3 Tobacco Harm ReductionSubmission 261