Draft Law No XIIIP-3849(3) amending Article 9(2) of Law No I-1143 on the control of tobacco, tobacco products and related products of the Republic of Lithuania
Kommissionens meddelelse - TRIS/(2021) 02580
Direktiv (EU) 2015/1535
Oversættelse af meddelelsen 001
No abre el plazo - Nezahajuje odklady - Fristerne indledes ikke - Kein Fristbeginn - Viivituste perioodi ei avata - Καμμία έναρξη προθεσμίας - Does not open the delays - N'ouvre pas de délais - Non fa decorrere la mora - Neietekmē atlikšanu - Atidėjimai nepradedami - Nem nyitja meg a késéseket - Ma’ jiftaħx il-perijodi ta’ dawmien - Geen termijnbegin - Nie otwiera opóźnień - Não inicia o prazo - Neotvorí oneskorenia - Ne uvaja zamud - Määräaika ei ala tästä - Inleder ingen frist - Не се предвижда период на прекъсване - Nu deschide perioadele de stagnare - Nu deschide perioadele de stagnare.
1. Structured Information Line
MSG 002 IND 2021 0434 LT DA 08-07-2021 LT NOTIF
2. Member State
3. Department Responsible
Lietuvos standartizacijos departamentas
Algirdo g. 31, LT-03219 Vilnius
Tel. +370 (5) 270 9358
Elektroninis paštas: firstname.lastname@example.org
3. Originating Department
Lietuvos Respublikos sveikatos apsaugos ministerija
Vilniaus g. 33, LT-01506 Vilnius
Tel. +370 (5) 266 1400
Elektroninis paštas: email@example.com
4. Notification Number
2021/0434/LT - X00M
Udkast til lov nr. XIIIP-3849(3) om ændring af artikel 9, stk. 2, i lov nr. I-1143 om kontrol med tobak, tobaksvarer og relaterede produkter i Republikken Litauen
6. Products Concerned
elektroniske cigaretter og genopfyldningsbeholdere med væske til genopfyldning af elektroniske cigaretter
7. Notification Under Another Act
8. Main Content
Formålet med lovforslaget er at forbyde markedsføring i Republikken Litauen af elektroniske cigaretter og genopfyldningsbeholdere med væske til genopfyldning af elektroniske cigaretter (i det følgende benævnt "genopfyldningsbeholdere til e-cigaretter"), forudsat at denne væske indeholder andre aromaer end tobakslugt og/eller -smag.
9. Brief Statement of Grounds
Lovforslaget har til formål at forbyde markedsføring i Republikken Litauen af e-cigaretter og genopfyldningsbeholdere til e-cigaretter, der indeholder væske, hvis denne væske (nikotinholdig eller nikotinfri) indeholder andre aromaer end tobakslugt og/eller -smag, hvilket vil mindske efterspørgslen på elektroniske cigaretter og genopfyldningsbeholdere til e-cigaretter og gøre dem mindre attraktive (især blandt de unge, der er særligt tiltrukket af de aromatiserede rygeprodukter). Dette er især relevant på baggrund af den bekymrende tendens til øget anvendelse af e-cigaretter i Litauen (navnlig blandt unge) [1, 2, 3, 4].
I henhold til bestemmelserne i betragtning nr. 47 i præamblen til Europa-Parlamentets og Rådets direktiv 2014/40/EU af 3. april 2014 om indbyrdes tilnærmelse af medlemsstaternes love og administrative bestemmelser om fremstilling, præsentation og salg af tobak og relaterede produkter og om ophævelse af direktiv 2001/37/EF (i det følgende benævnt "tobaksvaredirektivet"):
"(47) Dette direktiv harmoniserer ikke alle aspekter af elektroniske cigaretter eller genopfyldningsbeholdere. F.eks. har medlemsstaterne fortsat ansvaret for vedtagelsen af regler om aromastoffer. Det kunne være nyttigt for medlemsstaterne at overveje at tillade markedsføringen af produkter med aromaer. De bør i den forbindelse være opmærksomme på den potentielle tiltrækningskraft af sådanne produkter for unge og ikkerygere. <...>“
Efter anmodning fra Europa-Kommissionen afgav Den Videnskabelige Komité for Sundheds- og Miljørisici og Nye Risici (SCHEER) i 2021 en videnskabelig udtalelse om elektroniske cigaretter :
"<...> SCHEER konkluderer, at der er moderat evidens for, at elektroniske cigaretter er en indgang til rygning for unge. Der er stærke beviser for, at nikotin i e-væsker er medvirkende til, at der udvikles afhængighed, og at aromaer bidrager afgørende til at gøre det attraktivt at bruge og påbegynde anvendelsen af e-cigaretter.”
Der er gennemført en undersøgelse i USA om smagsstoffernes betydning for e-damp-produkterne og for tilfredsheden med dem blandt voksne (“The role of flavours in vaping initiation and satisfaction among U.S. adults”). Undersøgelsen viste, at størstedelen af de nuværende forbrugere af e-cigaretter (62,9 %) generelt gjorde brug af andre aromaer end tobaksmag (herunder frugt, mynte/mentol, slik, kaffe osv.), 24,2 % brugte tobakssmag og 12,9 % brugte lugtfri e-cigaretter. Smagen var en almindelig anført årsag til, at der blev skiftet over til e-cigaretter, og 29,5 % af respondenterne svarede således, at det var smagen, der var årsagen. Det er smagen, navnlig frugtsmag, der har fået unge voksne i alderen 18-24 til at begynde at bruge e-cigaretter, når man sammenligner dem med gruppen af voksne i alderen 35-44 år. De, der gjorde brug af de aromatiserede produkter, især mynte/mentol og øvrige smagsvarianter uden tobakssmag, var mere tilbøjelige til at bekræfte høj tilfredshed med brugen af elektroniske cigaretter og afhængigheden af elektroniske cigaretter var mere sandsynlig end hos respondenter, der ikke anvendte aromatiserede e-cigaretter.
Som anført i Kommissionens rapport til Europa-Parlamentet, Rådet, Det Europæiske Økonomiske og Sociale Udvalg og Regionsudvalget om anvendelsen af tobaksvaredirektivet , offentliggjort den 20. maj 2021:
"Der er stærke beviser for, at aromaer i e-væsker er attraktive for unge og voksne. Især unge bruger i høj grad utraditionelle smagsvarianter som f.eks. slik og frugt. Disse smagsvarianter har stor indflydelse på unge mennesker, idet de nedsætter bevidstheden om at gøre skade og øger lysten til at prøve. Medlemsstaterne forbyder i stigende grad aromaer til e-cigaretter."
I Verdenssundhedsorganisationens (WHO's) rapport om det globale tobaksforbrug i 2019 (kapitlet: "Elektroniske cigaretter, centrale oplysninger og landespecifikke henstillinger”) blev det anbefalet, at "parterne bør indføre forbud mod produktreklamer og aromatisering for at beskytte unge.”
Det er vigtigt at bemærke, at Litauen, der baserer nærværende lovforslag på de begrundelser, der nævnes i betragtning 47 i præamblen til tobaksvaredirektivet, på den seneste videnskabelige dokumentation og på WHO's anbefalinger, ønsker at følge andre landes vellykkede eksempel (både i EU og i verden) ved at indføre et forbud mod aromatiserede e-cigaretter og e-væsker til genopfyldning af disse for dermed at bidrage til målet om at reducere udbredelsen af e-cigaretter, hvilket er særlig relevant i lyset af den hastigt stigende brug af e-cigaretter i Litauen (navnlig blandt unge).
2 https://ntakd.lrv.lt/uploads/ntakd/documents/files/HBCS2018_LT.pdf (s. 42)
7 https://www.who.int/teams/health-promotion/tobacco-control/who-report-on-the-global-tobacco-epidemic-2019 (s. 59)
10. Reference Documents - Basic Texts
Henvisninger til basisteksterne: Udkast:
Udkast til lovforslag til sammenligning:
11. Invocation of the Emergency Procedure
12. Grounds for the Emergency
14. Fiscal measures
15. Impact assessment
Der forventes ingen negative konsekvenser i betragtning af lovforslagets formål og forskriftsmæssige karakter.
16. TBT and SPS aspects
Nej, udkastet er ikke en sundhedsmæssig eller plantesundhedsmæssig foranstaltning
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SJCC Ecodumas is one of the leading e-cigarettes retail and wholesale companies in Lithuania. The company has more than 38 shops and 1500 sales points in the largest Lithuanian cities, 113 employees.
The company asks European Commission to evaluate critically Draft Law No XIIIP-3849 (3) amending Article 9 (2) of Law No I-1143 on the control of tobacco, tobacco products and related products of the Republic of Lithuania (hereinafter “Draft law”), notification (No 2021/434 / LT), whereas:
Company recognizes Draft law as disproportionate measure restricting the free movement of goods, because:
- The real objectives of the draft law (non-availability of products to minors) do not correspond to the objectives of the Draft law set out in the notification notice.
- E-cigarette’s sale licensing requirements came into force in Lithuania on 1st May 2021.
- The adoption of the Draft law will encourage the illegal trade in e-cigarettes, which currently accounts for more than 65 percent of all market.
I write about the plan to prohibit 'flavourings other than tobacco flavours' in e-liquids for vaping. I am opposed to this plan as it will create a health burden on the people of Lithuania by lowering the rate at which people who smoke switch to vaping. It will thus act in contradiction to the 'Impact assessment' that states “no negative impact is expected”.
E-cigarettes are used primarily as an alternative for combustible tobacco products such as cigarettes. As such, they can act either as a way for people who smoke to switch to a much less harmful way of consuming nicotine or for those (typically young people) who don't smoke but are drawn to nicotine consumption, a diversion from smoking. I am one of the first group, and though I had no intention to completely switch to vaping nicotine when first trying it, I found I preferred vaping and made an instant and complete transition. I no longer am the slightest bit interested in smoking again. I have had cause to consider what my choices would be if I was doing my life over as a young person in these modern times. If vaping had been available when I first tried cigarettes at about the age of 13-14 years old, I would do some research and quickly realise that the much less harmful and more pleasant (in part due to the delicious flavours) option of vaping would be preferable.
In regard to 'Brief Statement of Grounds' “<...> SCHEER concludes that there is moderate evidence that electronic cigarettes are a gateway to smoking for young people. There is strong evidence that nicotine in e-liquids is implicated in the development of addiction and that flavours have a relevant contribution for attractiveness of use of electronic cigarette and initiation.” I would like to add a further comment. Continuing the thought experiment of 'if I was young today', and had begun nicotine vaping at the age of 14, it would be almost inevitable that a smoker would see me vaping and offer the 'real' thing (a combustible cigarette). Out of pure curiousity, I would try one (and most likely hate it in comparison).
Doing so would have seen me classified as one of the youths who 'proves' the gateway theory. It is complete nonsense. The vast majority of the young people who try vaping and end up having one or more cigarettes simply possess what's known as a common liability that attracts them to nicotine use. Those youth who are attracted to vaping by 'flavours' or the ability to do 'vape tricks' quickly tire of it and find something else to amuse themselves. This is born out in the 60% drop in vaping by youth in the United States over the last two years. It was a fad that is quickly fading.
My own country, Australia, currently has severe restrictions on vaping. For Australia, it's not flavours that are restricted, but nicotine (based on legacy laws that classify it as a dangerous poison). As a result of this near prohibition, the sale of strong (up to 6%) nicotine disposable vapes has flourished and being sold by people already breaking the law, there are none of the age restrictions being applied as existing for cigarettes, while fewer adult smokers have taken up vaping because they fear the consequence of the law in relation to their employment or other matters.
Please do not proceed with this arbitrary and anti-health measure which will see sales of flavoured nicotine vapes go to criminals who do not care about the quality of the products, the age of the customers or the results of their use. Smoking is the problem, not nicotine vaping.
The National Electronic Cigarette Association (NECA) provides the following comments and essential insights, which the European Commissionm(hereinafter - the Commission) requests to be taken into account when considering the notification of the Draft Law:
(i) the objectives of the Draft Law, as set out in its explanatory note, and in the Notification Notice differ. Against this background, we ask the Commission to base its assessment of the Draft Law and its compliance with EU legislation and principles specifically on the objectives of the Draft Law set out in the explanatory note to the Draft Law.
(ii) the adoption of the Draft Law should be considered as a disproportionate and unnecessary measure that will unreasonably restrict the free movement of goods.
(iii) the adoption of the Draft Law will not ensure the achievement of the objectives of the Draft Law, as the main tobacco products used among young people are cigarettes and heated tobacco products.nAccordingly, the adoption of the draft law will inevitably encourage the illegal trade in electronic cigarettes, while the shadow (illegal) trade in already regular cigarettes is one of the largest (3rd place) in Europe.
(iv) the Draft Law in Lithuania is intended to be adopted in principle without following the mandatory legislative procedures and in order to avoid conducting an independent expert assessment.
Regarding the aforementioned, we request the European Commission to take into account the comments set out in this letter when considering the notification of the Draft Law.
IEVA would like to express its concerns regarding the draft law N° XIIIP-3849(3) amending article 9(2) of Law n° I-1143 on the control of tobacco, tobacco products and related products notified by the Republic of Lithuania to the European Commission on the 8th of July 2021, under the reference 2021/434/LT.
According to the statement of grounds submitted by the Lithuanian authorities, the amending draft law intends to reduce the attractiveness and demand for e-cigarettes and e-liquids “especially for young people who are particularly attracted to flavored smoking products”. Such a ban is described as “particularly relevant due to the worrying trend towards the increase of the use of e-cigarettes (especially among young people) in Lithuania”.
IEVA is particularly concerned by article 1 of the draft law that foresees the prohibition to place, on the lithuanian market, electronic cigarettes and refill containers filled with liquids (both with nicotine and nicotine-free) containing flavours other than tobacco smell and/or taste.
IEVA believes the proposed flavour ban is not proportionate to the objective pursued as the measure strongly fails to be:
- Appropriate i.e. a suitable mean to attain the objective with a reasonable connection between the aim and the measure;
- Necessary i.e. Member States should choose the means which least restrict the free movement of goods
- It also has to be mentioned that the ban will highly increase black market.
- Apart from that, Lithuania already has a licencing law that fully regulates the market and prevents youngsters under 18 years old from buying such products.
- It will eliminate more than 10 k job places and will reduce tax paid by this business.
Overall, IEVA respectfully calls on the European Commission to examine the proportional character of the flavour ban proposed by Lithuania, and encourages the national authorities to adopt measures adapted to the pursued aim and based on thorough scientific evidence. For example, if licencing is already in place, the ban is no longer needed.
Hasn't the EU not produced enough burocratic limitations on its citizens? Who do you think you are you can tell adults what flavours they are allowed to use or not use. Put an age limit on them and do your job to make that this age limit is respected. But if you can't do that, I'm will not be the victim of your incompetence.
European Tobacco Harm Reduction Advocates contribution to TRIS notification 2021/0434/LT - X00M outlines why prohibiting all e-liquid flavours, apart from tobacco, will have a detrimental effect on public health in Lithuania.
European Tobacco Harm Reduction Advocates (ETHRA) is a group of 22 grassroots consumer associations in 16 European countries which support the public health approach of tobacco harm reduction, where people switch from high-risk products like cigarettes to low-risk products like e-cigarettes. We are mostly ex-smokers who have used safer nicotine products (vapes, snus, nicotine pouches, heated tobacco products) to quit smoking and remain smoke free. ETHRA represents approximately 27 million[i] consumers across Europe and is supported by experts in the field of tobacco control and nicotine research. ETHRA is a voluntary organisation with no industry conflicts of interest – see our Transparency Register entry: 354946837243-73.
The draft law aims to “reduce the attractiveness and demand of electronic cigarettes and electronic cigarette fillers.” If enacted, it will drastically restrict adult access to the products people use to quit smoking and remain smoke free, and cause harm by prolonging smoking.
Switching from smoking to vaping provides substantial health gains
The harms from smoking are due to the inhalation of toxic products of combustion, not from nicotine use. So, the critical distinction from a public health perspective must be between combustible smoked products and non-combustible smokeless products. Significant public health gains can be made if smokers transition away from deadly combustible tobacco products to low-risk e-cigarettes.
The draft law disproportionately focuses on youth use of e-cigarettes, without due regard for the consequences for adult smokers. Special Eurobarometer 506 shows that smoking prevalence in Lithuania is 5% higher than the EU average, at 28%[ii]. This makes it clear that smokers in Lithuania need more help and options to quit smoking rather than fewer.
Some countries recognise the potential vaping products have to reduce death and disease from smoking. In the UK the Royal College of Physicians said in its 2016 report, Nicotine Without Smoke[iii]: “the available data suggest that they [e-cigarettes] are unlikely to exceed 5% of those [risks] associated with smoked tobacco products and may well be substantially lower than this figure”.
Public Health England[iv] also concluded that vaping was at least 95% less harmful than smoking, and that smokers should be assured that switching to vaping is much less harmful than smoking. A study by Stephens WE[v], suggested e-cigarette vapour has cancer potencies of just 0.4% of cigarette smoke. Public health endorsement of vaping has contributed to the UK experiencing the sharpest decline in smoking prevalence in the EU, falling 21pp since 20062. It should also be noted that vaping among never smoking youths in the UK is extremely low, Public Health England’s latest evidence update reports that “between 0.8% and 1.3% of young people who had never smoked were current vapers[vi]”
The French Cancer Institute[vii] also recognises the huge harm reduction potential of vaping in their latest campaign, stating: “Without tobacco, without smoke and without combustion, the electronic cigarette represents an opportunity to reduce cancer mortality related to tobacco. It should be used with a view to quitting smoking for good.”
The latest call for a balanced approach towards the regulation of e-cigarettes comes from 15 past presidents of the Society for Research on Nicotine and Tobacco, the preeminent scientific professional society focused on nicotine and tobacco. This landmark paper[viii] states that the potential benefits of vaping for adult smokers are substantial. However, the past presidents regret that those benefits are not being fully realised in today’s environment of misinformation and a singular focus on the welfare of kids, to the detriment of the health of adults who smoke.
Quitting smoking can be a long and arduous journey that can involve multiple relapses to smoking. Therefore, it is crucial that smokers have as many options available to them as possible. As a consumer product vaping can reach more smokers and is an effective and popular means of smoking cessation. Data from Belgium, France, Ireland and the UK[ix] attest to this efficacy.
Scientific reviews and studies provide solid evidence that vaping is an effective means of smoking cessation. An ongoing living review by the Cochrane Tobacco Addiction Group consistently finds that vaping is more effective than Nicotine Replacement Therapies (NRTs)[x]. Randomised Control Trials (RCT), considered the gold standard, also confirm that vaping is more effective than traditional smoking cessation methods like NRTs alone. Hajek et al[xi] found vaping to be almost twice as effective as NRTs and Walker et al[xii] found e-cigarettes combined with NRT’s to be 2.5 times more effective than patches alone.
A further RCT[xiii] which aimed to assess the efficacy of e-cigarettes compared to NRTs for smokers who had previously been unable to quit, found that after six months 19% of the e-cigarette group had maintained smoking abstinence compared with only 3% of the NRT group.
Attractive flavours are critical factors in the effectiveness of e-cigarettes for smoking cessation, this is also why NRTs come in a range of fruity and mint/menthol flavours. The TRIS notification detail even acknowledges that flavours in e-liquids are attractive to adults. A common misconception is that tobacco flavour is sufficient for adult smokers to transition away from smoking, when in reality it is common for vapers to migrate from tobacco flavour to fruits and sweet flavours[xiv].
It shouldn’t come as any surprise that adults enjoy things that taste good, this is certainly the case when it comes to smoking cessation aids. This was demonstrated by researchers in the Netherlands[xv] who concluded: “Adults who have completely switched from smoking to e-cigarettes have often initiated e-cigarette use with fruity flavours rather than tobacco flavours, or switched from tobacco to non-tobacco e-liquid flavours over time.” The ability to disassociate from the flavour of tobacco, and enjoyment of the product being used, are important factors to avoid relapse to smoking.
A large-scale survey by Farsalinos et al[xvi] examined the flavour preferences of adults who had completely switched from smoking to vaping and concluded that fruit and dessert/pastry/bakery flavours, were the most prevalent choices.
A study published in the Journal of the American Medical Association[xvii] examined the association of flavoured e-cigarettes with subsequent smoking cessation and found that adults who vaped non-tobacco flavours were more likely to quit smoking than those who vaped tobacco flavours.
Given the important role flavours play in smoking cessation it is imperative that the unintended consequences of a flavour ban are considered. Such a ban would be disastrous for smoking cessation and public health as it would remove the products responsible for huge reductions in smoking prevalence from the market.
The added danger with limiting or banning flavours is that consumers are then forced to use the black market to obtain the product they need (or go back to smoking). This was the experience in Estonia where a flavour ban and high taxation led to an explosion of black-market products, reported to account for 62-80%[xviii] of all sales. In response, Estonia recently amended its legislation to permit more flavours.
States in the USA that have banned flavours have also seen thriving black markets develop as ex-smokers seek out the only products that have successfully kept them smoke free. Black market sales of flavoured vaping products are reported to be a regular occurrence in car parks around Long Island New York[xix]. Prohibition hasn’t eliminated the product; it has simply driven it underground and criminalised those whose only crime is wanting to remain, or become, free from cigarette smoking.
ETHRA recently conducted a survey[xx] of nicotine consumers in Europe, which attracted over 35,000 EU responses. We found that 94.6% of current vapers used a flavour other than tobacco. When asked about reactions towards the possibility of a flavour ban, 28% said they would be likely to restart smoking, and 71% would consider using the black market or other alternative sources.
Consumers turning to an unregulated black market, with no manufacturing standards, could pose significant health risks. Oil based flavourings, which are unsuitable for vaping, could easily be added to liquids by those unaware of the inherent danger of inhaling oil-based flavours.
A recent study by Friedman A[xxi] examined the effects of a flavour ban in San Francisco relative to other districts without a flavour ban. The study concluded that “San Francisco’s flavor ban was associated with more than doubled odds of recent smoking among underage high school students relative to concurrent changes in other districts.”
Although youth vaping in Lithuania is relatively high, this hasn’t translated into an increase in smoking. The TRIS notification detail cites youth vaping figures from the European School Survey Project on Alcohol and Other Drugs (ESPAD), as part of the rationale for the proposal to prohibit e-liquid flavours. However, the same ESPAD[xxii] survey shows that youth smoking rates are low. Past 30-day smoking, 1-5 cigarettes per day, is only 4.2%, this falls further to 2.2% for those smoking 6-10 cigarettes. It could be argued that youth use of vapour products has diverted them away from the most harmful method of nicotine consumption, which is smoking.
We are dismayed that the Government of the Republic of Lithuania wishes to limit the appeal of e-cigarettes when adult smoking prevalence remains stubbornly high at 28%. This 28% represents approximately 784,000 Lithuanian smokers who could greatly benefit from switching to a less harmful alternative to smoking. Vaping is proven to help smokers quit, and flavours are an essential part of this.
Removing flavours will keep more people smoking by making vaping less attractive. The Royal College of Physicians (London) explained this in 2016[xxiii]: “if [a risk-averse and precautionary] approach also makes e-cigarettes less easily accessible, less palatable, or acceptable, more expensive, less consumer-friendly or pharmacologically less effective, or inhibits innovation and development of new and improved products, then it causes harm by perpetuating smoking. Getting this balance right is difficult.”
We suggest that robust age of sale legislation is a much better way of tackling the issue of youth use. The current proposal to restrict flavoured e-liquid will have an extremely negative effect on adult smokers by removing the products that have helped millions of EU citizens quit smoking for good.
[i] Estimate of 27 million consumers provided by ECigIntelligence/TobaccoIntelligence. The actual figure is likely to be far higher because the data for smokeless tobacco is taken from research (Leon et al 2016) using data gathered in 2010 in only 17 countries
[ii] Comissão Europeia (2021) Special Eurobarometer 506: Attitudes of Europeans towards tobacco and electronic cigarettes.
[iii] Royal College of Physicians (London), Nicotine without smoke: tobacco harm reduction, April 2016
[iv] McNeill A, Brose LS, Calder R, Bauld L & Robson D (2018). Evidence review of ecigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England
[v] Stephens, W. E. (2018) ‘Comparing the cancer potencies of emissions from vapourised nicotine products including e-cigarettes with those of tobacco smoke’, Tobacco Control, 27(1), pp. 10–17. doi: 10.1136/tobaccocontrol-2017-053808.
[vi] McNeill, A., Brose, L.S., Calder, R., Simonavicius, E. and Robson, D. (2021). Vaping in England: An evidence update including vaping for smoking cessation, February 2021: a report commissioned by Public Health England. London: Public Health England.
[vii] Institut National Du Cancer. (2021). Tabac et prévention des cancers. Available at: https://www.e-cancer.fr/Acces-thematique/Tabac-et-prevention-des-cancers
[viii] Balfour, D. J. K. et al. (2019) ‘Balancing Consideration of the Risks and Benefits of E-Cigarettes’.
[ix] Interview on Tobacco Products Directive: notes by ETHRA, pps 8-9 Impact of e-cigarettes on smoking cessation. Available at: https://ethra.co/images/ETHRAs_notes_on_TPD_interview.pdf
[x] Hartmann-Boyce J, McRobbie H, Butler AR, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2021, Issue 4. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub5.
[xi] Hajek, P. et al. (2019) ‘A randomized trial of E-cigarettes versus nicotine-replacement therapy’, New England Journal of Medicine, 380(7), pp. 629–637. doi: 10.1056/NEJMoa1808779.
[xii] Walker N, Parag V, Verbiest M, Laking G, Laugesen M, Bullen C. Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial. Lancet Respir Med. 2020 Jan;8(1):54-64. doi: 10.1016/S2213- 2600(19)30269-3
[xiii] Myers Smith, K., Phillips-Waller, A., Pesola, F., McRobbie, H., Przulj, D., Orzol, M., and Hajek, P. (2021) E-cigarettes versus nicotine replacement treatment as harm reduction interventions for smokers who find quitting difficult: randomized controlled trial. Addiction, https://doi.org/10.1111/add.15628.
[xiv] Russell C, McKeganey N, Dickson T, Nides M. Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J. 2018 Jun 28;15(1):33
[xv] Havermans, A. et al. (2019) ‘Nearly 20 000 e-liquids and 250 unique flavour descriptions: an overview of the Dutch market based on information from manufacturers’, Tobacco Control, p. tobaccocontrol-2019-055303. doi: 10.1136/tobaccocontrol-2019-055303.
[xvi] Konstantinos Farsalinos, A. et al. (2018) ‘Patterns of flavored e-cigarette use among adults' vapers in the United States: an internet survey. -N-6565 for "Regulation of Flavors in Tobacco’
[xvii] Friedman, A. S. and Xu, S. Q. (2020) ‘Associations of Flavored e-Cigarette Uptake with Subsequent Smoking Initiation and Cessation’, JAMA network open, 3(6), p. e203826. doi:10.1001/jamanetworkopen.2020.3826.
[xviii] Baltic Times, Estonian FinMin looking into prospect of lowering excise duty for e-cigarettes 25 Nov 2019
[xix] Filter, Vape Bans Are Creating a Thriving Illicit Market 8 July 2020
[xx] European Tobacco Harm Reduction Advocates. EU Nicotine Users Survey report. June 2021. Available at: https://ethra.co/news/80-ethra-eu-nicotine-users-survey-report
[xxi] Friedman AS. A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California. JAMA Pediatr. 2021;175(8):863–865. doi:10.1001/jamapediatrics.2021.0922
[xxii] Molinaro, S. et al. (2019) ESPAD Report. Additional Tables. Table 3a. Available at: http://www.espad.org/sites/espad.org/files/20203880_TD0320532ENN_PDF.pdf
[xxiii] Royal College of Physicians (London), Nicotine without smoke: tobacco harm reduction, April 2016. Section 12.10 page 187
Dear colleagues in Lithuania
Please do not implement a flavour ban. This will do nothing to change youth use, which has incidentally been significantly overstated, and will deter adults from stopping smoking by switching to a far less harmful product. Banning flavours actually protects the cigarette industry and keeps people smoking. In the UK we have a permissive approach to vaping, and smoking rates are falling faster than ever. Young people are protected by sound age of sale legislation. Please consider this instead of banning flavours. Thank you