Vaping devices or e-cigarettes began to appear more than a decade ago. They were designed to deliver nicotine through heated vapour — eliminating tobacco smoke and reducing its cancer-causing effects. The idea was to help smokers reduce their health risks and hopefully quit tobacco.
Today that promise has turned into a public health nightmare.
Dr. Andrew Pipe is Canada’s foremost expert on smoking cessation. He is also chair of the Heart & Stroke board of directors. We asked Dr. Pipe to explain how vaping affects health and what needs to change.
How did this all get started?
In the Canadian context, vapes with nicotine were legalized in May, 2018. But at the outset, these products were not regulated in any meaningful way. It was essentially the wild west.
Many products deliver a phenomenal amount of nicotine.
What’s the main concern about vaping?
Nicotine is one of the most addictive substances available. Nicotine affects adolescent brain development, particularly the parts of the brain that control learning, attention, mood, and impulse control. What’s more concerning is that nicotine use in adolescence can increase the future risk of addiction to other drugs.
Health professionals have seen an explosion in the use of these devices –in the different solutions that are used and in the hundreds of ingredients and flavouring chemicals added.
Who is using vaping devices?
Almost half of vape users in Canada are youth or young adults.
That’s because these products have been very aggressively marketed using social media techniques and sinister messaging strategies that the tobacco industry uses to target young people.
The most recent figures reveal that 17% of students in grades 7-12 are current vapers and 29% have tried it. Another study found a 112% increase in the rate of youth vaping from 2017 to 2019.
Given the lack of public awareness surrounding the issue, many young people may not realize that an addiction to nicotine is still possible with vaping, even if tobacco is not involved. Recent survey data shows that among youth who vape daily in Canada, 57% have tried (unsuccessfully) to quit.
There is also emerging research to show that vaping can be a gateway to tobacco and cannabis use.
Vaping companies claim they only want adult smokers to use their products to quit smoking. If that’s the case, they’ve done a terrible job with their marketing strategy.
Why are youth vaping?
In short - product advertising is rampant, young people are being enticed with over thousands of attractive flavours. It’s not hard to get hooked when it tastes like your favourite candy.
A recent survey found that 9 in 10 youth and young adult vape users in Canada used flavoured e-cigarettes when they first tried vapes and continued to use flavoured vapes afterwards.
What’s revealing is that almost half of this age group indicated that they would stop vaping if flavours were not available. What do they enjoy most? After fruit flavoured vapes, mint/menthol was the most popular vape flavour among young Canadians in 2020 and 2021.
What do we know about the health impacts?
It's going to be 20 or 30 years, perhaps, before we fully understand the implications of vaping. The short-term impacts of vaping include damage to the function of blood vessels, along with increased blood pressure and heart rate. Many studies have found e-cigarette use to be associated with inflammation, oxidative stress, and haemodynamic imbalance, which are noted precursors of cardiovascular risk. And those who both vape and smoke are, it has been suggested, at higher risk for heart disease and stroke.
E-cigarettes have been shown to have some of the same negative health consequences as tobacco use such as increased risk of infections, weakened immunity, oral health issues and respiratory problems. In young people, we also see impacts on their developing brains. Nicotine is harmful and can stunt brain development. Emerging evidence also indicates an association between vape use and mental health issues among youth. What’s even more concerning is that the U.S. Surgeon General has found nicotine use in adolescence to increase the risk of future addiction to other drugs.
Overall – we have a significant public health crisis on our hands.
Should adult smokers continue to have access to vaping?
Vaping is less harmful than smoking, but it is harmful, nevertheless. There are potential advantages to the use of these devices as a smoking cessation aid, but the evidence is limited and unclear.
Heart and Stroke recommends current smokers receive advice from their doctor or other health practitioner. Seek advice that is tailored to your needs, just like any medications and other drug products.
Unfortunately, we know that most vapers are also current smokers, becoming what we call "dual users". There is evidence that dual users increase their overall risk of a variety of health concerns.
What needs to happen to contain this public health crisis?
First we need to play catch up. Canada has seen some recent leadership in policies to address the youth vaping crisis. But much more needs to be done to prevent youth uptake and reduce vaping rates among young people.
We need a comprehensive approach, which reflects the approaches we have taken to address the use of commercial tobacco products. Governments should:
- eliminate flavours, which appeal to young people, including mint/menthol,
- mandate plain and standardized packaging for all vaping products,
- add graphic and impactful health warnings to educate consumers on the risks of vaping,
- prohibit sales to those under 21 years of age.
So a whole range of policy measures are required. Then of course there's got to be appropriate enforcement and accountability.
It’s good to see that the provinces and federal government have started tackling this issue. There has been some leadership at the regional level with flavour restrictions, nicotine limits, age of purchase increases and taxation.
The federal government has restricted marketing and promotion to youth, limited nicotine content in vaping products to a maximum of 20 mg/ml, implemented a tax on vaping products as well as introduced a federal/provincial/territorial collaborative vape tax framework.
But this is only a start, and there’s still a lot to do. We’ll need to work hard to keep these harmful products out of the hands of young people and non-smokers. We also need firm policies that protect all people in Canada, not just those in certain provinces.
What Heart & Stroke is doing to advance policies against vaping
The tobacco industry is now big-time behind the vape industry. And with decades of experience in selling and addicting young people to harmful products, the tobacco industry is unparalleled in its ability to lie and to deceive the public, and to strenuously oppose any form of regulation.
Heart & Stroke and other organizations have been very active in making the case for regulation to governments and policy makers in every jurisdiction in Canada. We’ve called on governments to act quickly, because there’s an urgency around this issue.
