There’s no smoke, but the trend is on fire
With the dangers of nicotine having been firmly established over the years, fewer Canadian teens have been taking up tobacco. Now, however, there’s a disturbing related trend: more youth are vaping. The term refers to the use of e-cigarettes, or “vapes.” The battery-operated devices heat nicotine, along with flavourings and other chemicals, to create a water vapour that’s inhaled. There’s no smoke, burning, or scent. The gadgets, which are also called vape pens, mods, tanks, and e-hookahs, were originally designed to help people stop smoking. While not all products contain nicotine, they tend to appeal to smokers more than patches or gum because they mimic the smoking experience. The problem is that many teens perceive vaping as less toxic than cigarettes or, worse, altogether harmless. Some aren’t even aware that they could be ingesting nicotine.
David Hammond, professor at the University of Waterloo’s School of Public Health and Health Systems, says the prevalence of vaping has been increasing for the last several years. While this is clearly a concern, up until recently, much of that rise among youth was attributed to “trial”: kids trying it once or twice rather than using regularly. That has changed.
“Our data suggest that in the past year—from 2017 to 2018—more kids are vaping in general, and they’re vaping more regularly,” Hammond says. “We saw increases in nonsmokers as well.”
According to his research, in 2018, about 15 percent of youth reported vaping in the past 30 days, and about 10 percent reported vaping in the past seven days. “This is almost double the prevalence estimates from 2017,” Hammond says.
The prevalence of e-cigarette use (including trying an e-cigarette) went up to 23 percent among Canadian students in grades 7 to 12 in the 2016-17 school year, up from 20 percent in 2014-15, according to the Canadian Student Tobacco, Alcohol and Drugs Survey.
E-cigarettes aren’t new; they were introduced to Canada in 2007. So what’s driving the trend?
Hammond points to several factors, including new vaping technology and design along with aggressive marketing strategies.
Canada began allowing the sale of nicotine-containing vaping products in May 2018. That’s when the Tobacco and Vaping Products Act came into effect, replacing the 1997 Tobacco Act.
Along with the release of new products came an onslaught of ads that didn’t previously exist. One of the selling points of vapes has been the range of flavours: e-juice or vape juice comes in varieties such as mango, melon, berry, chocolate, peach, sugar cookie, and banana cream pie—tastes that are tantalizing to young people in particular.
Then there are scientific advances. San Francisco-based Juul Labs, which entered the Canadian market in September 2018, was the first company to offer “nicotine salt.” This chemical formulation of nicotine decreases the drug’s harshness, diminishing that rough feeling in the throat that accompanies smoking.
Also called nic salt or salt nicotine, nicotine salt consists of a chemical, often benzoic acid, that neutralizes the nicotine to create a more stable compound—one that’s smoother and more comfortable to consume.
Juul (which has even become a verb, “juuling” or “to juul”) also came up with a sleek new look. Smaller than previous market models, its vapes resemble a computer USB flash drive.
“These represent a new class of products,” Hammond says. “What we are understanding now is that nicotine salts allow these products to deliver very high levels of nicotine, and they do it in a very palatable way. It’s true of tobacco too, but if you have too high a concentration of nicotine in vapour, it leaves an acrid taste in your throat. Nicotine salts appear to get around that.
“Kids don’t see vaping like smoking: smoking is something your dad or grandpa does; most kids think it’s dirty,” he says. “Why would you want to do it when vaping is fun, it’s modern, it doesn’t smell, and you’ve got these great flavours?
“A lot of parents might not even recognize vaping products. One of the reasons kids like it is because it’s so easy to hide. Kids can do it in school. They can just put it in their sleeve and no one will know they’re vaping.”
Hammond emphasizes that e-cigarettes play an important and effective role in helping people quit smoking. However, they were never intended to introduce kids to nicotine, which is a highly addictive substance, and they are certainly not harmless.
Youth are especially susceptible to vaping’s negative health effects. The practice can affect brain development, memory, and concentration. It can also lead to addiction and physical dependence.
An Ontario study assessing vaping products at retail outlets determined that it was common for products to be mislabelled. Twenty-seven percent of products labelled as “with nicotine” had concentrations above what was stated.
Even if a vaping product does not contain nicotine, there is a risk of being exposed to other potentially harmful chemicals. Besides nicotine and flavouring agents, other ingredients found in vaping liquids include glycerol and propylene glycol. When the liquid is heated, other chemicals, such as formaldehyde, may form.
The long-term health effects of ingesting such chemicals isn’t known; neither are the lasting consequences of vaping in general on a person’s physical and mental well-being.
Vaping could be considered a gateway drug. Research suggests that e-cigarette use in youth is associated with smoking tobacco in later years. Plus, some youth are using e-cigarettes for cannabis. According to a study published in Journal of the American Medical Association Pediatrics, about one-third of middle and high-school students in the US in 2015 reported using e-cigarettes with non-nicotine substances.
Because of widespread concerns about the effect of vaping on youth, in April 2019, Health Canada launched consultations on how to reduce youth access and appeal. Potential measures included restrictions to online sales, prohibiting certain flavours, and limiting the concentration or delivery of nicotine in vaping products.
“I would argue that nicotine salt products like Juul’s are the first products that actually fulfil the potential promise of vaping along with the potential threat,” Hammond says.
“When I’m asked what does that mean for governments and regulators: they must find a way of cutting that cord and making sure these products are targeted to smokers rather than kids. That’s not been the case to date.”
Vaping products go by many names, and they may also be known by various brand names. Slang terms include: juice, smoke juice, e-smoke, mods, PV (personal vaporizer), and e-nic. Brands include Aspire, Eleaf, and Kanger.
To help kids understand the potential harms of vaping, consider these tips.