Would e-cigarette regulation alone improve adolescents’ health?

I read with interest the CMAJ article on adolescent e-cigarette use.1

That study concluded that e-cigarette use among adolescents is a serious public health problem and that regulation is the best strategy to curtail increasing e-cigarette use by adolescents. However, a recent study from the Yale School of Public Health shows that this measure can have unintended and dangerous consequences.2 The results show that banning e-cigarette sales to minors actually increases their use of conventional cigarettes. We may need to carefully rethink an e-cigarette regulation strategy.

I am an adolescent, and I strongly believe that adolescents are puzzled by the common-sense validity of a proposal for a stricter regulation to limit the availability of e-cigarettes. Further, I doubt that this strategy alone would be effective. Even though certain laws limit face-to-face sales of e-cigarettes to adolescents, there is much less oversight online.3^,4 Although most websites say buyers must be at least 18 years old, I know that adolescents and underage buyers can successfully place orders online. Moreover, online sales and targeted marketing are pushing adolescents toward e-cigarette use.5

Comprehensive prevention programs targeting adolescents are urgently needed in Canada. They need to be launched with the collaboration of schools, school boards, school administrators, parents, caregivers and youth organizations.

Getting adolescents involved in this prevention program is crucial and the key to success. I urge CMAJ to take a leadership role in a Canada-wide comprehensive school prevention program. We could perhaps tailor e-cigarette prevention programs similar to the old combustible cigarette prevention education programs.

We need an effective social media campaign to enhance adolescents’ knowledge about the ingredients in e-cigarettes, their potential adverse effects and the known health hazards of prolonged use and misuse. There also needs to be a strong public education and awareness campaign to counter common myths and misconceptions (e.g., like e-cigarettes are a therapeutic tool).