Evidence-based tobacco-control legislation on e-cigarettes is urgently needed

According to the US Centers for Disease Control and Prevention, every day about 1600 adolescents under the age of 18 years experiment with their first cigarette, and an additional 200 go on to become daily smokers.1 In fact, more than 95% of adults who are or were daily smokers tried their first cigarette before age 21.1 Therefore, empowering adolescents to avoid unhealthy behaviours is paramount, as we believe it is an important social and public health responsibility.

In a debate on vaping regulations in 2018, some Canadian policy-makers argued that there should be more leeway to advertise the benefits of vaping (e-cigarette) products.2 However, before more leeway is given to advertise the harm-reduction benefits of vaping products, we believe that the first step would be to establish whether vaping products are indeed safe smoking-cessation devices or harm-reduction tools.

How safe is vaping for Canadian adolescents? There is considerable methodologically strong research showing the consequences when adolescents start using these products. A Canadian longitudinal research study showed that among initial nonsmokers, those who use vaping products are more likely to start smoking combustible cigarettes a year later and are more likely to become daily smokers.3 This study was designed to control for susceptibility to cigarette smoking. It should be noted that the prevalence of high school students vapourizing cannabis through e-cigarettes is comparatively higher in Canada4 than in the United States.5

A US study showed that experimenting with e-cigarettes is reversing the previous long-term decline in adolescent smoking.6

In 2017, the Canadian Medical Association (CMA) forwarded its evidence-based recommendations regarding vaping for consideration in the House of Commons.7 The CMA reported that there was very low to low evidence at the time to support vaping as a smoking-cessation device or harm-reduction tool, and further emphasized that the restrictions on promotion of vaping products and devices should be the same as those for tobacco products.7 The conclusions of the CMA are supported by systematic reviews funded by the Canadian Institutes of Health Research8 and the World Health Organization.9

The National Academies of Sciences, Engineering and Medicine (NASEM) in the United States conducted a congressionally mandated comprehensive review of more than 800 peer-reviewed scientific studies on health effects of vaping on adolescents.10 It concluded that “there is substantial evidence that e-cigarette (vaping) use increases risk of ever using combustible tobacco cigarettes among youth and young adults” and “there is moderate evidence for increased cough and wheeze in adolescents who use e-cigarettes and an association with e-cigarette use and an increase in asthma exacerbations.”10

So far there have been more than 50 deaths and more than 2400 injuries related to vaping.11 The harms that e-cigarettes currently pose to nonsmoking teens and young adults far outweigh the potential benefits.12 Therefore, the recommendations of the CMA7 and the NASEM10 should be implemented to protect our vulnerable children and prevent a future tobacco epidemic in Canada.

It is well known that the industry promotes e-cigarettes using youth-friendly social media platforms. The Advertising Standards Authority (ASA), which regulates advertising in the United Kingdom across all media, recently implemented a socially responsible and commendable initiative banning Instagram e-cigarette posts.13 Four vaping companies, including British American Tobacco, have had Instagram posts promoting e-cigarettes banned by the ASA. Meanwhile, the British Broadcasting Corporation emphasized that urgent policy changes are needed from Facebook, Instagram and Twitter. We need to stop advertising harmful and highly addictive tobacco products to young people around the world.