Two-thirds of Canadian teens ages 12 to 17 have used e-cigarettes or vapes before smoking cigarettes, according to new data released by Statistics Canada.
For comparison, one-third of young adults between 18 and 24 years old reported picking up an e-cigarette before a smoke.
"This is the big concern that we always had at Heart and Stroke with respect to vaping, which was that we were quite worried a number of years ago, that it would be a gateway to cigarette use for youth. And in fact, that's what we see," says Manuel Arango, director of policy and advocacy at the Heart and Stroke Foundation.
"Now, you're getting dual use, and you're getting hit with the double whammy of very harmful vaping. And then very harmful smoking, and it's initiated by the vaping."
The StatsCan study states that in comparison to inhaling smoke from tobacco, vaping may be less harmful. It's a statement that John Hopkins Hospital also repeats in a blog post about whether vaping can help smokers stop their addiction.
But Arango emphasizes that "vaping is harmful, period. For health, especially for youth."
A 2021 study from a Swedish research team, led by Gustaf Lyytinen, a clinician at Helsingborg Hospital and researcher at the Karolinska Institute in Stockholm, found that e-cigarettes containing nicotine could result in heart attack, stroke, raise blood clotting risks, and harm small arteries.
While this study was small, it suggests that nicotine-laden e-cigarettes have similar health impacts on the body as traditional cigarettes.
In the past, some research suggested that vaping could help smokers quit cigarettes. But many others have argued the opposite.
"It's very inconclusive about whether even these products are useful for smoking cessation. It's just not there. And instead, what's happening is you're getting all of these youth becoming addicted to nicotine, and eventually smoking. So it's a bit of a public health disaster," says Arango.
A 2021 Heart and Stroke Foundation study found that "between 2017 and 2018, vaping among Canadians aged 16 to 19 increased by 74 per cent."
Taxation, vaping flavour ban
Federal Budget 2022 included a tax on vaping products, effective Oct. 1, 2022. The tax amounts to $1 for every 2 mL for vaping products for the first 10 ml of vaping liquid. In addition, the tax adds another $1 per 10 mL of vaping liquid after that.
Vape taxes is one preventive regulation from the federal government that Arango says can reduce young people's consumption of vaping products.
Some provinces have implemented a provincial tax but uniformity is important, he says.
"We need all provinces in Canada to match what the federal government's doing, and then to continue increasing those taxes because taxes really worked to reduce smoking, and they can work and assist in reducing vaping amongst youth, especially because these are price-sensitive," says Arango.
Another measure that's imperative, he says, is restricting flavours.
Nine in 10 young people said the flavours played a significant role in why they began vaping, and why they continue. Popular flavours among youth include berry, confectionary, mango and mint/menthol.
In 2021, the federal government proposed a ban on vaping flavours "to prevent vaping product use from leading to the use of tobacco products by young persons and non-users of tobacco products," the schedule to the Tobacco and Vaping Products Act reads.
But Arango observes that Health Canada has not included mint/menthol in the flavour ban.
"We know that mint/menthol is the second most attractive flavour. We're urging them to include mint/menthol, because it's something that youth also like."
Health Canada is also seeking to implement regulatory measures that would require manufacturers to report to the department about sales and ingredients in the products.
Arango says information disclosures are good for research but not necessarily helpful for the average person.
"Disclosing the ingredients is helpful for researchers and governments because they can then track and see what's maybe causing harm, aside from the nicotine, which addicts youth. But sometimes it's questionable whether people, youth will read the ingredients list if it's very small. What's preferable is bigger warnings," he says.
Similarly to cigarette warnings that was recently proposed and expected to be implemented in late 2023, Arango says "warnings that are prominent like on cigarettes that cover 75 per cent of the package that speak very directly to the harms of vaping, that would be more useful."