Vaping among Canadian teens doubles in 2 years, new research shows

New research reveals vaping among Canadian youth has risen dramatically over the past two years, and experts say it shows no signs of slowing down unless stricter regulations are put in place immediately.

A survey of more than 12,000 Canadians aged 16 to 19, done in three groups between 2017 and 2019, found that the number of those who reported vaping in the previous month had more than doubled to 17.8 per cent from 8.4 per cent in 2017. The results were published in the journal JAMA Pediatrics this week.

Those who said they had vaped in the past week rose to 12.3 per cent in 2019 from 5.2 per cent in 2017. Those who reported using e-cigarettes more than 20 times in the previous month jumped to 5.7 per cent from 1.8 per cent.

Overall, the number of Canadian young people surveyed who said they had ever tried vaping rose to 40.6 per cent in 2019 from 29.3 per cent in 2017.

"That is stunning, and there needs to be pressing action by federal and provincial governments to reduce youth vaping through a series of measures," said Rob Cunningham, a senior policy analyst with the Canadian Cancer Society.

David Hammond, a public health professor at the University of Waterloo who led the youth study, which also looked at rates of vaping in the U.S. and U.K., found similar trends among American but not British young people.

He said that is largely because the European Union has put a cap on the amount of nicotine allowed in e-cigarettes, at 20 milligrams per millilitre, while Canada and the U.S. have not.

The maximum amount of nicotine content currently allowed in e-cigarettes in Canada is more than triple that of the EU,at 66 milligrams per millilitre, according to Health Canada.

Health Canada said in a statement to CBC News it is "concerned about the rapid rise in youth vaping" and that the government has taken steps to address the issue including investments in public education, "intensified enforcement" of legislation and additional regulations.

The federal health agency said it proposed new regulations in December to prohibit the advertising of vaping products "anywhere they can be seen or heard by youth" and is currently reviewing feedback from Canadians "with a view to finalizing these regulations as soon as possible."

"Health Canada is considering taking further action to reduce the appeal of these products to young Canadians," a spokesperson said, "including further restricting nicotine concentration and flavours, as well as other possible measures described in the April 2019 consultation."

Juul cited as key factor in spike

Popular devices such as Juul or Vype use what are known as "nicotine salts" to deliver higher concentrations of the drug to the brain much in the same way that cigarettes do.

The Canadian Cancer Society says the highest amount of nicotine used in Juul products is 59 mg and 57 mg in Vype.

"This phenomenon was probably driven by Juul and the type of product and nicotine concentration in Juul," Hammond said.

"We've seen increases in the use of Juul and Juul-like products among kids to the same extent in Canada as the U.S., so that's why we think that that probably is the main reason that explains why England has not seen the same increases."

A spokesperson for JuulLabs Canada Labs said in a statement to CBC News that no one underage should use its products and that the company is committed to working with regulators, policymakers, and law enforcement to combat underage use.

"We do not want any non-nicotine users, especially those underage, to try our products since our products exist solely to help adult smokers find an alternative to combustible cigarettes," the spokesperson said.

JuulLabs Canada said it has never marketed to underage users, but the companyhasfaced a lawsuit in Canadaand its Americancounterpart was also sued inthe U.S.after being accused of doing just that.Juul Labs Ltd. also agreed to a settlementlast yearrestricting its advertising practices to youth in the U.S.

Imperial Tobacco Canada says in itsonline ad campaignthat "impulsive regulations" by government and health groups "won't do anything to reduce youth vaping" andsays on its websitethat its products aren't intended for youth use. Thecompany has not responded to a request from CBC News for a statement in response to the study.

Cynthia Callard, the Ottawa-based executive director of the health advocacy organization Physicians for a Smoke-Free Canada, said the organization is "very concerned" by the findings.

"These products produce harms that are not well understood, either by scientists and most certainly not by the young people who are picking them up," she said.

"Because of the power of nicotine addiction, this is not a fad that most users can be expected to 'outgrow' as they mature."

Young Canadians more likely to vape

A recent national survey of 8,600 Canadians by Statistics Canada found similar trends to the JAMAPediatrics study, showing young people were far more likely to vape than adults.

Fifteen per cent of those aged 15 to 19 said they had vaped in the previous month, with 36 per cent reporting they had tried vaping at least once in their lives.

Yet less than three per cent of adults aged 25 and over had vaped in the 30 days prior to the survey and just 12 per cent said that they had tried vaping at some point.

"It doesn't appear that we're doing any better with adults, and we're doing much worse among kids," Hammond said.

"I think we may have struck out, in that we're not doing a better job with the actual target group, and we're doing much worse with the group that we most wanted to protect."

The federal government moved forward with plans to place stricter limits on advertising and make health warnings on vaping products mandatory in December, with many provinces moving to impose their own restrictions on the products.

Prince Edward Island has prohibited the sale of e-cigarettes outside of adult-only specialty vape stores, while Nova Scotia has banned all flavours except tobacco as of April 1.

"The federal government promised a 'balancing act' between the need to provide adults with a legal supply and the need to protect children," Callard, of Physicians for a Smoke-Free Canada, said.

"Adults now have a legal supply, but the health of children is being sacrificed."

Cunningham, with the Canadian Cancer Society, said federal restrictions need to go a step further to curb the growing trend in vaping among youth as soon as possible.

"The federal government should be moving forward to finalize its regulations to restrict advertising, have a maximum nicotine level of 20 milligrams per millilitre and to restrict flavours," he said.

"We also have to remember that it's tobacco companies that are dominating the vaping market and marketing in Canada, and they have this long history of successfully having their products being used by youth."

Juul is partially owned tobacco giant Altria, the parent company of Marlboro cigarette maker Philip Morris, while Vype is sold by Imperial Tobacco Canada which is owned by the world's second largest tobacco company, British American Tobacco.

Smoking drops, vaping rises

Peter Selby, chief of medicine in the psychiatry division of the Centre for Addiction and Mental Health in Toronto, said while the rise in youth vaping is concerning, the JAMAPediatricsstudy also showed a decrease in reported youth smoking during the same period.

The number of Canadian young people who reported ever having smoked decreased to 7.4 per cent in 2019 from 11.9 per cent in 2017, while those who had smoked in the past month dropped to 3.8 per cent from 6.7 per cent.

"So, in a way it's a good sign that they themselves are moving down but not being exclusive cigarette smokers," he said.

"The biggest concern I have is that, yes, they take up vaping, but then we make it hard for vaping to continue. So now you'll end up with either more dual users or completely switching back to cigarettes."

Hammond said that while a drop in youth smoking rates is significant, it is to be expected as smoking rates have dropped annually for most of the past two decades.

"What is distressing is that e-cigarettes is creating a new generation of nicotine users right near the point at which we are close to extinguishing smoking among young people," he said.

"For their part, the industry is delighted that they have been able to expand the nicotine market for the first time in a generation."

Callard said that drop is largely due to public health efforts banning tobacco advertising, smoke-free laws and controls on cigarette products and packaging.

"There have been repeated federal surveys on youth smoking, and so far there is no evidence that vaping has improved the situation," she said. "Vaping adds to the problems of smoking; it does not replace it."