Vaping: The New Frontier for Tobacco Control

Tobacco use is the leading preventable cause of premature death and disease in Canada. Every year smoking kills about 45,000 Canadians.

Many people smoke for the nicotine in tobacco products, which is highly addictive. But it isn't the nicotine in cigarettes that presents the biggest health risk. When tobacco is burned, toxic and cancer-causing chemicals form in cigarettes and tobacco products.

This is one of the reasons that many Canadians are switching from smoking cigarettes to using vaping products, such as e-cigarettes. Vaping products contain only a fraction of the 7,000 chemicals found in tobacco or tobacco smoke, and at lower levels.

Over the last number of years, Health Canada's Tobacco Control Directorate has been studying vaping to better understand its risks and harms and to assess its potential to provide a less harmful alternative to smoking.

In May 2018, Parliament passed the Tobacco and Vaping Products Act, legalizing vaping products containing nicotine, in recognition of the fact that these products offer a less harmful alternative to cigarettes for adults who already smoke. At the same time, the legislation introduced measures to protect youth and adults who don't smoke from the hazards of these products.

We asked Dr. Samir Khan, science advisor in Health Canada's Tobacco Control Directorate, to talk to us about vaping and the new Tobacco and Vaping Products Act.

Samir, what is vaping?

Vaping is a less harmful alternative to smoking cigarettes. Instead of inhaling smoke from burning tobacco, you inhale vapour from an e-cigarette. Vaping products like e-cigarettes contain a liquid that is heated until it becomes a vapour. The vapour then turns into an aerosol, which is actually what you inhale.

What kind of research is the Tobacco Control Directorate doing on vaping?

The Tobacco Control Directorate has an advisory board that monitors and reviews the science of how vaping products affect health and provides Health Canada with advice. We also have our own science and research program that is setting up projects to look at the health effects of vaping. We're asking questions like what chemicals are found in vaping liquids? Are they harmful? What happens to a smoker who switches to vaping products? We are looking at the risks and benefits of vaping products at an individual and population level.

Another general question we're asking is about moving smokers to vaping products. This information is of interest to health providers as well as to people who smoke. And this research will tell us what kind of tools we can leverage inside or outside the federal government to move smokers from cigarettes to less harmful vaping products.

What is the research telling us so far about the risk and harms of vaping?

The research to date tells us that, like smoking, vaping exposes users to nicotine. Nicotine is highly addictive and vaping can lead to dependence. We also know that nicotine use can alter brain development among youth, which is concerning. Other research shows that vaping can irritate vapers' airways and cause lung inflammation.

Vaping products have only been in the marketplace for about ten years, so the research on their long-term health effects is limited. We do know that switching from smoking cigarettes to vaping will reduce exposure to many harmful chemicals, but we don't yet have the same level of understanding about long-term effects of vaping.

Why did Health Canada opt to legalize vaping products with nicotine?

Over the years we've had some success in reducing tobacco use in Canada. We've provided information, talked about cessation, and urged people to quit smoking. The next step is to move smokers onto less harmful products. Through legislation, we're allowing these products onto the market to give adult smokers less harmful options, while also protecting young people.

How are youth protected under the new legislation?

The Act makes it illegal to sell vaping products to anyone under age 18, and it prohibits advertising that could make these products appealing to youth. It also restricts promotion of vaping liquids that are flavoured like candy and desserts. The Act also gives us the flexibility to adjust the regulations or create new ones if necessary to deal with health and safety issues that arise, for example from new products that come onto the marketplace or from new information we discover through research.

What do you like about working in this field?

It sounds corny, but I like doing things to help smokers, their families and people around them. My background is in psychology and science, so I know how much an addiction can take over someone's life. Tools like vaping weren't available 15 years ago. Now they can potentially help smokers quit smoking faster or at least do less harm. At the same time, we reduce rates of disease and death, and that keeps me motivated.

What's the most challenging aspect of your work?

Addressing the risk to youth is a constant challenge. You don't want kids using e-cigarettes or getting addicted to nicotine. At the same time, you want adult smokers to have access to a less harmful alternative to smoking cigarettes. So you have to always balance the public health risk with the public health benefit.

So, when your friends want advice on vaping, what do you say?

If you don't smoke, don't vape. But if you are a smoker, you should think about moving to vaping as a less harmful option. It could be your gateway to going tobacco free.