Earlier this year, the first vaping-associated case of acute bronchiolitis, also known as popcorn lung, was shown to be associated with vape use in a 17-year-old Canadian individual. Since then, researchers have compiled an increasing body of evidence elucidating the harmful effects of vaping on the teenage body and brain.
Alongside her colleagues, Dr. Charlotte Moore-Hepburn, a U of T professor and pediatrician at The Hospital for Sick Children, conducted a preliminary public health surveillance study to get a glimpse of the current vaping-related injuries and illnesses found in Canada. A questionnaire was given out to practicing physicians of the Canadian Pediatric Society, 42 per cent of whom responded.
A similar study had been conducted four years prior, and the most shocking difference, said Moore-Hepburn, is the huge increase in cases over time. “Asking almost four years later, we’re seeing almost three times as many [cases],” she said in an interview with The Varsity.
Evidence for safe vaping unconvincing
The study reported 88 cases of the most severe vaping-related injuries, which resulted in hospitalization or intensive care unit admission. It did not report on nicotine addiction following vape usage or the long-term effects on adolescent development.
Moore-Hepburn pointed out that other studies of appropriate research design, including prospective clinical studies and institutional-based research, are needed to answer these urgent and consequential questions.
“[But] the absence of clear evidence of harm does not equal safety,” Moore-Hepburn said. “There are a lot of unknowns… and young people shouldn’t vape.”
One argument that has pervaded the nationwide conversation on the safety of vaping is that vaping is a less harmful and less dangerous alternative to traditional tobacco smoking, and that vaping can be used as a cessation device for smokers. However, the evidence supporting these claims is lacking.
“There really isn’t good evidence to support it being an effective tobacco cessation device… and we have no evidence to show that, over the long term, it’s safer than cigarette smoking,” Moore-Hepburn said. She also acknowledged that nicotine addiction is “incredibly challenging” to break, but suggested that teenagers who want to quit should turn to their health care providers instead of vaping.
Public health efforts are now pushing for the prohibition of any statements that may suggest comparative benefits of vaping in contrast with tobacco smoking. “The evidence simply is not there to suggest that [vapes] are better or even safe at baseline.”
Harmful flavouring additives
Some of the further dangers surrounding vaping include the inclusion of nicotine in high concentrations as one of the key ingredients, as well as a chemical compound known as diacetyl, one of several flavouring compounds that are added to enhance the appeal of vape products.
The dosage of nicotine in vaping liquid is high, even in comparison to smoking, making a vape “a much more effective nicotine delivery tool,” according to Moore-Hepburn. A highly addictive substance, nicotine has been shown to severely impact the cognitive capabilities of teenage brains, which continue to develop until the age of 25.
Flavouring compounds found in vape liquid also represent not only a health concern but also an ethical issue since the marketing of these vape liquids has been meant to appeal to younger audiences with the sale of flavours such as “pink cloud,” “key lime,” and “blue freeze.”
This may “unnecessarily draw young people to what could be a very hazardous product,” said Moore-Hepburn, and advocacy initiatives have started to be put into place to ban vaping products that are specially designed to be youth-friendly.
Should the vaping age be raised?
As vape products are relatively new to the market, especially compared to regular cigarettes, much work in the realms of research, education, and advocacy is needed and warranted, Moore-Hepburn maintained.
Progress has been made in the diagnosis of lung injury as a result of vaping, as one study involving 12 adolescents investigated the imaging results of these patients’ lungs. The images of the lungs of adolescent vapers showed severe, acute injuries, directly as a result of the inhalation of toxic chemicals.
Another timely piece to the vaping puzzle is that researchers have suggested that the sharing of vape devices can lead to a higher chance of COVID-19 transmission. This adds on another layer of risk to vaping.
Some advocacy efforts by the Canadian Heart & Stroke Foundation, for example, have strived for legislative change to raise the legal age to use vape products to 21 years old, up from the current legal age of 18 years old, as defined by the Tobacco and Vaping Products Act. However, others argue that changing the legal age is not as effective as the direct regulation of marketing and access to vape products.
“It is abundantly clear that it is far too easy for people considerably younger than 18 right now to get their hands on vaping products,” Moore-Hepburn said, adding that marketing to youth by vape manufacturers is a key aspect that advocates have been targeting. Other efforts have included attempting to lower the nicotine concentration that is allowed in vaping products, considering the slew of negative health consequences of the addictive chemical.
Although Moore-Hepburn stressed the need for more evidence on the long-term effects of vaping in teenagers, she clearly presented the existing evidence as concerning.
Moore-Hepburn said, “To protect yourself… the safest thing to do is to not vape.”
