How vaping is undermining Canada's battle against cigarettes

This column is an opinion by Dr. Anthony Graham, an honorary member of the advisory board of Heart & Stroke in Ontario, a professor of medicine at University of Toronto, medical director at Robert McRae Heart Health Unit at St. Michael's Hospital Unity Health Toronto, and a Companion Member of the Order of Canada. For more information about CBC's Opinion section, please see the FAQ.

Canada took a big step as a world leader in tobacco control when strict plain-and-standardized packaging rules for tobacco came into effect on Nov. 9. Unfortunately, and potentially tragically, we are falling far behind in another vital area of nicotine consumption and addiction – vaping.

Other countries and jurisdictions are either already way ahead of us or will be soon.

Canada's Tobacco and Vaping Products Act, which legalized vaping products with nicotine, was passed in May 2018, but the regulations put forth were not sufficient to protect youth from vaping.

Meanwhile, Manitoba, Quebec and P.E.I. have passed stronger provincial regulations to address youth vaping. Saskatchewan recently introduced and passed vaping legislation in a record two days thanks to the entire legislative assembly working together. British Columbia has proposed the most comprehensive restrictions, including a cap on nicotine levels, plain packaging with health warnings, increased taxes and limits around advertising.

As some provinces step up and take action in the face of poor federal direction, the result is a patchwork of provisions for regulating vaping equipment and products across the country.

This means that kids in some provinces are benefiting from better protection than others, and Canada's youth will pay a high price for this regulatory gap. While federal policy makers seem to be sitting on the sidelines, our youth are busy vaping.

According to a study out of the University of Waterloo published earlier this year, vaping among Canadian youth skyrocketed by 74 per cent in one year.

In the same timeframe, youth smoking rates for tobacco jumped by 45 per cent, from 10.7 per cent to 15.5 per cent, the first time such rates have gone up substantially in decades.

The increase brings the rate of youth smoking in line with all Canadians aged 15-plus, indicating our progress in tobacco control is at risk.

Why is this happening?

Nicotine is highly addictive, and vaping makes nicotine uptake far easier and more pleasant than smoking cigarettes. Nicotine can be inhaled without combustion smoke and with a wonderful chocolate or sweet fruit flavour.

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In fact, there are hundreds of fruit, sweet and dessert flavours available, many with fun, cool names like Sour Skittles, Salted Caramel and Sugar Cookie. They are designed specifically to appeal to youth, and they play a big role in enticing them to start and continue vaping.

These products are also advertised heavily – including through lifestyle marketing – on social media.

Vaping is an easy and tasty way for kids to get addicted to nicotine. And it can be as hard to quit as smoking.

A 2018 review by Public Health Ontario concluded that vaping is associated with an increased risk of starting to smoke cigarettes, even among youth considered to be at low risk of doing so.

Besides creating an addiction which could lead to tobacco smoking, research shows nicotine alters adolescent brain development and can affect memory and concentration, potentially hampering their ability to learn.

Of additional and serious concern to the risks of tobacco use are the recent reports of severe lung damage among young people who have been vaping. There have also been premature deaths.

Outside Canada, concrete action is being taken to limit vaping among youths.

In the U.S., 18 states have enacted or proposed increasing the legal age for purchase to 21, and at least nine jurisdictions have moved quickly to address the vaping crisis by restricting the sale of vaping equipment and/or the availability of vaping flavour pods.

Finland banned all vaping flavours except tobacco flavour in 2016, a move to limit vaping to serving as an aid to quit smoking.

In Europe there has been a vaping nicotine threshold level of no more than 20 milligrams per millilitre since 2014. In Canada, the nicotine limit is more than three times that, at 66 mg/ml.

Europe and countries in the Middle East and Asia have also mandated nicotine warnings and/or health warnings on packaging, and have stronger marketing restrictions than we have in Canada.

Even in China, where more than half of all men smoke cigarettes, the tobacco regulator has just decreed that vaping products should not be sold online, in order to try to stop young people from buying them.

So what needs to be done in Canada?

The federal government needs to act quickly to protect youth by strengthening vaping regulations. This includes implementing a comprehensive flavour ban, as has been done in other jurisdictions, as well as restricting promotion and sales, placing lower limits on nicotine levels, and mandating health warnings.

In short, Ottawa needs to do all the things it did successfully with traditional tobacco products. Protection is needed now, before we create a whole new generation battling nicotine addiction and poor health outcomes.

• This column is part of CBC's Opinion section. For more information about this section, please read our FAQ.