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When e-cigarettes hit the market almost 10 years ago, they were advertised as a clean, safe alternative to traditional smoking. To some extent, that’s likely true; they do seem cleaner and safer, and they may prove helpful to smokers who are trying to quit. That said, they may also carry some health risks of their own. If this evaluation sounds noncommittal, it is—scientists and national and provincial regulators are still duking it out, and the research on e-cigarettes (vaping) is in its early stages. Here’s what we know so far:

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What are e-cigarettes?

E-cigarettes were designed as a way for people to hold and inhale something that looks and feels like a cigarette without being exposed to tobacco smoke and its indisputable health risks. E-cigarettes are battery-powered devices that contain a liquid cartridge. When heated, the cartridge releases a vapour that the user inhales.

In Canada, there aren’t any standards or labelling requirements for e-cigarettes so it’s hard to know what exactly what they contain.

Here are some common ingredients that the vapour could contain:
  • Nicotine (usually—some e-cigs do not contain this)
  • Propylene glycol, a synthetic chemical that also shows up in some foods and toiletries, and other chemicals
  • Flavourings and colouring; these vary by brand
Here’s what the vapour does not contain:
  • Tobacco

There are currently no quality controls for making e-cigarettes and, to date, no products containing nicotine have been authorized by Health Canada. Although some companies label their products as nicotine-free, there have been tests that have found nicotine in them. This means that you can’t always trust what the packaging claims.

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How many young people are vaping?

E-cigarettes are in use, but maybe not as commonly as you might think. That’s according to a 2015 survey of 6,300 college students.

Using or not using e-cigarettes? 86% Never used, 10% Have used, but not in last 30 days, 4% Any use in last 30 days.

Source: American College Health Association–National College Health Assessment, Canadian Reference Group, Spring 2016.; anonymous, randomized survey.

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Could e-cigarettes harm my health?

At this point, researchers are sounding reasonably confident that e-cigarettes are less harmful than traditional smoking—but the research is far from complete. And e-cigarettes are unlikely to be completely safe.

The Framework Convention Alliance, an international organization focusing on eliminating tobacco-related harm, acknowledges the many areas of dispute regarding e-cigarettes. Nevertheless, it concludes, “e-cigarettes are almost certainly considerably less hazardous for individuals than cigarettes.”

If young people vape instead of smoking traditional cigarettes, they will avoid the harsh health effects caused by smoking tobacco, according to a 2016 study in Nicotine & Tobacco Research. These include cancers and heart disease caused by inhaling tar, a substance released as tobacco burns.

That said, no one can realistically tell you that vaping isn’t harmful at all. “Vaping may play a role in smoking cessation—that is, help people quit smoking. This however, still needs to be studied in greater detail. So overall, it’s a pretty complicated issue,” says Dr. Michael Khoury, a pediatric cardiology fellow at the University of Alberta Hospital, whose research on teens and e-cigarette use was published in the Canadian Medical Association Journal.

In people who would not otherwise smoke, using e-cigarettes could potentially contribute to health problems, researchers acknowledged in the Nicotine & Tobacco Research study.

The nicotine in some e-cigs has the potential to harm brain development in people in their early twenties, according to the World Health Organization. It’s conceivable that vaping could aggravate respiratory diseases, such as asthma and bronchitis.

Again, e-cigarettes vary in their ingredients, so their health effects likely vary, too. And relative to traditional smoking, e-cigarettes are the safer choice.

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Do e-cigarettes help smokers quit or create new smokers?

This is a point of contention among health professionals.

Vaping may be helpful in smoking cessation

Researchers are trying to figure out whether or not these devices can help people quit smoking altogether. The current evidence is mixed. E-cigs containing nicotine may be more effective for quitting smoking than a nicotine patch, according to a 2014 study published in Addiction. A 2016 analysis of multiple studies, however, found that e-cigarette use was associated with reduced rates of smoking cessation (The Lancet Respiratory Medicine).

In this context, it may be reasonable to try e-cigarettes as a smoking cessation aid—with caution. “By providing the nicotine that smokers need or want without the dirty delivery system of the cigarette, vaping [could] be an effective way for many people to quit smoking [traditional cigarettes],” says David Sweanor, Adjunct Professor of Law at the University of Ottawa, Ontario, who focuses on smoking cessation and anti-tobacco policy.

Vaping does not appear to be creating new smokers

The 2016 study in Nicotine & Tobacco Research explored whether vaping could create new smokers. The researchers (looking at a cohort of people born in 1997) found that although e-cigarette use has risen, traditional cigarette smoking has continued to fall. This suggests that vaping is not creating a new wave of smokers.

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Could my vaping harm people around me?

E-cigarettes don’t contain smoke, but they do create secondhand emissions. It’s still unknown what effect these emissions may have.

“Although the risks of secondhand vapour are likely to be substantially less than secondhand smoke, there may be some risks associated with chronic exposure to secondhand vapour,” says Dr. David Hammond, Associate Professor in the School of Public Health at the University of Waterloo, Ontario. “For this reason, many jurisdictions have banned vaping in places where smoking is prohibited.”

That said, “The risks from ‘secondhand vaping’ appear to be extremely low. Lower than things such as having an operating fireplace or a candle on a restaurant table,” says Sweanor. This suggests that you probably don’t need to worry much when someone occasionally vapes nearby.

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Why don’t we have better answers on how e-cigarettes may affect health?

Vaping hasn’t been around long enough for us to see its long-term effects. If e-cigarettes can potentially contribute to serious illnesses—such as cancer, lung disease, or heart disease—we won’t see that for years. Researchers can study how e-cigarette vapours affect the cells of lab animals, which may offer some insight but can’t show us exactly how vaping affects people in the long term. 

In addition, we don’t have much data on people who vape and do not also smoke (or never smoked) traditional tobacco products. Potentially, those people could serve as a control group, helping scientists untangle the relative influence of vaping versus traditional smoking on health. Among people who do both, that’s hard to figure out.

Lastly, some researchers are studying how e-cigarettes may help people quit smoking altogether. For these claims to hold water, the products’ (relative) safety and effectiveness have to be proven through a series of clinical trials.

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Are e-cigarettes regulated by the government?

The federal government has not enacted any laws regarding e-cigarettes. While e-cigarettes that contain the addictive substance of nicotine aren’t approved for sale, they are also not illegal.

“Though they are not regulated by Health Canada, that does not mean they are not regulated at all. There are provincial regulations on things such as age for purchase, points and conditions of sale, etc.,” says Sweanor.

Some provincial regulations include:

  • Sales limited by age: 19 and above in British Columbia, New Brunswick, Nova Scotia, Ontario; 18 and above in Manitoba and Quebec
  • Limited advertisement: No retail displays, signage, or advertising allowed outside of stores
  • Limited locations of sale: No sales in public buildings, pharmacies, or anywhere else tobacco sales are prohibited
  • Limited use by location: Use banned on all public and private school grounds, inside public spaces, and in workplaces. Use banned on health authority properties, except in designated smoking and vaping areas.

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Could I get addicted to e-cigarettes?

Nicotine is a highly addictive substance, whether you find it in traditional cigarettes or in e-cigarettes. The amount of nicotine in e-cigarettes can vary by product and manufacturer. There are no data yet on whether vaping leads to nicotine addiction.

Ready to quit? You can do this

Trying to quit without a plan can leave you without a way to cope when you get cravings. You’re more likely to succeed with a structured approach, says the Government of Canada. Ask your health care provider for tools and strategies that have been evaluated in studies and shown to be successful. To get started, click on these links:

Principles for successfully quitting

Steps in your tobacco liberation movement include:
  • Choosing the date you’re ridding yourself of tobacco.
  • Telling friends and family about it for support and to make you accountable.
  • Giving your environment a makeover:  Remove cigarettes, ashtrays, and anything that makes you think about smoking. Find alternatives to help you replace the habit, especially when you have cravings (e.g., healthy snack food, such as carrots or popcorn, or an assortment of delicious teas).
To quit permanently, your strategy has to be sustainable:
  • Look for life changes that you can live with; for ideas, check out former smokers’ strategies.
  • Make a list of things that are important to you and aim to keep doing them after quitting. This might mean spending more time with friends or pursuing your own goals, like joining the track team.

Quitting strategies that work

In studies, these tobacco cessation approaches have been shown to be helpful. For professional support, talk to a doctor or counsellor about what has been shown to work best.

  • “Motivational interviewing” is a specialist counselling approach that helps you come up with your own solutions. In a 2015 Cochrane review of
    28 studies, motivational interviewing with health professionals was more successful in helping people quit smoking than traditional health advice. Single, brief sessions appeared effective for quitting.
  • Dialectical Behavioral Therapy (DBT) is a form of cognitive behavioural therapy (CBT). The “dialectical” piece refers to two valid but opposing thoughts: (e.g., “I want to quit smoking” and “I would feel calmer right now if I had a cigarette”). DBT helps us understand our own stress triggers and develop effective self-soothing techniques. Mindfulness techniques are a foundational skill of DBT.
  • Nicotine replacement therapy (e.g., gum) or prescription medications (e.g., bupropion). In studies, using one of these two substances helped 80 percent more people to quit compared to a placebo, according to the Cochrane Collaboration, which reviews medical research.
  • Stress-busting alternatives help you avoid “just one” cigarette when you have a bad craving. One cigarette tends to lead to more, according to the Mayo Clinic.
  • Text-message, Twitter, or email program for regular quitting tips and support. Cessation programs delivered through Twitter can help keep people on track, evidence suggests.

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Chris Stuck-Girard is a Boston-based attorney and earned his MPH from Tufts University, Boston, this year. His work has appeared in various Boston Globe publications and Esquire.com.

Michelle Wallace is a Cleveland-based health journalist and editor of a consumer health blog for a major hospital. She has published articles for various health and wellness organizations, including not-for-profits, pharma, and medical insurance companies.

Naomi Leanage is a recent graduate from the University of Guelph-Humber with a degree in Media Studies and diploma in Journalism.