E-cigarettes, also known as vaping products, are battery-operated devices that mimic the smoking experience using an inhalation process that vaporizes fluid within the device. Research on e-cigarette use primarily among adolescents is just emerging. Studies in several countries including the USA, Poland, and Korea are showing a dramatic increase in interest and use of e-cigarettes by adolescents (Lee et al., 2014, Dautzenburg et al., 2013, Cory et al., 2012). Among US high school students, from 2011 to 2014 a nine-fold increase in e‐cig use (1.5–13.4%) was reported, with a similar increase observed in middle school students, and e‐cigs emerged as the most common method for using ‘tobacco’ in both age groups (Arrazola, et al., 2015). Additionally, over 7,700 fruit and candy flavorings of e-cigarette liquids are the number one reason that they appeal to adolescents (Ambrose et al., 2014). More than 460 brands of e‐cigs are available worldwide, and an estimated 6 billion dollars were spent on e‐cigs globally in 2014 (Euromonitor International, 2015). These numbers are expected to rise as awareness and popularity of e-cigarettes increase and as big tobacco companies, such as Imperial Tobacco, Lorillard, and R.J. Reynolds, focus on increasing their share of the e-cigarette market (Richtel). As with tobacco products, e-cigarettes may mitigate deterrence from the initial harsh sensations that nicotine induces until dependence develops and fosters ongoing use (Ambrose et al., 2014).
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There is substantial international variation in regulatory policies and the extent to which these are enforced. E-cigarettes containing nicotine are now legal in Canada since the passage of Bill S-5 in May 2018. This legislation legalized e-cigarettes with nicotine for adults in Canada and established a regulatory framework that included marketing restrictions and safety standards. However, regulations in Canada, Australia, and New Zealand are easily bypassed through Internet imports and lenient enforcement. E-cigarettes with and without nicotine are widely available for sale and are becoming increasingly prominent in various types of retail stores (Non-Smokers Rights Association, 2007). Erythropel HC., et al discovered in their study that some cigarette labels listing chemical content were inaccurate and therefore stressed the importance of accurate labels and warnings about the effect of mixing e-cigarette solvents. They also noted that individual ingredients are been combined to form more complex chemicals that are not disclosed to the user. When inhaled, these compounds will persist in the body causing mild irritations that could cause inflammatory responses.
In a study examining the popularity of e-cigarettes in Canada and other countries, its prevalence increased dramatically, surpassing that of nicotine replacement therapy by late 2008 (Ayers et al., 2011). According to Khoury and colleagues, 10% of the adolescents in their study were motivated to try e-cigarettes because of their novelty or the image ( “coolness”) that it portrays, and rarely did they use e-cigarettes to quit smoking (Khoury et al., 2016). This study also confirmed that most adolescents were not substituting e-cigarettes for cigarettes: instead, the odds of e-cigarette use were 12-fold higher in youth who also smoked cigarettes (i.e., “dual users”). Recent reviews have found little or no evidence to support the use of e-cigarettes as a smoking reduction and cessation device. Expert opinion is also divided as to the value of this product for smoking cessation. Public health experts warn of the potential for e-cigarettes to normalize smoking as their use becomes more frequent.
Cannabis vaping has received limited study but also appears to be on the rise among adolescents and young adults (Jones et al., 2016, Morean et al., 2015). Among e-cigarette users, cannabis vaping occurs more often in populations of high school-aged youth than adults (Morean et al., 2015). Recent data suggest that adolescents who vape cannabis most often use highly potent cannabis oil, wax, or liquid preparations (Morean et al., 2015). Scientific research over the last two decades has established that the human brain continues to develop into a person’s early 20s. The concern is rising that exposure to cannabis during this important developmental period causes greater adverse effects in adolescents compared with older adults, whose brains are fully developed (Giedd et al., 1999, Lenroot & Giedd, 2006 ). Cannabis exposure during adolescence, a critical period for brain development, can cause addiction, might harm brain development and could lead to sustained cannabis product use among youths. To date, however, few data exist on the use of vaping devices for cannabis consumption among youth despite these potential risks. Comprehensive and sustained strategies are warranted to prevent and reduce the use of all cannabis products among Canadian youths.
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