Jordan: When we talk about marijuana or tobacco on this podcast, we talk about smoking, and that’s how I know I’m old.
News Clip: Vaping among teenagers is hitting new heights in Canada. A new study is sounding alarm bells revealing that vaping among teenagers between the ages of 16 and 19 has increased 74% over a one year period.
Jordan: I know what vaping is, obviously, but what I didn’t realize is the extent to which it has revived nicotine use among teenagers, or how it might even be reviving smoking, and I do not want to be alarmist because lord knows people can make their own choice, and do whatever they want with their bodies. I smoked for a long time, it was my decision. But what I do think about a lot when I walk through fruit flavored clouds on street corners, is if we really know what vaping does to us in the long run, or if everyone using these things is just participating in a real time medical experiment, and if we’ll have to find out as the first Juul generation ages and if that is the case, then shouldn’t we at least try to make sure that generation starts with adults and not teenagers?
Jordan: I’m Jordan Heath Rawlings, and this is The Big Story. Carly Weeks is a health reporter at The Globe and Mail who covers, among other things, vaping. Hi Carly.
Carly: Hi.
Jordan: Why don’t you start for old people who are tremendously uncool people and explain exactly what vaping is?
Carly: Right. And I think that is a really great place to start because I don’t know if a lot of older people, like, say, over 25, understand just how cool vaping is to the younger generation and just how many people are vaping. So basically, what’s happened is that e cigarettes have been around for a while, it’s like this battery powered device that you can inhale vapor from, and they contain nicotine, and so…. you know, they’ve been marketed traditionally as an alternative to cigarettes, a safer way to smoke, and there is research to back up that that can be the case, that it is actually safer than cigarette smoking. The problem is that nicotine is addictive, and so when young people have sort of gotten on the e cigarette bandwagon, which has happened, it can have a lot of harmful results and the other thing that’s sort of new is that e cigarette technology has really evolved. So back in the day, you know, five or more years ago in Canada, the only e cigarettes that were available that, first of all, they weren’t supposed to contain nicotine, although often times they did illegally. But they also weren’t very great in terms of actually getting nicotine into your body. So a company named Juul came along, and they basically reinvented e cigarettes and they’ve created a product using nicotine salts that delivers a very high nicotine content…. very concentrated, but also without any of the throat or mouth irritation because apparently, I’m not a vapor. but apparently one of the problems is that when you’re inhaling, it can actually really cause a lot of irritation, and it can hurt. So now, basically, we have e cigarettes that deliver the same nicotine as cigarettes that is uncomfortable to inhale, and can also come in a variety of fruit and candy flavors, and so it’s a marketplace that’s been exploding.
Jordan: When did that start happening? Because, like you mentioned, I remember, you know, five years ago there were lots of these products available, none of them were particularly a market leader, and now I see it everywhere, especially Jewel, which is like on the front of convenience stores in Toronto advertising that they have these products available. When did that like; Did we cross the threshold sometime?
Carly: We certainly did. So for a long time health advocates have been warning about the rise of e cigarettes, and we’ve been watching the states where they’ve had legal nicotine containing e cigarettes for a lot longer, and so they’re much farther ahead in terms of the public health warnings. So what happened in Canada was that we finally got legislation legalizing nicotine containing e cigarettes that came into force May 2018, so about a year ago, just over a year ago, they were legally allowed on the market. A few months later, Juul issues a press release that they’re coming to Canada, and the reason why that’s significant is that in the United States, Juul has been, for the last couple of years the dominant player in the market, and so you know, the biggest player in this market is coming to Canada, and so these two events kind of unfold around the same time the legalization and then the entry of this big player, and then we really start to see this explosion. Now a few months after that, the Ontario government under Doug Ford passed new legislation that is very controversial that allowed e cigarette companies to openly market in places where young people can see them. So it’s common to have a specialty vape shop and, you know, obviously companies can market there, that’s been the way it’s gone. But now anyone in Ontario can attest to the fact that you walk outside and you see these ads everywhere, and they are very common. And you know, there’s Juul, there’s another product called vipe, there’s a couple of these products that are out there, so it’s not just one player, but, you know, we’re seeing these ads everywhere and so….
Jordan: Is that legislation specific to Ontario? Do other provinces have things that allow that?
Carly: That’s a good question. So we’re the only province that allows it. Ontario is the only province that passed legislation allowing this, every other province has strictly sort of restricted this. The exception are two provinces, Alberta and Saskatchewan, that have no legislation whatsoever so they’re in a gray zone. So until those provinces come on board, and there’s talk that they will, there’s, you know, pushes there to bring something online. It’s kind of a free for all in those provinces.
Jordan: So in other provinces in Canada, it would be similar to tobacco advertising, which would happen in, like, specialty places where it was allowed.
Carly: That’s right, yeah, and so that is where we’re hoping to get the federal government. Some would argue it’s in response to what Ontario’s done but the federal government a few months ago said, okay, we’re gonna crack down on advertising then. We’re not going to allow public place advertising and things like that. They would still allow some e cigarette advertising, but they would really, really rein it in. So no longer would you see e cigarette advertising at a convenience store, or a gas station or anything like that, which the e cigarette companies some of them do object to. They don’t want those changes to be brought in.
Jordan: You mentioned that it’s particularly appealing to teenagers and young people. How does that impact of the marketing? Do they market that way or is that just sort of a natural consequence from being able to advertise everywhere?
Carly: Right. This is, I think, one of the key questions, you know, in what comes first? Is it the marketing, is it the teen use? So the companies that sell e cigarettes will attest to the fact that they do not want young people using their products, that they don’t market to them, and they have efforts underway to stop youth from using them. On the flip side, I’ve interviewed a lot of health experts who say that’s bogus because we see that much like the tactics of the cigarette industry back in, you know, the sixties, the fifties, whatever, there is this clear drive toward youth use of e cigarettes. So in interviews that I’ve done, I’ve talked to health professionals who say that e cigarette companies you know, regularly market on campuses, you know, they are sort of pushing that market now that is a legal market because in most provinces you’re allowed to buy an e cigarette if you’re 18 or 19, so you know, it’s perhaps a bit of a grey line there.
Jordan: Just on the edge, ya.
Carly: But there has been some other research that’s come out that has shown that e cigarette companies are using social media and things like that to get their message out to young people, and so there is this question. You know while they’re saying that they’re not, at the same time something clearly appears to be trickling down. I mean, and anecdotally, I was walking down the street a week or so ago on Queen Street in Toronto, and I saw the big e cigarettes sort of van pull up with the open like it’s almost like a product demonstration was going on. Kids see this, they think it’s cool. I had one expert basically say, that one of the e cigarettes on the market, I believe it was a juul product is like the iPhone now. Like it’s that cool to have it, they come in really cool colors, and they’re so small it’s like a flash drive in your hand, and so, you know, whatever these companies are doing, it is appealing to young people. So whether or not they’re even tacitly doing it is almost, you know, a secondary question as we move into this idea of now what? They’re in the hands of young people, I have a niece who says everyone in her school vapes, she’s 14 you know, it’s scary.
Jordan: Anecdotally for sure, if you look around Toronto you see people vaping almost on every street corner. Do we have any numbers that can show us whether or not the practice is increasing in among young people in particular?
Carly: This has been the $1,000,000 question, and so for the very first time we can actually report data. So there’s a guy at the University of Waterloo who is one of the top experts when it comes to e cigarette use, and he’s been crunching numbers for a long time. So he did a study that looked at this period before e cigarettes became legal and before the big players with the new technology came on the market, and after, and sort of immediately after. And so the companies would say it was so immediately after that you know, they questioned the results and things like that, but basically what we’re seeing is that usage increased in that one year period by double, so like rates are literally twice what they were in a year’s time, and that should send a lot of alarm bells because we’re not just talking people who’ve ever tried. So the number of young people, this study, this particular study looked at 16 to 19 year old’s. The number who’d ever tried an e cigarette went up substantially to somewhere around like the 45% mark. So that’s high but, you know, you see numbers like that with alcohol and things like that. You know, let’s say you know, young people experiment, we know this. When you look at the people who were regular users, so have ever used in the last 15 or 30 days, those numbers were also high. That’s a concern because that means those people are likely addicted or are coming close to being addicted to e cigarettes, that’s why there’s so much concern. Daily use in young students, people, because I’ve had people question me about this, daily use is not a great metric in teens because they’re not really daily users of a substance, that’s just not their wheelhouse. They’re more like sort of weekly, or the weekly usage, you know bi weekly usage of that is a little bit more telling, and so when you see that 15% of people in that age group are regular users, that’s why people are so concerned, because that’s not a small number. And so this backs up what we’ve been hearing for months, which is that high schools are taking doors off of bathrooms because they can’t stop people from vaping. Parents, teachers they’re calling in, they’re flooding their constituents, like their MP and MPP’s offices with concerns with questions. David Hammond, who this researcher I mentioned who’s doing the research, he said he is getting like inundated with calls from people like what do I do? If he talks about his work at a party, he’s immediately flooded with questions like, how do I stop my teen? What do I do about this? It’s a problem across the country, and it does harken back, and I think the reason why there’s so much concern is it really does remind a lot of people of what the smoking epidemic was like at a time when if we look back a few decades, more than half of the population smoked.
Jordan: How does that; That was going to be my next question anyways, how does that rate among 16 to 19 year olds compared with smoking? Which I imagine has probably fallen dramatically over the last couple decades.
Carly: Yeah, you’re right, and so this is actually a really good point. One of the most frightening things about this study is that it’s actually showing that smoking rates among 16 to 19 year olds is on the rise again, after decades of falling like we’re talking decades. So I was able to go back and just look at the numbers since 1999 which shows a very clear fall, and smoking rates among young people are like the lowest they’ve ever been. But you see, like this has been going on for decades, and so to see those numbers going up, I mean, no one is saying that is the fault of e cigarettes because there’s other things that have happened at the same time, like cannabis is now legal as well. But apparently the researchers, they did sort of calculate that, they put the cannabis legalization into their analysis, and they said, even still it doesn’t account for the increase. So there is a question, is e cigarettes leading to a rise in cigarette usage? Some research has shown that yes, those two things are tied together because you get someone hooked on nicotine, and then they go to cigarettes, this is the concern. But yes, if you look back, we’re not seeing the high rates of e cigarette usage yet, like comparable to sort of the heyday of nicotine containing cigarettes but we’re still in early days. We’re talking very, very, like not even one year out from some of the new technology coming to the market in Canada.
Jordan: Well you mentioned at the beginning of our conversation that it’s safer in some respects than smoking cigarettes? And my question was, I think my whole team had this question, when we were talking about this story is, what do we know about it? Cause for smoking we didn’t know for decades what it was actually doing, and there are no people nearing their sixties and seventies now who have grown up vaping, right? So in what respect is it safer? And also what don’t we know?
Carly: Right. So I’m;And I get, like, sort of inundated with tweets and emails from the pro vaping community who say you know look, this is safer than cigarettes, and this is a viable alternative, and I think what we can definitively say right now, based on the preliminary studies that have come out, there’s been a couple of good studies, but still a lot that’s unknown. We can say right now that e cigarettes do appear safer in the long run than cigarettes because they just, they simply, they’re not as damaging to the lungs, they don’t contain as many harmful chemicals, etc. etc. That being said, there’s a lot we don’t know. So the questions that remain, some e
cigarettes will contain different substances than others and things like that. So what happens when you expose teen brains to that level of nicotine over a sustained period? You know who has done that study? These things are also ethically difficult to study, because you can’t just pump of under teenagers full of nicotine, and then leave a bunch of other teenagers nicotine free and see what happens to them. So this is like a real world living experiment that we’re going to sort of see evolve. What exactly is the harm that’s done to your lungs, to your internal organs by inhaling this vaper, because it’s not completely innocuous. Sure, it’s better, but these are things that we simply don’t know, and so these long term questions and things like that. It’s not just hand wringing, it’s not just in any state. These questions need to be answered, and they literally have not been able to be answered yet because of, this is just not something we’ve ever been able to study.
Jordan: When you talk to teachers, and parents and health professionals, what do they say we need to do? Because that’s I mean, that’s the big question, right?
Carly: Right. The good thing is that there is a lot that can be done, and so it’s not just sort of, you know, standing around whining and moaning, there are some real calls out for things to change. So one of the biggest and most effective things that they think can be done, and when I say they, I’m talking about health groups like the Canadian Cancer Society that have helped champion the reduction in smoking rates that have gotten us to where we are, they are calling for moving the age of legal purchase to 21. So you make legal purchase age 21 all of a sudden a lot of those things like on campus advertising, and other sorts of things start to go away. And, you know, let’s not forget in some provinces you may have, you know, an 18 year old who’s in a high school or certainly siblings of 18 year olds in high school and younger. So you move it to 21, and you start to eliminate access to that age group because we know that a lot of young people are getting access from older people who are buying for them in a social setting. So move the age, get rid of some of the flavors. So the United States is actually moving forward with this, it’s unclear right now where exactly, but they’re basically moving to get rid of a ton of the flavors that are out there, like one of the flavors is unicorn puke, you know, and there’s all these candy coloured flavors and, yeah, fruit flavors, it’s wild. So it’s kind of this funny. I mean….
Jordan: Didn’t we ban cigarillos that had those flavours recently?
Carly: Yes! We did, for the same reason that they’re appealing to youth. So those little baby cigarettes, those small cigarettes, we got rid of those flavors because they’re appealing to youth, and I think there’s still some problems there, there has been some loophole that still needs to be closed there, but yes, there’s like apparently a couple thousand e cigarette flavours are out there. One thing that Canada has done, I guess, is they’ve made it difficult for companies to openly market colours or flavors, but they’re still allowed to have the flavors in there. So the call is get rid of these flavors, all of a sudden you get rid of a lot of that youth appeal, right? So those two things their alone, and then also in combination ban advertising, that is just a no brainer that needs to be done right away, these are what these health groups say. There’s no reason why these things are being advertised. We do what we’ve done with tobacco, even cannabis, you know, there’s no sort of outright advertising for cannabis it’s kept in specialty stores, and, interestingly, the study that I was mentioning earlier that just came out. They compared e cigarette usage rates in Canada, the United States and England. England has a legal purchase age, I believe of 21, and they have advertising bans, like they’ve done a lot of the things that are being called for. Their race did not grow up in this period that we were talking about. Now they also you know there market is a little bit more mature, those e cigarettes have been around a bit longer, but there were not seeing the same type of spikes as we are in Canada. So perhaps a sign these measures work, we need these public health measures if we want to stop use vaping.
Jordan: Are those measures getting any traction politically right now? You mentioned the federal government earlier. Obviously, the advertising legislation was done by the Ontario government. Is there anybody in power willing to act on this? Or is it, are we at the stage of advocacy?
Carly: Right. I think it’s a combination of the two because the federal government has signaled that it’s very concerned about this epidemic. They I think even just last week, they came out with a couple of new proposals to crackdown, such as, you know, child resistant packaging and things like that, so they have a number of things that they’re hoping to do. The problem is we’re about to enter a federal election, and so all of the work that’s being done, like creating these regulations that would perhaps put more limits on advertising, are going to be in limbo. And will they be picked up? And so it’s just is another delay. So even though the federal government has indicated they would like to restrict advertising work, we’re probably years away from seeing that happen. So in the meantime, you have people in three provinces who are being exposed to advertising all the time. The Ontario government certainly has indicated that they’re like, there’s no change really on the horizon. It’s unclear what it would take to make that change happen, and I think now, as we do turn toward the federal election, will this be an issue? You know, I know a lot of health groups are contacting me, they’re saying here’s our wish list for the election and some people are talking about vaping. It seems like it could be a no brainer to put that, you know, on your agenda but at the same time, a federal party that does, you know, come out as sort of, you know, anti advertising and really pro regulation, they maybe raise the rankles of the industry.
Jordan: Did we just stumble or miss the boat when this started happening a couple of years ago, and now we’re trying to catch up? That sounds like a leading question but like every question I’ve asked you kind of comes back to the fact that it doesn’t seem like much of this was thought through in advance.
Carly: Right. We’ve known about the dangers of e cigarettes and youth vaping for years, and we’ve been able to look at the mistakes made by other countries that they’re now trying to like scramble to correct, like the United States, and I would say that the United States is actually much, much farther ahead than us. I mean, sure, they’ve maybe been dealing with the problem of it longer, but they’re FDA commissioner who just recently left his post, unfortunately. He has come out calling e cigarettes an epidemic, that this is one of the biggest threats to youth health that we’ve seen in decades, things like that. We’ve started to see some of that language from the Public Health Agency of Canada, from the federal health minister, but it’s taken a long, long time to get us here. I remember, you know, calling the federal government years ago, even under the previous conservative government trying to sort of say well where is the e cigarette legislation? Why isn’t this being dealt with? And it was just kind of like, yeah, this isn’t a priority, and so what happened in the meantime is that young people were buying e cigarettes online, were going out to retail stores where they were openly selling them, oftentimes with nicotine and really experimenting, like this market has been here for a while. The only thing that’s changed is that it’s legal and the products are much newer, cooler, and with higher nicotine content.
Jordan: So what happens when the next set of numbers come out? If they show that it’s doubled again, or it’s close to like, you know, we’re at 50 now, and it’s 22 or 23.
Carly: So you know, this is not necessarily the best analogy, but, you know, I also cover a lot of stuff going with opioids, and I’ve been covering the opioid story for years and so it wasn’t until 2016 the federal government actually started tracking how many people were dying, and now, every time the numbers come out four times a year, there’s a front page story. Oh, my God, look at how many people are dying 11 a day, now it’s 12 a day, this is terrible. We knew this a decade ago. This is just I mean, it’s changed, it’s evolved now elicit fentanyl, there’s all kinds of other problems, but it’s the same story. You know, this has been going on for a long time, and so the fear is, and there’s no reason to suspect anything will change is that these numbers will just have to get worse and worse and worse until we reach that fever pitch. That moment, when people say, you know we’re not gonna take this anymore, what are you doing to stop this? You know…. we’re already getting there, like there’s already so much concern that’s mounting, but you can see it’s palpable, it’s in people’s homes, it’s their teenage kids, it’s adolescence that they want to protect. They don’t know what to do, they don’t know how to stop it, and as it gets worse, like my fear is that we’re going to reach that crisis point like we did with opioids where it’s going to take something disastrous and catastrophic to really start to make a big, big change. Hopefully, we get there before then. That would be ideal.
Jordan: Thanks Carly.
Carly: Thank you.
Jordan: Carly Weeks is a health reporter at The Globe and Mail. That was The Big Story, for more just like that one, head to thebigstorypodcast.ca, search for whatever topic you want, you probably got something. You can talk to us @thebigstoryfpn on Twitter and, of course, you can rate us, and review us, as well as subscribe for free, while taking your friend’s phone and subscribe them, wherever you get podcasts on Apple, on Google, on Stitcher, or on Spotify. Thanks for listening. I’m Jordan Heath Rawlings, we’ll talk tomorrow.
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