UPDATE: On December 5th, 2019, provincial health minister, Randy Delorey, announced that Nova Scotia would the first Canadian province to ban the sale of any kind of flavoured e-cigarettes and juices by April 1st, 2020. "What we've seen in the last couple of years since e-cigarettes have become widely available in Canada and indeed throughout much of North America is a rapidly growing rate, in particular youth vaping," he told the CBC. "This is a good first step and I think we can anticipate a reduction in the number of youth vaping."
Elsie Buckner* was concerned that her then 14-year-old son Branden* might be vaping, so she searched his backpack and discovered that he had a vape pen. Approaching him about her discovery, he immediately denied it was his. Later, he admitted to owning the pen, but swore he was only vaping products not containing nicotine. Not long after this incident, Branden got caught vaping at school and was suspended. Knowing his school had a zero-tolerance policy for vaping and that there would be serious consequences if he got caught, Buckner realized vaping had become more of an addiction than just dabbling.
E-cigarettes were largely introduced to the mass market in 2004 and have been marketed as an alternative for cigarette smokers (with a legal purchase age in Canada of 18 or 19 years old, depending on the province), however, vaping and JUULing among younger people in Canada is on the rise.
A recent study led by David Hammond, a professor at the School of Public Health & Health Systems at the University of Waterloo, shows that the number of Canadian teens who regularly vape increased by 78 percent in one year. His findings are based on surveys of 16- to 19-year-olds conducted in 2017 and 2018. But what parents may not realize is kids as young as 12 are also experimenting with this growing trend. “We don’t know exactly when our son started,” says Buckner. “But I began to notice a change in his behaviour and found some flavoured e-liquid in his room when he was around 13.”
The U.S.-based Center on Addiction describes vaping as the act of inhaling and exhaling an aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device. Generally, a vape device consists of a mouthpiece, a battery-powered heating component, and a cartridge for the e-juice, or e-liquid. Typically, the e-juice contains nicotine, flavouring, chemicals and metals mixed with propylene glycol, which is used to make artificial fog, and glycerin—but there is no tobacco.
A pod vape (also called “pods”) is a smaller vape system, comprised of two part: the pod is filled with the e-juice and it snaps into a small battery, which heats the liquid, and is then pulled through the mouthpiece. The devices, such as JUUL, can look like a sleek flash drive and make it easier for “stealth vapers” to vape discreetly. There are also disposable vapes available in Canada, including STIG, which have a pen and pod attached and can be consumed then thrown away.
Essentially, e-cigarettes (also known as “e-cigs”) and vaping are the same thing.
A vape pod or cartridge lasts for about 200 puffs and can contain as much nicotine as 20 cigarettes. While there are some products on the market with little or no nicotine—the type of product Buckner’s son began using—products like the JUUL pods are either 3 or 5 percent nicotine.
Nicotine can have serious effects on the developing brain, warns Suzanne Beno, an emergency physician at Hospital For Sick Children in Toronto, Ont. “It puts young people at risk by lowering impulse control and increasing risk of addiction, while also increasing mood disorders and cognitive impairment.”
According to Beno, it only takes a starter kit of four pods to become physiologically addicted to nicotine. “Because there isn’t the same sort of negative physical feedback as there is with smoking, such as coughing and the unpleasant aftertaste, it's easy for kids to continuously vape,” she says. This means a lot of nicotine can be consumed in a very short amount of time.
Last February, Cassandra Wheatley*, a middle school teacher in northern Ontario, noticed students chuckling during science class on joules. They let her in on the joke, explaining what JUULing is. Later, she had the same students—who are between 12 and 13—ask to go to the bathroom during class, so they could sneak away to vape. “It’s what the cool kids are doing,” says Wheatley. “The high school smoke pit has morphed into the vape pit.”
In the age of social media, teens are more exposed than ever to vaping says Beno. Search #vapetricks on Instagram, and around 5.2 million posts will come up, including videos of young people performing complicated smoke tricks. A simple Google search will lead you to tutorials on how to “Ghost” where you suck the vapour into your mouth like you’re sucking through a straw and then gently release the puff so it resembles the shape of a ghost. Then you suck the vapour back in, so the ghost disappears.
“Vaping is a form of amusement for some teens,” says Wheatley. “It’s not just a chemical addiction, it’s like a lifestyle.”
Another big draw for younger vape-enthusiasts is flavoured e-juices. “Flavours like candy crush, green apple and unicorn tears are hugely appealing to youth,” says Beno. These flavourings can also make it harder for teachers and parents to detect. “I wouldn’t always be able to tell a student was vaping because it smells like perfume,” says Wheatley.
Vaping is also typically cheaper than smoking. While Buckner doesn’t give Branden money apart from lunch money, he still managed to cobble together enough cash to buy vape products. “They’ll get it from somebody’s older brother,” she says. Another one of Buckner’s sons told her he knew vape pods were being resold at schools for a profit. There’s also a plethora of online stores selling vape products for cheap.
Beno recommends parents have honest conversations about the dangers of vaping with their children. “It’s very similar to how you’d talk about other drugs,” she says. “Keep it conversational, don’t lecture them.”
Start by asking your child what they might already know about vaping, or use passing a vape store as an opportunity to discuss the issue.
A 2019 study out of the University at Buffalo found that kids who vaped tended to have older siblings who used the products to quit smoking. This influenced the perception of e-cigarettes as beneficial as well as potentially providing easier access to vaping products.
But Wheatley cautions against making vaping out to be taboo, so as not to encourage kids who may be drawn to breaking the rules. Instead, she talks to her students about the health issues and financial cost of vaping.
The Government of Canada has also produced a tip sheet for parents on teens and vaping, which encourages parents to set a positive example and be honest with their children regarding their own use and any regrets they may have. A family doctor will also be able to provide support.
While vaping is a relatively new, Dr. Nicholas Chadi, a pediatrician specialized in adolescent and addiction medicine at Sainte-Justine University Hospital Centre in Montreal suggests using the same sort of strategies you’d use to help teens quit cigarettes. He recommends one-on-one or group counselling or motivational interviewing, which helps teens resolve their insecurities and find the motivation they need to change their behaviour. Parents can also look into a phone/text line that can help them quit. “Find out what teens do and don’t like about vaping,” he says, “And have them come up with their own goals to quit or reduce their use.”
Parents can also set limits and boundaries around vaping. “Tell your teen this isn’t something you can do at home,” says Chadi. “Consistent rules are very helpful for young people.” Parents can also talk to their kids’ family doctor about medication options, like nicotine gum and patches.
When kids stop vaping, they experience nicotine withdrawal. “They may experience symptoms like nausea, tremors, sweating or a headache,” says Beno. They’ll also likely feel a desire to get another hit.
Wheatley, has witnessed withdrawals with her students. One time during a school outing, she noticed a 13-year-old student was pacing, complaining and exhibiting anxious behaviour. “You could tell he wanted his fix,” she says. “Unlike adults, kids don’t have the agency to do so when they’re in a school setting.”
Research also shows vaping is more likely to lead to cigarette smoking, marijuana use and other risky behaviour in teens. “I believe it’s a slippery slope,” says Buckner. “My husband kept saying our son’s going to be vaping marijuana. And I said no, he won’t do that. But later he admitted to it.”
In addition to the effects of nicotine, Beno says is already concerning evidence around the respiratory effects of vaping.
“The aerosol young people are vaping is not safe,” she says. While there’s a misperception that it’s safer because you’re not inhaling tar, e-juice still contains harmful chemicals with both short- and long-term effects. For instance, formaldehyde has been found in some pods, a chemical that has been linked with cancer. “It’s a very scary Pandora’s box right now,” says Beno. While vaping has been associated with increased bronchitis and asthma, a recent severe respiratory illness in youth has also been linked to vaping. “We still don’t know enough yet about the risks of vaping,” she says.
Recently, the first vaping-related illness was reported in London, Ont. when a teenage boy was put on life support due to a respiratory illness linked to vaping. Meanwhile, 47 people have died from vaping-related injuries in the U.S., and the US Centres for Disease Control is currently coordinating an investigation into hundreds of severe lung illnesses linked to e-cigarette use.
Another alarming side-effect Beno has seen is young people coming into the emergency room with burns and eye injuries. “It’s likely because batteries were faulty and exploded or were tampered with,” she says. Additionally, toddlers have presented with nicotine toxicity after ingesting the e-juice.
Buckner will share articles and research with Branden, who’s now 15, on the topic, but she’s pretty sure he’s still vaping. To support him, she’s arranged for him to see an addictions counsellor.
“A lot of parents think it’s not going to happen to their kids,” says Wheatley. “But addiction doesn’t discriminate.”
* Names have been changed.