|Published in 2018. |
Out of date in 2022
The NASEM conclusions were founded on less than one-third of the evidence now available.The NASEM report was commissioned by the U.S. Food and Drug Administration in 2016. The committee looked at literature that was indexed for publication before August 31, 2017. Of the more than 10,000 articles indexed on PUBMED mentioning e-cigarettes or vaping, more than two-thirds have been published AFTER the committee had released its conclusions.
- E-cigarettes have increased the number of young nicotine users in some countries.
- Young people who use e-cigarettes are more likely to smoke conventional cigarettes.
- Dual use is common and harmful.
- When purchased as consumer products, e-cigarettes are not effective cessation aids.
- E-cigarettes cause damage to respiratory and circulatory systems.
- Other governments have provided more recent scientific assessments.
- Health Canada's messaging on e-cigarettes is out-dated. .
|Prevalence of cigarette and e-cigarette use, 2004-2018|
USA NYTS. From Creamer, M et al.
In Canada, the rate of nicotine use continues to be high. Data from the 2020-2021 Canadian Tobacco and Nicotine Survey (CTNS) [C ] confirm that one in seven teenagers and young adults (14% and 13% respectively) is a past-month vaper, and that one-third of high-school age kids have tried nicotine. These numbers underestimate the problem among 17-19 year-olds, as they include the younger ages (15 and 16) where prevalence is lower. Larger surveys of Canadian youth allow a closer look at each grade, and show that the child who enters high school in grade 9 as likely as not to have tried vaping before graduating. [D]
E-cigarettes are now the main product that is getting kids hooked on nicotine. The decline in cigarette smoking among young Canadians, for example, reflects a shift in the products they are recruited to use, not a decrease in initiation.
2. Young people who use e-cigarettes are more likely to smoke conventional cigarettes
The NASEM committee found "moderate" evidence that young people who used e-cigarettes were more likely to subsequently smoke cigarettes.
It is now better understood that young e-cigarette users are 3-4 times more likely to become cigarette smokers than adolescent non-users of nicotine. This increased susceptibility, combined with the large number of young vapers, raises concerns that we may see a reversal of the downward trend in youth vaping. This appears to have already happened in another country with relaxed vaping regulations. In the most recent cycle of the Year 10 school survey, as reported by New Zealand's ASPIRE 2025 research team [E] both cigarette smoking and vaping had risen.
Multiple studies have now confirmed that adolescents who use e-cigarettes are at least three times more likely to take up smoking than non-users of e-cigarettes. Significant reviews and meta-analyses which confirm this association include a systematic review and meta-analysis conducted by researchers based in Australia, using studies that were published before October 2020. Sze Lin Yoong and colleagues restricted their analysis to longitudinal studies only, thus strengthening the certainty of the findings. Their meta-analysis of 17 such studies of e-cigarette use at baseline and subsequent ever cigarette use ( found a relative risk of cigarette uptake of 3.01. All 17 studies showed a positive relationship. [F]
New research is showing that "normal" or "typical" use of e-cigarettes is not associated with success. A longitudinal survey in the United Kingdom found that daily e-cigarette users were significantly more likely to quit smoking than were people who were using NRT or going "cold turkey", while non-daily e-cigarette users were significantly less likely to quit smoking than people using other methods or no method at all. More than half (60%) of all e-cigarette users were in the category of less-successful non-daily. [T] Other researchers have found similar associations. [U]
5. E-cigarettes cause damage to respiratory and circulatory systems.
- evidence supporting e-cigarettes as an effective smoking cessation device was "weak".
- evidence that second-hand exposure to e-cigarette vapour posed risks was "weak to moderate".
- evidence that e-cigarettes helped smokers cut down on the amount smoked was "weak to moderate".
- evidence that e-cigarettes could cause cancer in the respiratory tract was "weak to moderate".
- evidence that e-cigarettes posed risks for coronary disease was "moderate".
- evidence that e-cigarettes were a gateway to smoking for young people was "moderate"
- evidence that e-cigarettes with nicotine were addictive was "strong"
- evidence that flavours in these products contribute to initiation was "strong".
Review commissioned for the Spanish government. Spain's public health agency concluded in 2020 that "To date, no toxicological or drug studies have been performed on the long-term safety of e-cigarette use in humans; without these data it is impossible to say with certainty that e-cigarettes are safer than cigarettes. With this in mind it is impossible to recommend these devices as a useful tool against the cessation of traditional tobacco consumption." (machine translation) [AK]
Review commissioned for the Australian government. The Australian National Centre for Epidemiology and Public Health concluded that e-cigarettes did not help people quit smoking, but did increase the probability of a young person starting to smoke.[AL] (The evidence review was separately published.) [H]
For the Netherlands government, the Trimbos Institute reviewed the literature and found that e-cigarettes were effective as cessation products for only a small group of smokers, and that success rates were comparable to "regular" methods. Because most e-cigarette users in that country also continued to smoke, it cautioned about the additional risks of dual use. [AM]
At the request of the French government, the French High Council for Public Health reconsidered its 2016 conclusion that e-cigarettes were a useful tool to help people quit smoking. After reviewing new evidence, they issued a revised finding in November 2021: "Evidence-based knowledge in insufficient to propose to health professionals that they use electronic nicotine delivery systems to help thier patients quit smoking." [unofficial translation].[AN]
Unlike the governments cited above, Health Canada has not updated its assessment of the risks of vaping for several years, and cites no research on risks or cessation more recent than 2018.
A more truthful, blunter message to young people is warranted. Something like: Smoking kills, and vaping almost certainly kills too.