Young Canadian vapers are as likely to report breathing problems as their smoker peers

This post draws attention to a recent study reporting on the potential impact of vaping and smoking on the respiratory health of young Canadians. 

The paper "Associations between vaping and self-reported respiratory symptoms in young people in Canada, England and the US" was published in BMC Med on May 29. It draws on data from the ITC Youth Tobacco and Vaping Survey and was authored by members of that project team, including two Canadians based in Waterloo (Jessica Reid and David Hammond).

The ITC Youth survey is a (usually) annual web-based survey of older teenagers (aged 16 to 19 years) who live in England, Canada and the United States. These young people are asked a series of questions about their opinions and behaviours concerning nicotine products (tobacco and non-tobacco), with some additional questions also about cannabis and alcohol use and about their life circumstances. 

In 2020 and 2021 the survey included questions about recent experience of certain respiratory problems: shortness of breath, wheezing, chest pain, phlegm and cough. This BMC paper reports on the analysis of the responses to those questions.

Both vaping and smoking increase the likelihood of respiratory symptoms and by about the same amount

Overall, they found that those who vaped or smoked in the past 30 days were about 50% more likely to experience these respiratory problems, and those who did both or who vaped intensively were twice as likely. (The odds ratios shown above are extracted from the paper and the authors adjusted them to reflect a number of personal characteristics as well as for the use of other substances.)

Salt nicotine and some flavourings are associated with higher rates of respiratory symptoms (with caveats), but the type of vaping device does not seem to matter.

Those who reported using salt nicotine were more likely to report respiratory symptoms than were those who reported using non-salt. However, about half of the survey respondents were not aware of the nicotine type they used, and these uncertain respondents were included with the non-salt reference group. For this reason, the authors urged caution in relying on self-reported data on nicotine type in all studies. 

Those who used sweet flavours and mint-menthol flavours were as likely as the (much smaller) number who used tobacco or tobacco-menthol flavourings to report respiratory symptoms. Those who used fruit, multiple and other flavours were more likely to do so.

The results were not entirely what the researchers had predicted.

Before the study began, the authors registered their five hypotheses. They anticipated that those who vaped would be less likely to report respiratory symptoms than those who smoked, and that flavourings would make no difference to likelihood of experiencing these respiratory issues. The results did not support these hypotheses.

They did find evidence for their other hypotheses -- that more intense vaping would be associated with more symptoms, that types of nicotine devices did not make a difference, and the experiences in the three countries would be similar.

Not the first paper to support concerns about vaping and respiratory health among Canadian youth

This is not the first study involving young Canadians which has found an increased risk of respiratory problems among those who vape. A study led by Michael Chaiton and colleagues also found that among 16 to 25 year-olds the "use of e-cigarettes was associated with increased rate of respiratory symptoms, and that the greater the frequency of vaping the higher the number of symptoms." (Smoking, e-cigarettes and the effect on respiratory symptoms among a population sample of youth: Retrospective cohort study. 2023, was published in January 2023)

More reasons for Minister Saks to act

Some of the data reported in this study was gathered after a former Minister of Health issued draft regulations to restrict flavourings in vaping products.

This study underscores the urgency of this seemingly-abandoned proposal. It suggests that vaping flavours hurt the lungs of young Canadians not only because they are an inducement to use vaping products, but also because some flavourings themselves are linked to harm.

This week health organizations published an advertisement in Parliament Hill's local newspaper (the Hill Times) reminding the Health Ministers of the importance of banning these flavours. Banning flavours in vaping products falls under the responsibility of addictions minister Ya'ara Saks, while measures to address flavours in nicotine pouches falls under the responsibility of Minister of Health Mark Holland. While Minister Holland has publicly stated his intention to take action, Minister Saks has remained largely silent on the subject since her appointment last July.