What role do parents play in exposing children and teens to vaping?

Last December, CBC News reported that an increasing number of teens were vaping. And that the rate of increase had grown substantially ever since the government made it legal to sell nicotine vaping products (also known as e-cigarettes) in the spring of 2018. 

Now, a new U.S. study published in the journal Pediatrics suggests some parents may think vaping is harmless. 

The research from Harvard University, released on Monday, found that parents who use e-cigarettes were much more likely than cigarette smokers to permit vaping inside the home. And that parents who vaped were also more likely to permit vaping inside their cars.

The findings were based on interviews with more than 750 parents who reported using e-cigarettes, tobacco cigarettes or both. The researchers found that only about 20 per cent of parents who used e-cigarettes (either alone or in combination with tobacco cigarettes) strictly banned vaping in their homes and in their cars.  

Jeremy Drehmer, a tobacco control researcher and lead author of the paper, called the permissiveness around vaping inside homes and cars an "alarming trend."  He said he and his colleagues were concerned that parents believe that the aerosol produced by e-cigarettes is harmless. 

Co-author Jonathan Winickoff said, "Frankly, it's frightening — it's where we were with the exposure of children to combusted tobacco smoke 25 years ago."

The authors said they were concerned that parents have been misled by the marketing of vaping products. Nicotine replacement products like patches and nasal sprays are approved as part of smoking cessation programs.

Some people (including some health professionals) make a link between vaping and smoking cessation. But the evidence isn't yet clear and no such medical claims can be made with certainty. 

Although the study focuses on the exposure of children and teens to vaping by adults, as a physician, I'm concerned that the issue of youth taking up vaping themselves is closely related. 

One of the leading brands when it comes to vaping devices is Juul. Although Juul says its products are meant for adults only, teens like them because the devices are small, easy to conceal and easy to personalize with decals. 

Juul officially entered the Canadian market a few months after government legalization. It had entered the U.S. market three years earlier, in 2015. As reported in the New York Times, the company's initial ads featured young hipster models. Although the initial campaign did not target teens, it soon became clear that teens were posting photos of themselves using Juul vaping devices on Instagram and elsewhere.

The Times also reported that Juul decided to depict users as age 35 and older to better reflect their campaign to get adult smokers to switch to vaping and eventually shifted from using models to showing testimonials of people who said they had used vaping to quit tobacco.

Traditional big tobacco companies have also turned to vaping as a new product line as more people quit smoking cigarettes. Imperial Tobacco wasn't far behind Juul in bringing its own vaping device, Vype, to Canada. Like Juul, Imperial Tobacco says it does not support selling or marketing vaping products to youth (which also happens to be illegal).

But the fact is, many teens have started vaping. And regardless of whether it's smoked or vaped, nicotine reaches the brain quickly and affects the prefrontal cortex, a part of the brain that controls emotions and impulses. Experts believe the brain doesn't finish developing until age 25.

There are also other potential risks of harm. There is evidence that e-cigarette vapour contains formaldehyde, nitrosamines, silicates and lead. In some analyses, the levels of these chemicals have been found to be much lower than found in tobacco smoke; in others, comparable or even higher levels have been found. The jury is out on the harm posed by these chemicals.

On the issue of second-hand vape smoke, the authors of the study in Pediatrics said vape products produce an invisible plume of nicotine and ultrafine toxic particles that spreads in the air and coats surfaces. The authors ask if Americans "want to wait another 25 years to see how this corporate experiment ends."

What needs to be done? The authors of the study concluded that users of e-cigarettes must be advised not to vape in enclosed spaces like homes, office buildings and cars. Here in Canada, the government needs to strengthen warnings to parents and teens about the dangers of youth vaping. Law enforcement authorities need to put more effort into stopping the sale of e-cigarette devices to underage users on the Internet. 

Some say anything that is done now is like trying to put the marketing genie back into the bottle. Let's hope it's not too late.