Safety Alert - Those who vape are advised by Health Canada to monitor for symptoms of lung illness (e.g. cough, shortness of breath, and chest pain) and to seek medical attention right away if they have concerns about their health.
Vapour products are electronic devices that are designed to heat a liquid solution and produce an aerosol that the user inhales.1,2,5,6 These vaping devices are commonly known as vapes, vape pens, electronic cigarettes, e-cigarettes, e-hookahs, and mods, and they are also referred to by their brand names.1,2,5,6 Vapour products come in many colours, shapes and sizes; some are small and resemble everyday items like USB drives and pens, while others are much larger.1,2,6
Vapour products are made up of four components: a mouthpiece, a tank or cartridge that holds the vaping liquid, a heating element, and a battery.1,3,4
Vaping liquids (also known as e-juice or e-liquid) typically contain a variety of chemicals including a carrier solvent (e.g. propylene glycol and vegetable glycerin), chemical flavourings, and nicotine.1,2,3,5 When added in the recommended amounts to food, propylene glycol, vegetable glycerin, and flavouring chemicals are generally considered safe to injest.5,7,9 Although they may be safe to eat, the safety of inhaling these chemicals into the lungs remains unknown.7 At high levels, these chemicals may be toxic and may cause irritation and damage to the lungs.7
Nicotine is the highly addictive drug found in tobacco products, such as cigarettes, cigars and chewing tobacco. Although some vaping devices and e-liquids do not contain nicotine, most do,1,4,6,8 and the nicotine content varies from device to device.4,6,8 Currently, there are no laws to regulate the amount of nicotine in vapour products – this means the manufacturers can add as much nicotine as they want.8 What is even more concerning is that vapour product labels do not always list the true nicotine content; some brands have claimed to be nicotine-free but were tested and found to contain nicotine.2,6
The design of vapour products has evolved over the years with new devices that use cartridges or pods to deliver nicotine more efficiently, making them even more addictive.7 These pod devices use nicotine salts instead of a traditional e-liquid solution that contains freebase nicotine.7 Vapour products using a nicotine salt solution deliver very high concentrations of nicotine to the user, providing a greater nicotine “hit” compared to traditional vapour product models.4,7 For example, one 5% strength JUUL pod contains roughly the same amount of nicotine as one pack of cigarettes (20 cigarettes).9,10,11 Recent studies have shown that individuals using nicotine salt pod devices have similar amounts of nicotine in their blood compared to those who smoke cigarettes.7
Vaping is the act of inhaling and exhaling an aerosol that is produced by a vapour product.1
When a vapour product is activated, the heating element begins heating the vaping liquid stored in the cartridge.1,3 As the vaping liquid is heated, it becomes vapourized and then condenses into an aerosol.1,3 The aerosol is inhaled through the mouth and into the lungs where it is absorbed into the bloodstream.1,3 The left over aerosol is exhaled.1,3
A common myth is that the cloud produced by a vaping device is harmless water vapour. In reality, vaping devices produce an aerosol that is made up of tiny particles, heavy metals (e.g. nickel, tin and lead), toxic substances (e.g. formaldehyde, cadmium and benzene), and nicotine.2,4
The amount of potentially toxic substances a person can be exposed to from vaping or from exposure to second-hand vapour is affected by the type of the device and its settings, the battery power, the e-liquid components, the amount of nicotine, the frequency of vaping, and the amount of exposure to vapour.4,12 For example, using a vapour product with higher power and high temperature settings can produce more chemicals.
New research suggests that vapour products may be safer than combustible tobacco products (e.g. cigarettes). However, this data is not conclusive, and studies show that vapour products and the aerosol they produce are not harmless.7,13
Vapour products expose users and the people around them to harmful toxins, including cancer-causing chemicals, diacetyl, volatile organic compounds, heavy metals, and ultrafine particles that can be inhaled deeply into the lungs.2,4,7,13
Vapour products are still relatively new, and more research is needed over a longer period of time to fully understand both the short- and long-term health risks associated with vaping and exposure to second-hand vapour. However, evidence at this point is demonstrating that inhaling the chemicals produced by vaping devices can have negative effects on the body, including the lungs and heart.6,8,12
Vapour products expose users to harmful toxins and high levels of ultrafine particles that can be inhaled deeply into the lungs and may cause inflammation and increased mucus in the airways, as well as lung damage, and lung disease.7,9,13 Vaping may also worsen symptoms of asthma and other existing lung diseases.7,9 Those who vape may also have a higher risk of developing lung infections, a delayed recovery from these infections, and an increased risk of developing complications such as pneumonia.7
Of particular concern are the recent reports of severe lung illness among people who use vapour products. Symptoms experienced include cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever, and weight loss.6,7,9,14,15 Some individuals experiencing severe lung illness required hospitalization due to the severity of their symptoms.15
The specific causes of these alarming lung illnesses are under investigation in both Canada and the United States. At this time there has yet to be a consistent product, substance, or additive found in all cases – the specific cause of these vaping-associated lung illnesses remains unknown.15,16
Nicotine may cause an increased risk of developing heart disease among those who smoke tobacco products,8 and research suggests that people who vape may also be at a higher risk of developing heart disease.7,8,13 Vaping with nicotine has been shown to increase heart rate, and nicotine from vapour products may cause arteries and blood vessels to stiffen, potentially damaging these delicate tissues.7,8
Nicotine is not safe for individuals to consume while pregnant, as nicotine is toxic to developing fetuses and can negatively influence brain development in utero.13 Nicotine use during pregnancy may also cause premature births and low birthweight babies.6 Those interested in quitting smoking while pregnant are encouraged to talk to their health care provider about options of quitting during pregnancy.12
The aerosol from vapour products contain chemicals that are suspected or known to cause cancer.6,7 For example, formaldehyde is a cancer-causing substance that can form in the aerosol if e-liquid overheats or if there is not enough e-liquid going to the heating element of a vapour product.6 Emerging studies suggest that some chemicals in vapour product aerosols are capable of changing and mutating DNA and that long-term exposure to these aerosols could increase the risk of cancer.4,7
There is conclusive evidence that vapour products can explode and cause serious injuries and burns.2,4 This risk is significantly increased when batteries are of poor quality, stored improperly, or modified by the user.4 In addition, nicotine can be toxic, even in small amounts.12 Deaths and non-fatal nicotine poisonings could occur by unintentionally swallowing, breathing, or absorbing e-liquid through the skin or eyes.2,12
Brain development continues throughout the teenage years, completing around the age of 25.2 Research has shown that exposure to nicotine before the age of 25 can “rewire” the brain and cause long lasting negative effects on attention, memory, concentration, and learning.2,4,12,17
Evidence has also shown that exposure to nicotine before the age of 25 can decrease impulse control, increase the risk of experiencing mood disorders (such as depression and anxiety), and increase the risk of developing nicotine dependence and addiction.4,12,17
Nicotine in any form is highly addictive. Compared to the adult brain, a teen brain finds nicotine more rewarding and will progress faster to nicotine dependence and addiction.12,17 Some vapour products have the capability of delivering higher amounts of nicotine compared to conventional cigarettes, which could put young people at even greater risk of developing nicotine dependence.7,9,13
There is strong evidence that young people who vape products with nicotine are at a higher risk of ever using and becoming addicted to other combustible tobacco products (e.g. cigarettes).2,4,8 A recent study found that young people who use e-cigarettes were 4 times more likely to smoke tobacco cigarettes.18
Research also suggests that nicotine exposure before the age of 25 can sensitize the brain, making it more vulnerable to the effects of other drugs, and prime it for future addiction to other drugs.2,12,19
Vaping devices are still relatively new, and more research is needed to fully understand the long-term health risks associated with vaping. Data is not yet conclusive on whether vaping is safer than smoking. Regardless, vapour products are not harmless. 7,13
Ways to reduce harms from vaping include:
Seek medical attention if you experience coughing, shortness of breath, chest pains, or have other concerns about your health. Be sure to inform your health care provider that you are using vapour products or have in the past.
The sale and use of tobacco and vapour products are regulated by various laws at the federal, provincial, and municipal levels.
The Smoke-Free Ontario Act, 2017 (SFOA, 2017) is a provincial law that regulates the sale, supply, use, display, and promotion of tobacco and vapour products, as well as the smoking and vaping of cannabis. SFOA, 2017 Inspectors hired by the Middlesex-London Health Unit enforce this law in our region and can issue a fine to anyone caught in violation of smoking and vaping laws in the city of London and Middlesex County.
In Ontario, the sale and supply of tobacco and vapour products is restricted to individuals 19 years of age or older.20 This means that a person cannot sell or give vapour products to anyone under 19 years of age. Sharing a vapour product with someone under 19 years of age is considered “supplying”, and is also against the law.
Anyone caught selling or supplying vapour products, including vaping liquid/e-juice, to anyone under the age of 19 can be issued a fine of $490.21
There are also strict laws in Ontario about where you cannot use vapour products. Essentially, you cannot vape in any place where you cannot smoke tobacco products. This includes any enclosed workplace, any enclosed public place, and any other place designated as smoke-free and vape-free.22
Vaping on school property has become a particular concern over the past few years. It is illegal to use vapour products in public and private schools, including the grounds associated with the school, as well as public areas within 20 metres of any point on the perimeter of the school’s grounds.22 This law applies to vaping in a vehicle parked on school property, as well as any outdoor grounds used by the school (e.g. playground, sports field, etc.).
Anyone caught vaping in prohibited areas can be issued a fine of $305.21
Vapour products have quickly evolved since coming into the Canadian market in 2004.23 Originally, vapour products closely resembled a traditional cigarette, but now these devices come in different colours, shapes, and sizes, with features that allow them to be customized by the user.1,2,6 Newer vapour products come in youth-friendly USB designs, and they use nicotine salt technology that allows the device to produce and deliver higher levels of nicotine.4,7 These vapour products have become very popular among young people, due to their small size that can be easily hidden, and their ability to be charged using computers and phone chargers.6
Vaping rates have increased dramatically, particularly among non-smokers and youth. A recent survey of Ontario students in grades 7 through 12 shows that vaping rates among youth have doubled over the past 2 years. In 2019, 23% of students (grade 7 to 12) reported using an e-cigarette in the past year (up from 11% in 2017).24 Approximately, 1 out of every 8 students reported regular use of vapour products in 2019.24
These trends are concerning because it appears that a new generation of teenagers are becoming addicted to nicotine through vapour products.
Have open and honest conversations (PDF 249KB) with your child about the use of vapour products, tobacco products, cannabis, alcohol and other substances. Parents and caregivers who provide their child with accurate and balanced information can help their child make informed decisions.
It is important for you to address vaping early and often to prevent vapour product use and protect your child’s health and development. You are one of the most powerful influences in your child’s life and building positive connections now will help foster resilience so that your child can make positive decisions about their health in the future.
It is natural for young people to feel curious and ask questions. Questions about vaping are not necessarily an indication that they are experimenting. Encourage your child to ask questions about vaping and allow opportunities for open discussions that are free from judgement and criticism.
Look for teachable moments to bring up the topic of vaping. For example, when you see an actor vaping in a movie, you can discuss how vaping and smoking are shown and often glamourized in the media (e.g. movies, television, online). Or, if you see an advertisement for vapour products online, you can discuss how vaping companies find ways to directly market to youth (e.g. colourful designs and fruity, child-friendly flavours).
Use these conversations as an opportunity to provide accurate information, clear up confusion, and dispel myths about vaping. Evidence-based information has been provided throughout this page, and additional resources, such as Health Canada’s Tip Sheet for Parents, are also highlighted below.
Keep the dialogue going; young people benefit from hearing information more than once. It is okay for your conversation to happen over time, and you can continue the conversation by creating regular check ins.
Young people are affected by the environments and behaviours they see often. Smoking and vaping around children and youth can make these behaviours appear normal, and young people often model what they see.25 Therefore, it is important to model a smoke-free and vape-free lifestyle. Consider quitting and ask your child to support you during your next quit attempt; witnessing how challenging it can be to quit smoking or vaping might persuade your child to never use tobacco or vapour products.25
Lastly, you can find supports in your community to help reinforce healthy messaging with your child. For example, Public Health Nurses in your child’s school are a great resource to talk about healthy behaviours. They can also provide support for students interested in quitting smoking and vaping.
Compared to cigarettes, vapour products have not been around for very long. There is still a lot of research needed to help us understand the best ways to help people quit vaping.
Although research on quitting vaping is still in the early stages, there are a lot of successful strategies to help people quit smoking that can be used by people who want to quit vaping. Nicotine is the highly addictive drug found in cigarettes as well as most vapour products. Quitting focuses on changing behaviours or the habit of smoking or vaping, as well as managing the addiction to nicotine.
Cravings are short but intense urges to smoke.26 Cravings are normal and can still happen after months and even years of not smoking; but, over time, they will happen less often and feel less intense.26
A successful technique used to kick nicotine cravings is the 4Ds Strategy:26
Consider making your own "vaping quit kit" to help keep you distracted and busy. Some ideas include: a reusable water bottle, sunflower seeds with the shell, your favourite healthy sugar-free snack, a stress ball, elastic bands, fidget toys, sugar-free gum, or mints.
Other strategies to help you quit vaping might include:
Behavioural counselling, or talking to a health care professional with extra training to help people quit nicotine, has also been found to be an effective way in supporting someone in their attempt to quit tobacco use.27 This approach teaches the person coping and problem-solving skills that they can use to avoid their nicotine cravings and prevent relapse, while also providing support and encouragement.27 This type of counselling can be accessed through:
There are many resources and tools available to help you quit and stay vape-free. Use resources that meet your needs, and remember that quitting takes time, patience and practice. You can do this!
Research is unclear about whether or not vapour products are effective as a cessation tool to help people break their addiction to nicotine.4,13
Although vapour products might be seen as a tool to help people quit smoking, these devices are not currently being tested, manufactured, or regulated as a stop smoking aid in Canada, and they have not been approved by Health Canada for this use. If a person is interested in quitting smoking, they should use a medically approved quit smoking aid that has strong evidence showing it is effective and safe to use.28
Nicotine Replacement Therapy (e.g. the patch, gum, lozenge, mist, and inhaler), and medications such as Champix and Zyban have been approved by Health Canada and are evidence-based treatments that reduce nicotine withdrawal symptoms and help people quit smoking.27,29 When these quit aids are used, there are clear parameters in terms of dosage, duration of use, and frequency of use. Vapour products, on the other hand, are diverse and deliver nicotine at varying levels, therefore making it challenging to use these devices as quit smoking aids.
In addition, there is a concern about individuals using vapour products while continuing to smoke cigarettes. This dual use can compromise efforts by those trying to quit smoking.30 For example, instead of cutting back on nicotine, using vapour products while also continuing to smoke cigarettes could expose the user to even higher amounts of nicotine, strengthening their nicotine dependence and making their quit attempt even more challenging. Dual use may also cause additional health risks to the user. Emerging research suggests that dual users have an increased risk of breathing problems, asthma, and chronic lung disease,31,32 and their risk of experiencing a heart attack may be significantly increased.28
Adults using vapour products to quit smoking are encouraged to speak to their health care provider to discuss other cessation options.5,14,15 Those using vapour products to quit smoking are strongly advised not to return to smoking cigarettes.14,15 Individuals who vape are advised to monitor themselves for symptoms of lung illness (e.g. cough, shortness of breath, and chest pain) and to seek medical attention right away if they have concerns about their health.5,14,16
