Artefacts

What is the situation?

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What impact does the current situation have on health outcomes, quality of life and other societal costs, such as noise, air pollution or increased healthcare spending?

• Vaping is the act of inhaling and exhaling an aerosol produced by a vaping product, such as an electronic cigarette (Bonner et al, 2021). Vaping products contain nicotine and non-nicotine ingredients (Bonner et al, 2021). Individuals that vape are thus exposed to nicotine and other dangerous chemicals.

• Studies have shown that vaping increases the risk for adverse brain development, fetal development, cardiovascular diseases and respiratory diseases (Gotts et al, 2019; Pisinger and Dossing, 2014; Tehrani et al, 2022). Vaping has been strongly linked to many respiratory diseases such as asthma, Chronic Obstructive Pulmonary disease (COPD), E-cigarette Vaping Acute Lung Injury (EVALI), Bronchiolitis obliterans and lung cancer (Tehrani et al, 2022).

• The presence of novel compounds found in vapes have an unknown impact on health (Pisinger and Dossing, 2014). Studies have clearly demonstrated a link between vaping and adverse health effects however, vaping is still very novel and the long-term health effects are not fully understood (Tehrani et al, 2022). The evidence for long-term health effects is currently insufficient and further research needs to be done (Gotts et al., 2019).

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Which groups of people are at higher risk of health problems and poorer quality of life?

• Sub-populations like Indigenous communities, racialized communities, those living with mental health and substance use disorders, and 2SLGBTQ+ communities are more adversely affected by smoking and vaping prevalence.

• It was reported that over 26% of Indigenous people in BC reported smoking and vaping daily or occasionally, which is more than twice the rate of the general population (BC Lung Foundation (BCLF), n.d.). Similar rates are seen amongst Indigenous youth.

• BCLF (n.d.) reports in 2017 smoking and vaping rates were two to three times higher among Indigenous youth in BC compared to non-Indigenous youth.

• Additionally, 85% of people seeking mental health or substance use disorder treatment use tobacco or vaping products in Canada, compared to 15% of the general population (BCLF, n.d.).

• BCLF (n.d.) reports that smoking and vaping rates are much higher in the LGBTQIA+ population than in the general population, particularly among youth and young adults. They found that 22% of high school students who identify as lesbian, gay, or bisexual reported daily cigarette and vaping product use in 2014 compared to 11% of non-LGBTQ+ persons (BCLF, n.d.).

• The Government of Canada (2024) has found that younger Canadians are more likely to vape. They found that 17% of students in grades 7 -12 reported using a vaping product in Canada (Government of Canada, 2024). Furthermore, the Government of Canada (2024) found that 16% of grade 7-12 students that use vaping products use products that contain nicotine.

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Which settings or situations are high risk, or pose a unique opportunity for intervention?

• Vaping products that contain nicotine are highly addictive. Many studies have highlighted the negative effects nicotine has on adolescents. In adolescents, nicotine harms the parts of the brain that controls attention, mood, and impulse control (US Department of Health and Human Services, 2016).

• Vaping products that contain nicotine can affect brain development and lead to learning disorders in younger individuals (World Health Organization, 2023).

• Furthermore, Jonas (2022) found that adolescents and young adults who use vaping products are three times more likely to use cigarettes later in life.

• As a result, I believe this is an extremely important health issue that needs to be addressed and interventions to decrease vaping should be targeted at adolescent high school students from grade 8 to 12.

 

How do local stakeholders perceive the situation? What is their capacity to act? What are their interests, mandates, current activities?

• Vaping use among Canadian adolescents has been viewed as a growing problem and has sparked concerns among parents, educators, physicians, and politicians (Cherif and Kalo, 2024).

• Parents, educators, physicians, and politicians all have the capability to act but at different levels

• Parents can act directly on individuals, educators can act on individuals and the community through smoking cessation education, physicians can act on individuals and the community through smoking cessation education and politicians can act on communities, provincially and nationally.

• In Canada, politicians and policies have made it is illegal to sell vaping products to individuals aged under 18 years. To further limit the purchase of vaping products among young adults, the minimum age has been increased to 19 or 21 in some provinces (Cherif and Kalo, 2024).

 

What are the needs, perceptions and supported directions of key influential community members, and the community-at-large?

• Key community members and the general public hold diverse perceptions about vaping, often varying by age and vaping status, health concerns, risks and addiction (Cherif and Kalo, 2024).

• Needs range from tailored health information, particularly for youth and smokers, to supporting vaping cessation programs (Cherif and Kalo, 2024).

• Supported directions focus on protecting young people through stricter regulations and education, while ensuring access to cessation resources (Cherif and Kalo, 2024).

 

What influences are making the situation better and worse?

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•What high-risk or negative health behaviours by various groups of people are affecting the situation?

• The high-risk behavior that is associated with vaping is the inhalation of heated gaseous smoke into the lungs and the exhalation of gaseous smoke into the atmosphere.

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Which underlying causes or conditions are driving these behaviours (e.g. individual, community, organizational or system-level causes)? Are there protective factors that can help avoid or alleviate the situation (such as ensuring walkable communities or encouraging strong parent-child relationships)?

• Individual: lack of education and awareness, social media, ease of accessibility, socioeconomic status, psychological determinants of use

• Community: marginalized groups (Indigenous individuals, LGBTQ+, etc), peers who vape, social settings like schools, cultural influences

• Organizational or system level: regulatory policies   

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Which strengths and weaknesses present in your organization may affect your course of action? Which opportunities and threats in your environment may affect your course of action?

• Strengths in BCLF interventions

  • Promotion of vaping cessation and education to patients

  • Increased access to educational material for teachers, parents and healthcare professionals

  • Allows patients in rural communities to access education

  • Culturally appropriate cessation resources 

• Weaknesses in BCLF interventions

  • Lack of personal connections (information available online)

  • Difficult in accessing services if not comfortable using technology

  • Areas with limited or poor internet access can result in poor access

• Opportunities in the environment

  • Provide education to youth in high school to increase knowledge and awareness

 

What possible actions can you take to address the situation?

 

What are other organizations doing, or what have they done in the past, to address this situation? Specifically, what local policies, programs and environmental supports are being developed or implemented within the community? What evaluation data are available for these activities?

• To further limit the purchase of vaping products among young adults, the minimum age has been increased to 19 or 21 in some provinces (Cherif and Kalo, 2024).

• In Canada, vaping products can have a maximum of 20 mg/mL of nicotine concentration. Any vaping products that visibly exceed this concentration cannot be manufactured, sold or packaged (Cherif and Kalo, 2024).

• Australia introduced legislation that banned the sale of single-use, non-therapeutic vaping products. Furthermore, Australia plans to improve and redefine the standards for therapeutic vapes through the limitation of flavours, decreasing nicotine concentrations, and implementing plain pharmaceutical packaging to reduce the appeal (Cherif and Kalo, 2024).

• Nearly 80% of Asian countries have regulated e-cigarettes. In South Korea, nicotine e-cigarettes are found under the tobacco category, and they cannot be sold to minors. The import, sale, possession, and use of e-cigarettes have been banned in Singapore. In Japan, nicotine e-cigarettes are illegal. In China, vaping products are now banned in public spaces and subject to excise tax. In 2019 India banned e-cigarettes but continue to be illegally distributed and used by young adults (Cherif and Kalo, 2024).

• Locally in BC, the BCLF has a policy campaign to achieve a smoke-free generation (SFG). The SFG policy campaign proposal bans the sale of tobacco and vaping products to anyone born on or after a specific date (BCLF, n.d.)​​. To achieve this the BCLF proposes increasing the legal age at which people can purchase tobacco and vaping products every year. As a result over time, the SFG campaign aims to create a generation of young people who have never been able to buy tobacco or vaping products (BCLF, n.d.) This would hopefully effectively eliminate the sale and use of tobacco and vaping.

• Vaping prevalence surveys will provide the most information regarding successfulness of interventions.  

 

What is the best available evidence that exists to support various courses of action?

• BCLF supports and found that vaping cessation interventions that are developed and implemented in collaboration with marginalized communities and utilize culturally appropriate cessation resources will have the best results and decrease vaping prevalence (BCLF, n.d.). 

 

References:

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BC Lung Foundation. (n.d.). A Smoke-Free Generation in British Columbia. BC Lung Foundation. Retrieved from https://bclung.ca/wp-content/uploads/2024/07/A-Smoke-Free-Generation-in-BC-Mar-4.pdf

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Bonner, E., Chang, Y., Christie, E., Colvin, V., Cunningham, B., Elson, D., ... & Tanguay, R. L. (2021). The chemistry and toxicology of vaping. Pharmacology & therapeutics, 225, 107837. https://doi.org/10.1016/j.pharmthera.2021.107837

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Center for Disease Control and Prevention. (2024). Social Determinants of Health (SDOH). Retrieved from https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html

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Cherif, D., & Kalo, C. (2024). How to Address E-cigarette Usage Among the Canadian Adolescent Population. McMaster University Journal of Public Health, 2. Retrieved from https://journals.mcmaster.ca/mujph/article/view/3770

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Government of Canada. (2024) About Vaping. Retrieved from https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping.html

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Gotts, J. E., Jordt, S. E., McConnell, R., & Tarran, R. (2019). What are the respiratory effects of e-cigarettes?. bmj, 366. https://doi.org/10.1136/bmj.l5275 

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Jonas, A. (2022). Impact of vaping on respiratory health. bmj, 378. doi: https://doi.org/10.1136/bmj-2021-065997

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Pisinger, C., & Døssing, M. (2014). A systematic review of health effects of electronic cigarettes. Preventive medicine, 69, 248-260. https://doi.org/10.1016/j.ypmed.2014.10.009

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Tehrani, H., Rajabi, A., Ghelichi-Ghojogh, M., Nejatian, M., & Jafari, A. (2022). The prevalence of electronic cigarettes vaping globally: a systematic review and meta-analysis. Archives of Public Health, 80. https://doi.org/10.1186/s13690-022-00998-w

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US Department of Health and Human Services. (2016). E-cigarette use among youth and young adults: A report of the Surgeon General.

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World Health Organization (2024). Evaluation in health promotion: Principles and perspectives. World Health Organization. https://iris.who.int/handle/10665/272659#:~:text=Health%20promotion%20initiatives%20need%20effective,effectiveness%20in%20achieving%20their%20aims.

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