Studies have shown overwhelming public support for prohibiting the sale of e-cigarettes to minors, restricting youth access and nicotine content, prohibiting use in smoke-free places and banning marketing.
Adolescents and public policy advocates for a tobacco-free healthy childhood may find these results particularly interesting as adolescents’ e-cigarette use has reached epidemic levels in Canada.
Further, these results could be used to advocate for evidence-based interventions to regulate e-cigarettes in Canada. More important, perhaps, is to recognize that current interventions to prevent adolescent uptake on e-cigarettes are limited and need much improvement.
Combating the misinformation that e-cigarette use is a harmless tobacco cessation tool is a challenging task. Misinformation is rampant online and on adolescents’ social media feeds and is so pervasive that most children do not see vaping as a risky addictive habit with high potential for cessation challenges later in life. Strategies and approaches used by the tobacco industry to promote products such as highly addictive e-cigarettes are detrimental to adolescent health.
We need to work with the world’s powerful information disseminators online – Facebook, Twitter, YouTube, Instagram, Snapchat and Google as well as social media influencers – to stop spreading misinformation on e-cigarettes. It is also necessary to build an easy-to-use platform to direct adolescents’ information requests on e-cigarettes to credible medical organizations such as the Canadian Medical Association (CMA) and the Canadian Pediatric Society (CPS).
Given that adolescents are everyday users of social media with its widely disseminated misinformation, clinicians, parents/caregivers and teachers must help adolescents think critically about the relevance of the information they encounter.
Accumulating evidence from clinical case studies suggests that inhaling vapour from e-liquid chemicals (volatile organic compounds, ultrafine particles, and heavy metals) can damage the lungs and result in lung pathologies and clinical illnesses. In addition, eight systematic reviews/meta-analyses have concluded that smoking is related to adverse outcomes associated with COVID-19. As one study concludes: “COVID-19 infection is associated with significant severity and mortality in COPD.”
Two other recent studies reached similar conclusions: one out of Australia found that smoking, vaping and second-hand smoke all may raise COVID-19 risks while the other out of the United Kingdom shows that current smoking is associated with 1.8 times higher odds of confirmed COVID-19 relative to never smoking, independent of age, sex, ethnicity, key worker status and comorbid health conditions.
There is a widely held misconception that young people who contract COVID-19 usually will have mild viral symptoms. But the latest research suggests that one in three young adults are vulnerable to falling seriously ill, with those who smoke being particularly at risk.
Thus, prioritizing measures to help prevent and reduce the disproportionate effect of smoking on the younger populations must be part of the national prevention strategy.
The most recent position paper published in the European Journal of Preventive Cardiology encourages public campaigns to raise awareness of the adverse effects and prevent initiation of vaping. It advises health professionals to inform their patients and the general public of the possible adverse health risks of e-cigarettes.
Meanwhile, the U.S. Preventive Services Task Force recently updated recommendations on prevention and cessation of tobacco use among children and adolescents seen in primary care settings. It recommends education and brief counselling with a clinician to prevent initiation of tobacco use. Behavioural counselling interventions used by primary care clinicians are used to prevent or stop tobacco use. These interventions include digital or print-based education and face-to-face or telephone counselling, among others.
Prevention or reduction in severity of as many cases of COVID-19 will be a critical step to reduce morbidity and mortality and conserve an already strained healthcare system. Tobacco prevention efforts will be a critical intervention in this effort.
*The authors have no conflicts of interest to declare.
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