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E-cigarette use among youth and young adults

The increasing volume of research on the harmful effects of e-cigarettes and vaping products, especially among youth and young adults, raises public health concerns. In 2016 the ban policy was adopted nationwide by the FDA, followed by 8 out of 10 Canadian provinces during 2015-2017, and nationwide since 2018.

Online surveys revealed an increase in vaping

Online surveys conducted as part of the International Tobacco Control Policy Evaluation Project (ITC) provided the researchers with data on vaping usage.1 The surveys involved approximately 13,000 participants aged between 16 and 19 years from Canada, England, and the US. The surveys asked the participants questions about smoking and vaping habits, including device preferences.

The frequency of vaping in young people increased between 2017 and 2018 in Canada and the US, but not in England. This increase emerged from all the categories assessed, which included use of vaping devices ever, in the last month, in the last week, and in 15 or more days during the past month.

The association between vaping and smoking in adolescents is another source of concern, and this study found that the frequency of teen smoking increased in Canada and to a lesser extent in England, while it did not in the US.

How do bans impact sales of e-cigarettes to young people?

In one study, e-cigarette use reportedly increased despite a ban. However, there was a smaller increase where the ban was in effect (from 5.3% to 5.6%, as compared to 4.4% to 9.7%).2  

According to the researchers, although the ban on e-cigarette sales to minors did have a significant effect on the increased rates of e-cigarette use among young people, other inhibitory methods may also be required. The researchers suggest that “this policy should be supplemented with other measures that can reduce young people’s desire to obtain e-cigarettes through social sources, such as a ban on e-cigarettes with flavors that appeal to youths and children.”

Do in-school prevention programs work?

To address vaping amongst school students, twelve middle schools in Texas introduced the CATCH My Breath vaping prevention program. CATCH My Breath is thought to be the first evidence-based, vaping prevention program to be introduced and evaluated in the United States. The program is collaboratively carried out by teachers and students, including four interactive class modules and various methods of social messaging.

The study3 found that e-cigarette use was lower in schools that participated in the vaping prevention program compared with those that did not. Students were found to be half as likely to experiment with vaping in schools that implemented the CATCH My Breath program.

CATCH My Breath is thought to be the first effective program of its kind and it continues to grow and evolve. An elementary school version is currently in production and additional research studies to analyze the ongoing effectiveness of the program are underway.

CATCH My Breath is now implemented in over 2000 schools across the United States. With research regarding the risks of vaping growing, this is an important step forward in health education for adolescents.

Do e-cigarettes increase the likelihood of smoking in teens?

Researchers found that in the group of non-smokers who have never smoked and were not likely to smoke, 45.2 % of students who had used e-cigarettes had reported trying smoking cigarettes two years later. Comparatively, only 13.5% of teens who were not e-cigarette smokers reported having tried cigarettes in the two years that followed.

Among the group likely to smoke in the future, 62.4% of teens who smoked e-cigarettes reported trying cigarettes in the 2 years that followed the initial survey, with 36.1% who had never tried e-cigarettes reporting that they tried cigarettes in the following two years.

The study4 found that students who previously used e-cigarettes were more likely to report trying cigarettes in the future, including groups of teens not likely to smoke in the future, or unlikely to try cigarettes based on their survey responses. This suggests that e-cigarettes may be acting as a new gateway for a new generation of smokers who may have not traditionally been at risk for smoking cigarettes.

Celebrity endorsements increase positive attitudes towards e-cigarettes

It has been reported that celebrity endorsements significantly increase the positive attitudes towards e-cigarettes and e-cigarette smoking intentions as compared to non-celebrity endorsements and product advertisements.5

E-cigarette “smoke” has been linked to cell damage, lung inflammation, asthmas and respiratory infections. Nicotine exposure during the teenage years can affect memory, attention, and emotional regulation.


  1. Hammond, D., Reid, J. L., Rynard, V. L., Fong, G. T., Cummings, K. M., McNeill, A., Hitchman, S., Thrasher, J. F., Goniewicz, M. L., Bansal-Travers, M., O’Connor, R., Levy, D., Borland, R., & White, C. M. (2019). Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: Repeat national cross sectional surveys. BMJ (Online), 365.
  2. Hai V. Nguyen, Association of Canada’s Provincial Bans on Electronic Cigarette Sales to Minors with Electronic Cigarette Use Among Youths, JAMA Pediatr. Published online November 4, 2019. doi:10.1001/jamapediatrics.2019.3912
  3. Kelder, S., Mantey, D., Van Dusen, D., Case, K., Haas, A. and Springer, A. (2020). A Middle School Program to Prevent E-Cigarette Use: A Pilot Study of “CATCH My Breath”. Public Health Reports, p.003335491990088.
  4. S.Aleyan, A.Cole, W.Qian, S.T Leatherdale. (2017). Risky business: a longitudinal study examining cigarette smoking initiation among susceptible and non-susceptible e-cigarette users in Canada. Retrieved from BMJ Open:
  5. Phua J, Jin SV, Hahm JM. Celebrity-endorsed e-cigarette brand Instagram advertisements: Effects on young adults’ attitudes towards e-cigarettes and smoking intentions. J Health Psychol. 2018 Mar;23(4):550-560. doi: 10.1177/1359105317693912. Epub 2017 Feb 1. PMID: 28810409.

Image by Lindsay Fox from Pixabay 



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