E-cigarettes
============

* Mehdi Aloosh
* Janice Johnston
* Bart Harvey

## E-cigarette use is increasing in Canada, especially among youth

The ever use of battery-powered electronic nicotine delivery systems devices or e-cigarettes by Canadians aged 16–17 years increased from 29.3% in 2017 to 37% in 2018 (and reported use on at least 15 of every 30 days increased from 2.1% to 3.6%). Moreover, the prevalence and frequency of vaping increased among never and experimental smokers in parallel with the rise of use of JUUL (an e-cigarette with high nicotine concentration).1

## E-cigarette use is strongly associated with the initiation and ongoing use of cigarette smoking

Current evidence indicates that among those aged 14–30 years, nonsmokers who use e-cigarettes have a greater than 3-fold increase (23.2% v. 7.2%) in the initiation and use of cigarette smoking.2 This difference suggests that for every 6 nonsmokers using e-cigarettes, 1 of them will begin smoking cigarettes.

## E-cigarettes are an additional smoking cessation tool

A recent randomized clinical trial provides evidence supporting e-cigarettes as an effective smoking cessation tool.3

## E-cigarettes are unregulated products with potentially dangerous health effects

Long-term, direct health risks caused by using e-cigarettes are expected to take many years to become apparent. However, nicotine is highly addictive. Moreover, of great concern, recent findings have suggested that e-cigarette exposure may result in serious pulmonary effects.4

## Clinicians should ask about e-cigarette use

Because of the evidence regarding the effect of e-cigarette use on the initiation of smoking, consistent with Canadian Task Force on Preventive Health Care recommendations,5 physicians should, as appropriate, consider counselling nonsmokers on this and other health risks of e-cigarettes during primary care visits. In addition, for those who have successfully used e-cigarettes as a smoking cessation aid, clinicians should support the cessation of e-cigarette use, considering the current epidemic of vaping-related pulmonary illnesses.4

## Footnotes

*   *CMAJ* Podcasts: author interview at [https://soundcloud.com/cmajpodcasts/190552-five](https://soundcloud.com/cmajpodcasts/190552-five)

*   **Competing interests:** No competing interests were declared.

*   This article has been peer reviewed.

*   *CMAJ* invites submissions to “Five things to know about …” Submit manuscripts online at [http://mc.manuscriptcentral.com/cmaj](http://mc.manuscriptcentral.com/cmaj)

## References

1.  Hammond D, Reid JL, Rynard VL, et al. Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys. BMJ 2019;365:l2219.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjE3OiIzNjUvanVuMTlfNy9sMjIxOSI7czo0OiJhdG9tIjtzOjIzOiIvY21hai8xOTEvNDEvRTExMzYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Soneji S, Barrington-Trimis JL, Wills TA, et al. Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis. JAMA Pediatr 2017;171:788–97.
    
    

3.  Hajek P, Phillips-Waller A, Przulj D, et al. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med 2019;380:629–37.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1056/NEJMoa1808779&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=30699054&link_type=MED&atom=%2Fcmaj%2F191%2F41%2FE1136.atom) 

4.  Christiani DC. Vaping-induced lung injury. N Engl J Med 2019 Sept. 6 [Epub ahead of print]. doi:10.1056/NEJMe1912032.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1056/NEJMe1912032&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=31491071&link_type=MED&atom=%2Fcmaj%2F191%2F41%2FE1136.atom) 

5.  Thombs BD, Jaramillo Garcia A, Reid D, et al.Canadian Task Force on Preventive Health Care. Recommendations on behavioural interventions for the prevention and treatment of cigarette smoking among school-aged children and youth. CMAJ 2017;189:E310–6.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTg5LzgvRTMxMCI7czo0OiJhdG9tIjtzOjIzOiIvY21hai8xOTEvNDEvRTExMzYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)