By Lisa Rapaport

More American and Canadian teens are vaping than ever before, according to a new study, and researchers say the availability of e-cigarettes with more nicotine may partly explain the trend.

The study team examined data on smoking and vaping by youth in Canada, England and the U.S. and found that between 2017 and 2018, the proportion of 16- to 19-year-olds who reported vaping in the past 30 days rose by almost 50% in the U.S. and nearly doubled in Canada, while remaining relatively constant in the UK.

The proportion of teens who said they had vaped in the previous 30 days rose in Canada from 8.4% in July-August 2017 to 14.6 % in August-September 2018, and in the U.S. from 11.1% to 16.2% while remaining stable at just under 9% in the UK.

“2018 marked the point at which new vaping technology started to take over the market, led by JUUL,” said David Hammond of the School of Public Health at the University of Waterloo in Canada, who led the study.

“The vapor from these products has a different chemistry that allows them to deliver very high levels of nicotine, similar to regular smoked cigarettes,” Hammond said by email. “However, England has set maximum limits on nicotine concentrate, which cuts the nicotine level in half compared to the same brands sold in Canada and the U.S., and England has also more strict rules on advertising of e-cigarettes than the other two countries.”

JUUL debuted its e-cigarettes in the U.S. in 2015 and now commands more than half the market, researchers note in The BMJ. JUUL became available in the UK in July 2018 and in Canada in September 2018.

Teen use of JUUL e-cigarettes increased in all three countries during the study period. The proportion of U.S. adolescents who reported JUUL was their usual brand surged threefold between 2017 and 2018 from 1% to 4.5%.

Many youth think vaping is not harmful and many are unaware of the nicotine levels in the current generation of products, Hammond said. He added, “Parents and kids should know that these products are capable of producing addiction and may have long term health risks from exposing the lungs to chemicals from e-cigarettes.”

Some previous studies suggest that teens who vape may also be more likely than those who don’t to start smoking traditional cigarettes and marijuana.

Big tobacco companies, including Altria Group Inc, Lorillard Tobacco Co and Reynolds American Inc, are all developing e-cigarettes. The battery-powered devices feature a heating element that turns liquid containing nicotine and flavorings into a cloud of vapor that users inhale.

In an emailed statement, JUUL said, “We don’t want any non-nicotine user to use our products, especially youth,” JUUL said in an emailed statement. “We agree with the authors of the study about the need to find ‘the optimal regulatory balance that provides smokers with reasonable access to these products, while restricting features of such products that appeal to youth . . . ‘ and our actions to prevent underage use reflect that. We have taken aggressive action in both the U.S. and Canada to combat underage usage of our products while preserving the opportunity for adult smokers to switch from combustible cigarettes.”

One limitation of the study is that it relied on teens to truthfully report any vaping or smoking. Another drawback is that a one-year study may not necessarily reflect what would happen with vaping trends in the future.

Still, parents should talk to children and teens about the dangers of smoking and vaping, said Professor Linda Bauld, chair of public health at the College of Medicine and Veterinary Medicine at the University of Edinburgh, UK, who coauthored an editorial accompanying the study.

“Parents should explain that vaping products are for adult smokers trying to quit, not teenagers who have never smoked,” Bauld said by email.

“Vaping is less harmful than smoking, that’s why it is a good option for adult smokers,” Bauld said. “But that doesn’t mean that it is risk free and it is better for teenagers to use nothing – no vaping, no smoking.”

SOURCE: and The BMJ, online June 20, 2019.