What do teachers need to know to support discussions with other teachers, discussions between teachers and students as well as teachers and parents, guardians and caregivers? And what do students need to know and be able to do in order to make informed decisions about Vaping?
With the recent increase in the prevalence of vaping within the student population and educator requests for more information to support student health and well-being; we have broadened the scope of this blog to provide information on vaping all forms of substances including cannabis.
In the eighth installment of our “Clearing the Air about Cannabis” series, we spoke with Dr. Laurie Zawertailo from the Nicotine Dependence Clinic at the Centre for Addiction and Mental Health (CAMH) about vaping and youth, in the context of the recent news that came out of Canada and the US.
Read on to discover information about vaping, and how to approach conversations with students and resources for further reading.
We recently sat down with Dr. Laurie Zawertailo from the Nicotine Dependence Clinic at the Centre for Addiction and Mental Health (CAMH) to answer your questions about vaping.
Dr. Zawertailo is a Senior Scientist in the Addictions Research Program at CAMH and an Associate Professor in the Department of Pharmacology and Toxicology at the University of Toronto. Her program of research has included electronic cigarettes (e-cigarettes) / vapes since 2013, and her research focuses on utilizing brain imaging techniques to study changes in the brain following tobacco smoking and vaping.
What is Vaping?
Vaping is the act of inhaling of vapor created by electronic cigarettes (e-cigarettes) or other vaping devices. Vaping devices come in a variety of shapes and sizes, with some looking like conventional cigarettes. They all contain a battery and heating element, a chamber for the e-liquid and a mouthpiece. The liquids can be flavored or not, and can contain nicotine or THC. 1 The liquid is heated to approximately 250C to produce the vapor. There is no tobacco in an e-cigarette and no combustion takes place meaning that the tar and by-products of combusted tobacco that are known to cause disease are not present in e-cigarettes. A video on the Health Canada website can give you a quick introduction on the mechanics of vaping.1
What are students most likely vaping? Are there signs that I can tell they were vaping when they come/come back to class?
According to the 2017 Ontario Student Drug Use and Health Survey (OSDUHS):
- 10% of students have taken more than just a few puffs in the past year from an e-cigarette.
- Almost half (47%) of students used e-cigarettes that contained nicotine
- 7% of students have vaped cannabis, either through a vaporizer or an e-device.2
The prevalence of vaping among adolescents is far lower than cannabis use (in any form) and alcohol use. Past year use among Ontario students’ grades 7 through 12 was:
- Alcohol 42.5%
- Cannabis 19%
- Opioid pain relievers 10.6%
- Tobacco cigarettes 7%
- e-cigarettes 10.7%2
The OSDUHS survey sample is considered representative of all students in grades 7-12 in publicly funded schools in Ontario. These percentages represent the averages for students across Ontario versus localized statistics
What is the age or grade in which vaping is most problematic so we know who we should specifically be designing lessons for as part of healthy living?
According to the 2017 OSDUHS, those in grade 12 (19%) were twice as likely to have tried an e-cigarette compared to those in grade 9 (9%) and 3 times more likely to have used cannabis in the past year (37% of Grade 12s versus 9% of Grade 9s).2
The vast majority of vaping among this age group is experimental with only a very small proportion reporting daily or almost daily use. In addition, in teens who are never smokers, e-cigarette use is very low with less than 1% of never smokers using an e-cigarette.
What are the best instructional strategies to use to really have an impact on my students about the dangers of vaping?
First of all, it needs to be made clear that the recent reports of acute lung injury related to vaping has been shown in almost all cases to have resulted from vaping THC cartridges obtained from the black-market.3 As a result, the primary danger seems to be in using cannabis oils and liquids within a vaping device. Therefore the best strategy for protecting youth from the dangers of vaping is to adopt a harm reduction approach and to advise them that if they are going to use vaporized cannabis to only use products obtained from legal sources and to use them in a device that is meant specifically for that product. For more information on a harm reduction approach access our previous blog: Clearing the Air About Cannabis: Using a harm reduction approach to cannabis education in the classroom and the school setting.
With respect to vaping nicotine, the same advice holds. If an individual is going to choose to use e-cigarettes, only use products and devices obtained from a reputable source with a high level of quality control. However, nicotine itself can be highly addictive. Therefore, youth should be advised to use of e-cigarettes only occasionally and to refrain from daily use which can quickly become habitual, which in turn may, in some individuals, lead to use of traditional cigarettes that we know are extremely harmful. Medical experts currently do not know the long-term health effects vaping nicotine may have on youth and adults, which is why it is so important to encourage parents and schools to inform their children and students that these products are not without risk of harm.
Strategies to help students learn about the dangers of vaping include:
- Having one-on-one conversations;
- Encouraging open dialogue;
- Using language that avoids criticism.
When discussing the harms of vaping, it is good to have credible information on health effects like from this Government of Canada website.4 Providing statistics is helpful, but providing concrete examples or testimonials from youth who have experienced the direct harms of vaping is another option that is more relatable.
How did this become a problem so quickly?
E-cigarettes and vapes have been available in Canada since 2004, but in recent years, their popularity and use have increased significantly. The Tobacco and Vaping Products Act (TVPA) was enacted on May 23rd 2018 to regulate the manufacture, sale, labelling, and promotion of tobacco and vaping products sold in Canada.5 The purpose of the TVPA is to protect the health of Canadians and raise public awareness of the health effects of tobacco products, but another aspect of the act was to allow the legal purchase of vape products that contain nicotine.
Many youth see vaping as trendy and have a false belief that vaping is harmless and pose no risk to brain and lung health. This belief is strengthened given that many vaping devices do not contain health warnings like traditional tobacco cigarette products.
For adults who are currently addicted to smoking tobacco cigarettes, vaping is an alternative delivery method of nicotine that is less harmful because they contain fewer chemicals and toxins compared to traditional tobacco cigarettes, and there is no combustion.
One of the best ways to counter this marketing influence is to help students realize that they are being targeted, and to help them become aware of the health concerns associated with vaping. However, this in itself poses a challenge since we do not know a lot about the long-term effects of vaping on behavioural or brain changes in youth. To combat this issue, CAMH, is currently conducting a research study in youth ages 18 to 25 who use e-cigarettes/vapes on a regular basis using a sophisticated brain scan called a functional magnetic resonance imaging (fMRI). An fMRI is a technique that uses a magnetic field to create images of the shape and structure of the brain, and measure activity of specific brain regions. Using this scan, CAMH will examine brain changes associated with daily e-cigarette/vape use compared to cigarette smokers and non-nicotine users of the same age. If you know someone who may be interested in participating or to learn more about the study, please visit “Find a CAMH Study” (use keyword “E-Cigarette”).
I don't know enough about vaping myself so I don't know where to begin with having discussions with students. Where can I get facts/ data about vaping and its effects to use with my students to have discussion?
If you want more information on vaping, Health Canada has released a tip sheet for talking with teens about vaping. Simcoe Muskoka Health Unit has also launched the Not an Experiment campaign which provides basic information on vaping, as well as information on the health risks associated with vaping. CAMH is also hosting a Facebook Live event on November 28 for parents and teens to learn more about vaping from a panel of experts.
For access to a database of resources visit Cannabis Education Resources including Ophea’s Cannabis Education: Activate the Discussion Elementary and Secondary Discussion Guides! You can also sign up for Ophea’s monthly e-newsletter eConnection to read future cannabis Q&A columns and to stay up-to-date with the latest issues, events, and resources. Visit Ophea’s Clearing the Air About Cannabis Q&A Form to submit your questions for December’s Q&A column.
Thank you!
Ophea and the Provincial System Support Program at CAMH
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References
1. Health Canada. (2019). About Vaping. Retrieved from: https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping.html#a2
2. Boak, A., Hamilton, H., Adlaf, E. M., & Mann, R. R. (2017). Drug use among Ontario students, 1977-2017: Detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS) (CAMH Research Document Series No. 46). Retrieved from: https://www.camh.ca/-/media/files/pdf---osduhs/drug-use-among-ontario-students-1977-2017---detailed-findings-from-the-osduhs.pdf
3. Centers for Disease Control and Prevention. (2019) E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury — Utah, April–October 2019. Retrieved from: https://www.cdc.gov/mmwr/volumes/68/wr/mm6842e1.htm
4. Government of Canada. (2019). Consider the Consequences of Vaping. Retrieved from: https://www.canada.ca/en/services/health/campaigns/vaping.html?utm_source=google&utm_medium=cpc_en&utm_content=youth_5&utm_campaign=vapingprevention2019&utm_term=dangers%20of%20vaping
5. Health Canada. (2018). Tobacco and Vaping Products Act. Retrieved from: https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/legislation/federal-laws/tobacco-act.html