Why we need a ban on “vaping”
E-cigarettes are the latest addition to teenage trends. Electronic cigarettes, often called e-cigarettes, are battery-operated devices designed to look like regular tobacco cigarettes. They contain an atomizer, which heats liquid containing nicotine, turning it into a vapor that can be inhaled and creating a vapor cloud that resembles cigarette smoke. (mayoclinic.org). The act of inhaling and exhaling the vapor produced by an e-cigarette is commonly known as vaping. We will further explore the harmful effects of vaping, its growing trend among teenagers, and why we need a provincial ban on the use of e-cigarettes in schools.

First of all, e-cigarettes contain nicotine, a substance that can also be found in actual cigarettes: “Most liquids have nicotine in them, even though they may be sold as “nicotine–free”. Tests of some of the products labelled as nicotine-free have found nicotine in them.” (myhealth.alberta.ca). There are plenty of known harmful effects of nicotine, such as: “Nicotine is highly addictive. When you stop using it, you can get withdrawal symptoms including feeling irritable, depressed, restless and anxious.” (webmd.com), and as medical daily reports: “Normally, vascular muscle cells place themselves around blood vessels to help keep blood flow and blood pressure under control. Inflammation, chemicals, and nicotine, however, can cause these cells to transform into drills that chew through tissue. These cells then push into the arteries and end up accumulating into plaque, blocking blood flow, and creating a ‘atherosclerotic’ artery.” (medicaldaily.com). Also: “Nicotine binds to an area of the brain known as the adrenal medulla, which increases the flow of adrenaline. This in turn causes increased blood pressure, heart rate and respiration, and these conditions exacerbate existing heart and blood pressure problems.” (cosmosmagazine.com). “It also acts on the nerves that control respiration to change breathing patterns. In high concentrations, nicotine is deadly; in fact one drop of purified nicotine on the tongue will kill a person. It's so lethal that it has been used as a pesticide for centuries.” (teens.drugabuse.gov). The Medical Discovery News reports; “with e-cigarettes, smokers may not know how much of it they’re getting. A lack of regulation and quality control means the amount of nicotine in each drag of an e-cigarette is inconsistent. The U.S. Food and Drug Administration determined that since e-cigarettes are not considered a drug delivery device, the agency has no jurisdiction over them.” (medicaldiscoverynews.com).

In addition to nicotine, e-cigarettes also contain some of the extremely harmful carcinogens that are also found in actual cigarettes as: “the administration issued a health warning about e-cigarettes after its tests show they contain harmful chemicals such as diethylene glycol, a component of antifreeze that’s toxic to humans and is banned in food and drugs. There were also detectable levels of a known carcinogen called nitrosamine and other toxic chemicals that users could potentially inhale.” (medicaldiscoverynews.com). Moreover, e-cigarettes have cartridges with liquid chemicals in them, and as the Alberta quits website further adds: “Because chemicals in the cartridges vary, it’s hard to know what e-cigarette users and people nearby are breathing in... the U.S. Food and Drug Administration found cancer causing chemicals in some of the cartridges.” (albertaquits.ca). Health Canada also advises against using e-cigarettes, saying: “e-cigarettes may cause nicotine poisoning and addiction.” (albertaquits.ca)
Furthermore, the U.S. Food and Drug Administration conducted a laboratory analysis of e-cigarettes: “FDA's Center for Drug Evaluation, Office of Compliance purchased two samples of electronic cigarettes and components from two leading brands. These samples included 18 of the various flavored, nicotine, and no-nicotine cartridges offered for use with these products. These cartridges were obtained in order to test some of the ingredients contained in them and inhaled by users of electronic cigarettes. FDA's Center for Drug Evaluation, Division of Pharmaceutical Analysis (DPA) analyzed the cartridges from these electronic cigarettes for nicotine content and for the presence of other tobacco constituents, some of which are known to be harmful to humans, including those that are potentially carcinogenic or mutagenic.” (fda.gov). Specifically, the analysis of the electronic cigarette cartridges from the two leading brands revealed the following: “Diethylene glycol was detected in one cartridge at approximately 1%. Diethylene glycol, an ingredient used in antifreeze, is toxic to humans. Certain tobacco-specific nitrosamines which are human carcinogens were detected in half of the samples tested. Tobacco-specific impurities suspected of being harmful to humans—anabasine, myosmine, and β-nicotyrine—were detected in a majority of the samples tested. The electronic cigarette cartridges that were labelled as containing no nicotine had low levels of nicotine present in all cartridges tested, except one. Three different electronic cigarette cartridges with the same label were tested and each cartridge emitted a markedly different amount of nicotine with each puff. The nicotine levels per puff ranged from 26.8 to 43.2 mcg nicotine/100 mL puff. One high-nicotine cartridge delivered twice as much nicotine to users when the vapor from that electronic cigarette brand was inhaled than was delivered by a sample of the nicotine inhalation product (used as a control) approved by FDA for use as a smoking cessation aid.” (fda.gov).

The use of e-cigarettes amongst teenagers is concerning. The Centers for Disease Control and Prevention reports: “The findings from the National Youth Tobacco Survey, in today’s Morbidity and Mortality Weekly Report, show that the percentage of high school students who reported ever using an e-cigarette rose from 4.7 percent in 2011 to 10.0 percent in 2012. In the same time period, high school students using e-cigarettes within the past 30 days rose from 1.5 percent to 2.8 percent. Use also doubled among middle school students. Altogether, in 2012 more than 1.78 million middle and high school students nationwide had tried e-cigarettes.” (cdc.gov). The study also found that: “76.3 percent of middle and high school students who used e-cigarettes within the past 30 days also smoked conventional cigarettes in the same period. In addition, 1 in 5 middle school students who reported ever using e-cigarettes say they have never tried conventional cigarettes.” (cdc.gov). This raises concern that there may be young people for whom e-cigarettes could be an entry point to use of conventional tobacco products, including cigarettes. Also: “An estimated 15 per cent of kids aged 13 to 17 in Canada have tried tobacco. From 2010 to 2011, e-cigarette usage doubled south of the border.” (winnipegfreepress.com).
The World Health Organization released a report on Electronic Nicotine Delivery systems or ENDS, commonly known as e-cigarettes, on July 21st, 2014 which contains the following information regarding e-cigarettes: “The capacity of ENDS to deliver nicotine to the user varies widely, ranging from very low to levels similar to that of cigarettes, depending on product characteristics, user puffing behaviour and nicotine solution concentration. Nicotine is the addictive component of tobacco. It can have adverse effects during pregnancy and may contribute to cardiovascular disease. Although nicotine itself is not a carcinogen, it may function as a “tumour promoter”. Nicotine seems involved in fundamental aspects of the biology of malignant diseases, as well as of neurodegeneration. The evidence is sufficient to caution children and adolescents, pregnant women, and women of reproductive age about ENDS use because of the potential for fetal and adolescent nicotine exposure to have long-term consequences for brain development.” (apps.who.int). It also addresses the issue of nicotine overdose through ENDS: “The main health risk from nicotine exposure other than through inhalation is nicotine overdose by ingestion or through dermal contact. Since most countries do not monitor these incidents the information is very scarce. Reports from the United States and the United Kingdom nonetheless indicate that the number of reported incidents involving nicotine poisoning has risen substantially as the use of ENDS has increased. The actual number of cases is probably much higher than those reported.” (apps.who.int). The report summarizes, stating: “the existing evidence shows that ENDS aerosol is not merely “water vapour” as is often claimed in the marketing for these products. ENDS use poses serious threats to adolescents and fetuses. In addition, it increases exposure of non-smokers and bystanders to nicotine and a number of toxicants. Nevertheless, the reduced exposure to toxicants of well-regulated ENDS used by established adult smokers as a complete substitution for cigarettes is likely to be less toxic for the smoker than conventional cigarettes or other combusted tobacco products. The amount of risk reduction, however, is presently unknown.” (apps.who.int). The report also includes the following information regarding adolescents: “The limited existing survey data from a handful of countries show that experimentation with ENDS is increasing rapidly among adolescents and that in itself is of great concern even if most of the young ENDS users also smoke. In fact, except in one case, the surveys show that there are few exclusive ENDS users who have never smoked (mostly around 1% of the population). These data do not allow the conclusions to be drawn as to whether this is a sign of adolescent smokers switching to ENDS, an established pattern of dual use, or a temporary experimentation fashion. Therefore, in the absence of longitudinal data, existing evidence does not allow an affirmation or rejection of the role of ENDS in increasing nicotine addiction among adolescents above existing uptake rates, much less as to whether ENDS lead to smoking in these countries. Among adults the pattern of dual use seems also the predominant one, resulting in a reduction of smoked cigarettes and with few never smokers starting to use ENDS (below 1% of the population).” Thus the WHO urges the governments to regulate the use of e-cigarettes in public places and indoors: “"ENDS [Electronic Nicotine Delivery Systems] users should be legally requested not to use ENDS indoors, especially where smoking is banned until exhaled vapour is proven to be not harmful to bystanders.” (ibtimes.co.uk).

The full report can be found here: http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf?ua=1

The American Heart and Lung Association also released a policy statement on August 24th, 2014 regarding e-cigarettes and the need for strict regulations on their use. The policy statement includes statements like: “Over the last 50 years, 20 million Americans died because of tobacco. We are fiercely committed to preventing the tobacco industry from addicting another generation of smokers. Recent studies raise concerns that e-cigarettes may be a gateway to traditional tobacco products for the nation’s youth, and could renormalize smoking in our society. These disturbing developments have helped convince the association that e-cigarettes need to be strongly regulated, thoroughly researched and closely monitored.” (newsroom.heart.org). It also includes statistics on the use of e-cigarettes amongst youth: “Data from the 2011 to 2012 National Youth Tobacco Survey showed that among students in grades 6 through 12, current e-cigarette use (≥1 day in the past 30 days) increased from 1.1% in 2011 to 2.1% in 2012 and any use of e-cigarettes (ever use) increased from 3.3% to 6.8% in the same corresponding years. Overall, by 2012, 1.78 million high school and middle school students nationwide had tried e-cigarettes. For those students who had ever used e-cigarettes, 9.3% reported never smoking conventional cigarettes, whereas 76.3% of current e-cigarette users responded that they also smoke conventional cigarettes. Among never-smokers, 0.7% were currently users (past 30 days), which indicates that few never-smokers who try e-cigarettes continue their use.” (newsroom.heart.org). The AHA ended their policy statement saying: “The AHA supports effective FDA regulation of e-cigarettes that addresses marketing, youth access, labelling, and quality control over manufacturing, free sampling, and standards for contaminants. The regulation should allow for quality-controlled products for adults who want to transition from conventional cigarettes to e-cigarettes or to quit or reduce smoking. Bottles containing nicotine refill liquids can be toxic if swallowed, so cartridges and bottles should have proper warning labelling and child-proof packaging. It is important that the relevant government agency monitor whether these devices are used for delivery of other drugs and medications. Companies should not be able to claim that e-cigarettes are a cessation aid unless they are approved by the FDA for that purpose.” (newsroom.heart.org).

The full policy statement can be found here: http://newsroom.heart.org/news/american-heart-association-issues-e-cigarette-recommendations

The Heart and Stroke Foundation, Canada advices the federal, provincial, and municipal governments to adopt policies such as, ban on the use of e-cigarettes in public places (heartandstroke.com); Health Canada has imposed a ban on the sales or use of e-cigarettes that contain nicotine while it “last publicly addressed vaping in 2009, advising Canadians not to buy or use the products because the safety of the products had not been proven. The agency also reminded Canadians that no company has been granted market authorization under the Food and Drugs Act to manufacture and sell e-cigarettes that deliver nicotine.”(heartandstroke.com). The Canadian Lung Association is currently updating their Position Statement (pending) based on current scientific evidence and recommendations from the World Health Organization, Health Canada, and the U.S. Federal Drug Administration. (quitnow.ca).
In October of 2014 the Vancouver School Board imposed a ban on e-cigarettes from school property. The city of Red Deer Alberta issued a statement in June of 2014, saying the use of e-cigarettes was banned everywhere a normal cigarette was banned. (Winnipeg free press) Winnipeg School division, the largest school division in Winnipeg has banned the use of e-cigarettes on school property after a meeting of the Board of Trustees, held on October 6th, 2014. The Board adopted the following motion: “That the use of Electronic Vaporizer Devices is not permitted in schools or on school property in the Winnipeg School Division.” (winnipegsd.ca) Nova Scotia, and Toronto have also banned the use of e-cigarettes in public places, while Hamilton and Quebec have proposed that a similar action be taken against vaping. (Winnipeg Free press).

Our action plan is to get a provincial ban on the use of e-cigarettes on school property as other school divisions in Winnipeg, like the Seven Oaks School Division, Louis Riel School Division still don’t have regulations concerning e-cigarettes, or vaping. I have emailed the respective school divisions requesting their thoughts regarding e-cigarettes. I am further planning to spread awareness about the harmful effects of e-cigarettes, and why there should be a provincial ban on its use on school property amongst the general public through posters and social media. I will further try to run a petition, and then finally contact the provincial government regarding the issue.
In summary, electronic cigarettes are an increasing trend amongst adolescents, and even thought they are extremely harmful, there is no provincial ban on the use of e-cigarettes in schools. Thus, we need to address the issue soon by convincing the province to adopt a ban on their use in schools.

Bibliography
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www.winnipegsd.ca