What We Heard Report: Health Effects of Vaping End-of-Grant Workshop
Workshop report summary
On March 7-8, 2023, four Institutes at the CIHR (Cancer [ICR], Circulatory and Respiratory Health [ICRH], Human Development Child and Youth Health [IHDCYH], and Neurosciences Mental Health and Addiction [INMHA]), as well as the Canadian Cancer Society, with support from Health Canada hosted a workshop to review the findings of the Health Effects of Vaping research grants. These grants were created in 2020 in response to growing concerns regarding the unknown health effects of vaping and the rapid increase in vaping in Canada, particularly amongst youth.
In addition to presenting research findings from the vaping catalyst grant recipients, the workshop also heard from leading experts in the field, identified gaps in evidence, engaged people with lived and living experience (PWLLE) and discussed priorities for future research.
Note: Vaping is the common term applied to inhalation of aerosols generated through non-combustible delivery systems, such as electronic nicotine delivery systems (ENDS). These devices can be used to aerosolize nicotine, cannabis or other active agents commonly suspended in liquids. Cigarettes and “joints”, on the other hand, are combustible delivery methods of nicotine and cannabis to the lungs. In this report, we will use the term “vaping” to signify inhalation of aerosols produced by vaping/ENDS devices.
If you would like a copy of the full End-of-Grant Workshop report, please email: support-soutien@cihr-irsc.gc.ca
Highlights of Research Findings
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Health Effects
Vaping aerosols produced by E-cigarettes and other vaping devices have notable impacts on a several different physiological responses, including some that differ from those seen with traditional combustible tobacco inhalation through cigarette use. There are also differences in responses in females and males, suggesting that not all responses are universal.
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Cellular death
Exposure to aerosols from vaping leads to increased measures of cell death and reduces how quickly the airway epithelium can repair after injury.
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Regulations
Regulatory strategies hold more merit for youth vaping prevention than non-regulatory strategies; however, combining a variety of strategies is more effective than any individual intervention alone.
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Infection Risk
Both cannabis smoking and vaping induce changes in epithelial cell barrier function, which may exacerbate subsequent H1N1 infection.
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RNA Damage
People who inhale aerosols from vaping have significant changes in the RNA profiles of their lung cells that mimic changes seen in other chronic lung diseases. These changes may be early indicators that long-term e-cigarette use could result in chronic lung disease (similar to smoking traditional cigarettes).
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Lung Function Changes
Disturbances in gas exchange are common among young persons who regularly vape. This raises the possibility that long-term vaping may cause small airway dysfunction.
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Immune Responses
Data indicate that even one short-term exposure to vaping aerosols alter the function of immune cells in blood and in the airways.
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Addressing Information Gaps
During pregnancy and the postpartum period, the most frequent reasons for vaping cannabis are to manage insomnia, depression and anxiety, headaches/migraines, and lack of appetite. Inhaling aerosols from vaping is also used to avoid pharmacological alternatives that are perceived as more harmful.
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Misinformation
Inhalation of nicotine aerosols was initially proposed and marketed as a harm reduction/smoking cessation strategy; however, most people who use vaping products were non- or never-smokers.
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Dual Use Risks
Concurrent use of e-cigarette and cigarettes are associated with a higher rate of all-cause health services use. This suggests that the use of vaping aerosols may be an epidemiological biomarker for youth and young adults with increased health morbidity.
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Addiction
When identifying the factors associated with aerosol vaping, the location of the last purchase, the number of days a pod lasts, and the frequency of nicotine use while vaping were the most important predictors for vaping dependence amongst daily vapers.
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Sex-based differences
In a study of nicotine reward and withdrawal in rats, only male adult and adolescent rats showed significant nicotine withdrawal. Female adolescent and adult rats had higher levels of nicotine and metabolites in the brain and plasma. The data also showed decreased functional connectivity in rats exposed to nicotine, with females showing greater reductions in connectivity.
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Mental Health
Vaping use and inhaling aerosols lead to higher risks of mood and anxiety disorders amongst youth and is a contributor to the growing mental health crisis facing young people.
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Youth
Amongst adolescents and young adults, about half report not receiving information about how to use cannabis safely, as well as the potential physical and social harms of cannabis.
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Policy
Provinces that fully restrict the sale of vaping products with nicotine concentrations over 20 mg/mL find fewer of these products in both brick-and-mortar and online stores.
Figure: Effective Mobilization of Evidence into Practice
Long Description
This image is an illustration depicting discussions about effective mobilization of evidence into practice. At the top of the image, heading text reads “Effective mobilization of evidence into practice”. The word “into” is written in a lightbulb that is being carried by three figures. At the top left of the image, the names of the moderator and panelists are written: Sonia Johnson, Terry Dean, Manuel Arango, Rob Cunningham, and Lynda Belneaves.
Below the participants names, text reads “There are now half a million people who use vapes but don’t smoke.” Below this, there is an illustration of a person with a thought cloud at the top of their head. In the thought cloud, text reads “knowledge mobilization is a key strategy.” Below the thought bubble, text reads “essential to engage with government and individuals with lived experience.” To the right of this, text reads “understand peoples’ health literacy” with an arrow pointing upwards, away from this text. The arrow has text on it that reads “bridge the gap” and it points to an illustration of Canada’s Parliament building. Below the arrow, a series of three ascending check boxes is depicted with check marks in each one with a figure climbing the boxes.
Below the illustration of the Parliament building, text reads “youth ambassadors” and “utilize social media”. To the left of the Parliament illustration, text reads “putting lived experience at the centre helps our research resonate.” An arrow coming from the illustration of Parliament points at an illustration of a document that reads “influence policy change.” A ribbon comes from the “influence policy change” document and wraps around an illustration of a magnifying glass with text in it that reads “when informing policy” with an arrow pointing to text that reads “keep science at the forefront.” The ribbon has text on it that reads “understand the policy landscape.”
At the bottom of the image, below the ascending check marks, text reads “need clinical guidelines to move research”. A ribbon connects this to text that reads “medical authorization will help support cessation use” and another ribbon points to text that reads “controls would prevent usage by youth.”
To the right, there is an illustration of a prescription document with a speech bubble coming out of it that reads “prescriptions enable dialogue with clinicians.”
In the bottom right corner of the image, there is an illustration of three people holding a sign that reads “you’re making us sick!!!”. Above the sign, text reads “elevate youth voices!”
Footer of the image shows the logos of the Canadian Institutes of Health Research and the Canadian Cancer Society - Health Effects of Vaping - End of Grant Workshop - March 7-8, 2023 - Live Graphic Recording by: Brittany Datchko - Fuselight creative
Priorities for Future Research
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Harms of inhaling aerosols
- Identify the composition and toxicology of vaping liquids and devices.
- What are the consequences of disposing vaping devices (e.g., batteries, single-use devices, multi-use devices, etc.) products on the environment?
- What prevention strategies could be used for people who vape aerosol products as a harm reduction method for smoking cessation?
- Explore social attitudes/stigmas around vaping aerosol products vs smoking.
- Study vaping through independent methods as, although tobacco and cannabis research can be leveraged, use of vaping products is different in many ways.
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Engagement and Experience of People Who Vape
- Determine why people vape aerosol products.
- Explore patterns of use including polysubstance use and substance use after cessation of vaping product use.
- Identify sources used/available for products and information on health effects.
- Investigate youth curiosity around vaping aerosol products and vape shops.
- Assess differences across the lifecycle, including youth, older adults, and the ante-partum/post-partum periods.
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Data Collection and Standardization
- Develop standardized data and assessment tools, including the categorization of vaping products (active substances, carrier liquids, and brands), speed of delivery, patterns of use, co-exposure to other substances, and standardization of population health questions about vaping.
- Encourage comprehensive and systematic data collection, including measures of user behaviour, social determinants, and mental health conditions.
- Integrate an equity framework to help identify variations in health effects and use behaviours amongst various groups (including marginalized communities) and younger vape product users.
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Collaboration
- Eliminate silos in the research and policy space, identify ways to enable a holistic and interdisciplinary approach to evidence generation and mobilization, and develop a national task force on vaping product use.
- Encourage governments to take on a greater leadership role to support the regulation, standardization, and availability of devices on the market.
- Develop a standardized data platform through a coalition of researchers and policymakers and a national cohort on youth vaping to understand the long-term health effects.
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Education and Knowledge Mobilization
- Provide up-to-date education and communication surrounding the negative health effects of inhaling aerosols from vaping products.
- Promote education and access to evidence that supports knowledge mobilization for youth allies such as parents, guardians, clinicians, teachers, and coaches.
- Develop educational products that are accessible and written in plain language to help with understanding, uptake, and use.
- Create opportunities for knowledge sharing amongst researchers to share research findings.
- Create opportunities for knowledge sharing amongst youth and PWLLE to understand issues, create awareness, and reduce use of vaping products.
- Customize knowledge sharing products and efforts for diverse audiences: clinical guidance for healthcare professionals, social media campaigns through multiple platforms used by different members of the public.
Learn More About How Canada Supports Health Research
- Video 1: About CIHR
- Video 2: How does CIHR decide what health research to fund?
- Video 3: What is health research?
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