Lecture Notes on Smoking and Vaping

SMOKING AND VAPING

  • Title: Ever changing but always the same

Categories of Smokers

  • Daily Smokers
    • Heavy Smokers: Defined as those who smoke 25 or more cigarettes per day.
    • Moderate Smokers: Defined as those who smoke between 15 to 24 cigarettes per day.
    • Light Smokers: Defined as those who smoke 14 or fewer cigarettes per day.
  • Occasional Smokers: Individuals who have smoked at least one cigarette in the past month, but not on a daily basis.

Changes in Smoking Rates

  • In 2013, approximately 15% of people aged 12 years and older smoked, a decrease from 19.9% in 2011, and 25.9% in 2001.
  • Since 2013, the proportion of smokers has fluctuated between 13% and 15%, with 15% recorded in 2017.

Smoking Consumption Trends

  • Alongside the decrease in smoking rates, overall tobacco consumption has also declined.
  • The average number of cigarettes smoked daily has decreased from:
    • 17 in 2001
    • 15 in 2011
    • 13.9 in 2013
    • Remained consistent at 13.7 in 2017.

Demographic Trends in Smoking

  • Smoking has decreased across all age groups, with the most significant reductions observed among youth aged 18-19 and 15-17.
  • Rates continued to decrease until 2013, after which they have stabilized.

Regional Differences in Smoking Rates

  • Provinces with Lowest Smoking Rates:
    • Prince Edward Island: 12%
    • Ontario and British Columbia reported similarly low rates.
  • Provinces with Highest Smoking Rates:
    • Newfoundland and Labrador: 20%.
  • Average daily cigarettes smoked:
    • Lowest in Ontario: 12.7
    • Highest in Newfoundland and Labrador: 18.6.

Harmful Effects of Smoking

  • Smoking is the leading cause of premature death in Canada, accounting for 21% of all deaths over the past decade.
  • Heavy smokers lose approximately 12 years of life expectancy compared to non-smokers.
  • Smoking follows a dose-response relationship: the more one smokes, the greater the risk of disease and death.

Diseases Caused by Smoking

  • Lung Cancer:

    • Leading cause of cancer deaths: 27% of all cancer deaths (approx. 19,000 in 2008).
    • Smoking is responsible for 85% of new lung cancer cases.
    • Second-hand smoke results in at least 800 additional lung cancer deaths per year.

  • Cardiovascular Disease:

    • All forms of tobacco use increase the risk of ischemic heart disease and stroke.
    • Contributes to hypertension and atherosclerosis.

  • Chronic Obstructive Pulmonary Disease (COPD):

    • Major cause of long-term disability and premature death.
    • Restricts breathing and reduces physical capacity.

  • Asthma:

    • Smoking aggravates existing asthma conditions.

  • Ectopic Pregnancy:

    • Risks increase for women who smoke during or prior to pregnancy.
    • An ectopic pregnancy occurs when the ovum implants outside the uterus, significantly increasing the risk of miscarriage and complications.

  • Diabetes:

    • Smoking raises the risk of developing type 2 diabetes by 30-40%.
    • Many other cancers are associated with smoking, including cancers of the esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, rectum, and acute myeloid leukemia.

Alternate Tobacco Products

  • Cigars:

    • 3% of individuals aged 15 and older smoked any type of cigar in 2013, compared to 2% in 2017.
    • Among youth, 5% of those aged 15-19 smoked in 2013 (3% in 2017) and 7% aged 20-24 smoked in 2013 (5% in 2017).
    • 5% of cigar smokers were under the legal purchasing age.
    • Rates of cigarillo use declined from 8% in 2009 to 4% in 2013 to 2% in 2017.
    • Legislation was enacted in 2010 to restrict marketing to youth.

  • Water-pipe Tobacco (Hookah):

    • 10% aged 15 and older reported trying a water-pipe in 2013; 14% aged 15-19 and 29% aged 20-24.
    • By 2017, only 1% aged 15 and older reported using a water-pipe in the past month.

  • Smokeless Tobacco:

    • 8% aged 15 and older reported trying smokeless tobacco in 2013: 6% aged 15-19, 10% aged 20-24.
    • Usage has significantly decreased, with only 1% reporting use in the past month in 2017.

Vaping or E-cigarettes

  • In 2013, 9% aged 15 and older reported trying e-cigarettes:
    • 20% of those aged 15-19 and 20% aged 20-24.
    • Usage dropped to 2% in the past month for those aged 15 and older, with 3% in 15-19 and 4% in 20-24.
  • By 2017, 15% aged 15 and older reported trying e-cigarettes:
    • 23% among 15-19-year-olds and 29% among 20-24-year-olds.
    • 3% of those aged 15 and older reported past month use: 6% for ages 15-19 and 6% for ages 20-24.

Potential Harms of Vaping/E-cigarette Use

  • If vaporizer fluid contains nicotine, the associated harms found in conventional smoking apply.

  • Health issues include:

    • Dependence (Addiction)
    • Memory and Concentration Issues
    • Cognitive and Behavioral Problems
    • Bronchiolitis Obliterans (Popcorn Lung):
    • Inflammation of the bronchioles resulting in shortness of breath, wheezing, and fatigue.
    • Caused by diacetyl, a butter-like flavoring used in some vaporizer fluids and regulated by Health Canada.
    • No confirmed cases of popcorn lung due to vaping in Canada.

  • Chemical Exposure:

    • Vaporizer fluids typically contain:
    • Vegetable Glycerine and Propylene Glycol: Noted as safe in cosmetics and sweeteners but were not intended for inhalation.
    • Artificial Flavors: Generally considered safe in foods.
    • Long-term inhalation risks of these chemicals remain unclear.

  • In September 2019, there was an increase in vaping-related respiratory diseases termed Severe Pulmonary Disease Associated with Vaping.

    • Symptoms include cough, shortness of breath, chest pain, fatigue, diarrhea, or vomiting.
    • Cases were predominantly associated with THC (cannabis) products, and multiple compounds might contribute (e.g., vitamin E acetate).
    • Recorded 20 cases in Canada as of August 2020 and 2,807 cases in the U.S. as of February 2020, resulting in 68 deaths.

Vaping/E-cigarette Use for Smoking Cessation

  • Current research indicates that vaping may be safer than smoking cigarettes, but not without risks.
  • Harms from smoking, such as cancer and cardiovascular disease, are more severe than those associated with vaping.
  • Second-hand exposure to nicotine and airborne particulates is reportedly lower from e-cigarettes than conventional cigarettes.
  • However, there’s insufficient evidence supporting that e-cigarettes are more effective cessation aids compared to other methods.
  • Breakdown of past-month e-cigarette users in 2017:
    • 20% were former smokers.
    • 65% were current smokers.
    • 15% were never smokers.
    • Among never smokers, 58% were aged 15 to 19 and 33% were aged 20 to 24.

The Big Issue: Vaping/E-cigarettes Among Youth

  • Study conducted from 2013-2016 with 2,292 grade 9 students in Niagara region, Ontario:
    • 69.8% had heard of vaporizers/e-cigarettes.
    • 30.3% learned about them from a friend.
    • 23.8% learned from store displays.
    • 10.4% reported using vaporizers/e-cigarettes.
    • 2.6% used regular cigarettes.
    • 3.7% used cigarillos.
    • 1.4% tried smokeless tobacco.
    • 2.5% used a water pipe.

Factors Influencing Vaporizer/E-cigarette Use Among Youth

  • Increased likelihood of usage if the youth:
    • Currently smoke tobacco.
    • Have friends who smoke.
    • Have family members who smoke.
    • Are permitted to smoke at home.
    • Are male.
  • Decreased likelihood if the youth:
    • Understand that smoking can cause lung cancer.
    • Report good stress levels or excellent mental health.

Motivations for Using Vaporizers/E-cigarettes

  • When asked why they used vaporizers/e-cigarettes:
    • 71.9% answered it was because it was "cool/fun/new".

Youth Vaping Prevalence Trends in Canada

  • Vaping prevalence among Canadian youth in grades 7 to 12 has risen:
    • 20% in 2015
    • 23% in 2017
    • 11% reported daily use.
    • Comparison: Only 18% tried conventional cigarettes and 1% smoked daily.
  • Youth perception of vaping risks:
    • 78% believed occasional smoking posed slight/moderate health risk.
    • 65% thought regular smoking posed a significant health risk.
    • Conversely, only 8% believed occasional vaping had great risk, while 23% perceived no risk.
    • For regular vaping, 26% believed it posed great risk, while 10% perceived no risk.

Q&A

  • Questions from the audience regarding various aspects of smoking and vaping were invited, indicating the need for further discussion and clarity on the topic.