First-of-its-kind CAMH study on why young people vape

Toronto teenager Ryan started vaping like most kids his age.  A couple years ago he was hanging out with his friends, one of them brought a nicotine pod vape and he tried it out.

“That was my first experiment with vaping,” says Ryan, 17. “I thought it was fun doing tricks in the mirror and stuff.”

Two years later, he is an ex-vaper.

“I just decided it was something I didn’t need in my life.  I started realizing I was relying on it and it became less cool,” says Ryan.

In a first-of-its-kind CAMH-led study, researchers have found significant differences in how young Canadians perceive the negative impacts of vaping compared to smoking, highlighting what the authors say is a critical need to develop unique vaping prevention and cessation public health strategies for this population. 

The rate of vaping among Canadians under 30 has exploded in recent years.  According to the most recent CAMH Ontario Student Drug Use and Heath Survey (OSDUHS) released late last year, the rate of vaping among students between grades seven and 12 has more than doubled in just the past three years, from 11 per cent to 23 per cent.

In a study published in the journal Addictive Behaviours, “Is vaping cessation like smoking cessation? A qualitative study exploring the responses of youth and young adults who vape e-cigarettes,” the authors conclude that a better understanding of the key differences in perceived barriers to quitting vaping verses smoking, and the different motivations for wanting to quit, is needed to develop effective health policy strategies. The research is part of a larger project to study and eventually create vaping cessation programs for young Canadians under the age of 30.

Ryan is a case in point. Even though he was motivated enough to quit to attend one of the focus groups for the CAMH study, he can’t pinpoint what kind of harm reduction messaging would work with other teenagers.

“I’m actually quite interested in marketing and honestly I have no idea how you would create a marketing message telling kids not to vape.”

CAMH Youth Engagement Initiative Advisor Dan Davis believes that the rise in the popularity of youth vaping may be connected to the parallel spike in self-reports of higher psychological distress among teenagers in recent years. 

The study authors conducted a series of focus groups among youth aged 16 to 18 and young adults between 19 and 29.  All participants were self-identified consumers of e-cigarettes (most of them using nicotine pods) who expressed interest in quitting.

Among the key differences in perceived barriers to quitting e-cigarettes compared to smoking are:

• Enjoyment of vaping flavours.  Some participants noted that they would be less inclined to want to vape if vaping products did not have the flavours they enjoyed most, suggesting that the regulation of vaping flavours may help with cessation efforts.  “I personally think that for me to quit vaping at this moment in time, I would just need, like, vapes that don’t taste good.  The flavour is what keeps me there,” said one participant.
• Convenience and discreetness.  The ability to vape anywhere at any time, including first thing in the morning in bed, at school or even in the shower, was another perceived barrier to quitting. “Honestly everywhere, just anytime I’m at school, at home in my room, when I’m with my friends, when I’m driving, watching a movie in a movie theatre, in a class, anything, just it’s always there,” said another.
• Social acceptability of vaping.  The authors state that the kind of stark public health messaging about the health dangers of smoking that has been so effective in bringing the rate of youth smoking to historic lows may be “alienating” to young people who vape, particularly among teenagers.  “They are a very informed cohor,t but they are suspicious about messaging, especially from government,” says Dr. Chaiton, who compares it to what young people saw as inconsistent messaging about COVID, where teens were told to socially distance from their friends in the summer while bars and restaurants for adults were open. “The ‘do as I say, not as I do message’ doesn’t work.”
• Lack of self-awareness of vaping behaviours. While on one level being media-savvy and cynical about public health messaging about vaping, some young people who vape say they do not know some of the basics about what they are ingesting. “Honestly I don’t even understand the difference between milligrams and that because JUUL it’s like either three per cent or five per cent and I don’t fully understand how much nicotine I’m using… I don’t know, which is like kind of scary to think about, that I don’t even know what I’m doing.”

Part of the reason for this lack of awareness, the authors say, is that publicly available information on vaping cessation strategies for young people is virtually non-existent.

That presents a tricky challenge for public health messaging on vaping cessation, Dr. Chaiton says, because the promotion of vaping as an alternative to smoking remains a key harm reduction strategy for adults who smoke.  Meanwhile, most young Canadians who vape have never smoked.

Study co-author CAMH Research Analyst Sherald Sanchez says that separate from the potential physical harm, nicotine addiction due to vaping can be detrimental to mental health.

“Dependence itself is something you have to take seriously. There is an element with nicotine dependence where there is an escalation in use that can lead to a worsening of mood problems, including anxiety and depression,” says Sanchez. “You think you are helping yourself, controlling your stress through vaping, while making it worse over time because you are lacking autonomy over your choices.  The greater our ability to control our feelings and behaviours, the happier we are.”

That is part of the dilemma Malcolm, 18, is now facing.  A first-year university economics student, Malcolm has tried to quit, but says with the stress of school, now is not the right time.

“I thought of quitting in the summer, but I decided there was no point because once I went back to school I would start up again,” says Malcolm. “There is too much on my plate right now for there to be other things going on in my mind that could affect my performance at school.”

Malcolm says the addictive nature of vaping crept up on him (something Dr. Chaiton referred to as “insidious”).  He started to notice that when he had a busy week at school, his rate of vaping would go way up.

“I knew it was addictive but not to the extent it actually is,” says Malcolm. “You don’t realize you are getting addicted until you are way in it.  If I could go back and stop, if I could take back all that money I’ve spent over the last four years, I definitely would.”