May 31st is World No Tobacco Day as the World Health
Organization puts the spotlight on tobacco harms -- and advocates for reduced
tobacco consumption. This story looks at new research on electronic cigarettes.
Next week we feature the first anniversary of CAMH’s Tobacco-Free
A comprehensive study underway on electronic cigarettes is investigating
their long-term health effects as well as their potential as a cessation aid for
existing tobacco smokers.
“The tobacco control and research community is split on this issue,” says Dr.
Robert Schwartz, Principal Investigator and Executive Director of the Ontario
Tobacco Research Unit (OTRU). While there may be potential for e-cigarettes to
support tobacco harm reduction and cessation, “there are concerns about possible
adverse health effects, as well as the renormalization of smoking and tobacco
uptake among youth.
“The long-term effects of e-cigarettes are unknown and demand caution when it
comes to public policy.”
The 18-month study is an OTRU/CAMH partnership funded by Ontario’s Ministry
of Health and Long-Term Care Health System Research Fund.
Dr. Robert Schwartz
E-cigarettes have arrived on the scene over the past few years as traditional
tobacco cigarettes come under increasing controls. E-cigarettes use a heating
device to deliver a flavoured vapour, which may contain nicotine, inhaled by the
smoker. The products come in a range of shapes and sizes – some look almost
identical to a standard tobacco cigarette. Some tobacco companies have now
entered the e-cigarette business and market.
Approximately 15 per cent of Ontario high school students now say they have
tried e-cigarettes, according to the latest CAMH survey.
Dr. Schwartz, who is also a Senior Scientist in the Social and
Epidemiological Research Department at CAMH, notes that in Canada, legislation
prohibits the sale of e-cigarettes containing nicotine; however that ban has not
been actively enforced. Meanwhile, provincial governments have been moving to
apply existing tobacco controls to e-cigarettes.
Ontario recently proposed new regulations in Bill 45 (Making Healthier
Choices Act), intended to come into effect January 2016. The regulations
would mirror tobacco cigarette policy by restricting:
- e-cigarette sales to minors (under 19 years of age);
- e-cigarette use in enclosed public places, and
- the point-of-sale promotion of e-cigarette products.
A key element of the new OTRU/CAMH study launched in 2014 is a survey of
about 2,000 tobacco smokers; of those, about 1,300 have tried or used
Preliminary findings show that:
- Approximately 80 per cent of those who had used e-cigarettes said they did
so with the intent to reduce or quit smoking tobacco cigarettes
- Some say they successfully quit using e-cigarettes as a cessation aid
- About 40% of e-cigarette users said the product contained nicotine
- Both nicotine and non-nicotine e-cigarette versions may help to reduce
cravings for tobacco.
For those tobacco smokers who want to quit, “it’s not yet proven whether this
could be a game changer,” said Dr. Schwartz. “Designed properly, an electronic
cigarette might be an effective cessation strategy for tobacco smokers who
typically try to quit many times, and who try many strategies before they stay
“At the same time, we need to look closely at potential public harms related
to e-cigarettes,” he says. There are several important questions:
- What are the long-term effects of e-cigarette vapour, which may contain
propylene glycol, various flavourings, and nicotine?
- How much nicotine do e-cigarette users typically inhale and what are the
- Are e-cigarettes addictive?
- If e-cigarettes become normalized, what are the long-term harms for the
population as a whole?
“We don’t want to wake up 20 years from now to see a new generation of young
adults addicted to nicotine from e-cigarettes and experiencing health
To answer those questions and others, the study looks at e-cigarettes from
many different angles.
Along with the longitudinal survey of e-cigarette users, researchers are
reviewing social media e-cigarette messages and have completed a web survey of
young users. They will analyze results from blood samples of users, conduct a
cessation effectiveness trial, and convene an international panel of experts to
examine findings and trends.
In addition to this primary research, the team is synthesizing global
knowledge on e-cigarettes from a variety of sources and studies, and analyzing
the application for policy in Ontario.
The study will be complete in spring 2016. As findings become available, they
will be used to inform the Ministry of Health as the province advances its
This will require a careful balancing act, says Dr. Schwartz. “The proposed
regulations in their current form do leave some room for cessation strategies
while balancing with controls and caution for population harms.”
As a feature of this study, the Ministry and other health system policymakers
and providers can approach the research team directly with specific questions as
issues surface and legislation evolves.
The research team includes:
- Robert Schwartz and Laurie Zawertailo, Principal Investigators
- Thomas Eissenberg, Roberta Ferrence, Shawn O'Connor, Peter Selby and Melodie Tilson, Co-investigators
Click here for further details on the study.