Dr Martin Juneau, M.D., FRCP

Cardiologue, directeur de l'Observatoire de la prévention de l'Institut de Cardiologie de Montréal. Professeur titulaire de clinique, Faculté de médecine de l'Université de Montréal. / Cardiologist and Director of Prevention Watch, Montreal Heart Institute. Clinical Professor, Faculty of Medicine, University of Montreal.

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30 June 2020
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Smoking continues to decline among young people


  • The percentage of young Canadians aged 16–19 who smoke cigarettes on a regular basis continued to decline between 2017 and 2019, from 3.8% to 2.3%.
  • This decrease in youth smoking is correlated with an increased use of electronic cigarettes, with the proportion of young people having vaped at least once in their lives increasing from 29 to 41% during this period.
  • These vapers are, however, mostly occasional or regular smokers, which suggests that the electronic cigarette represents an alternative to traditional cigarettes and contributes to the decline in smoking observed among young people.

One of the greatest successes of tobacco control in the last 20 years has been the dramatic decline in smoking among young adolescents. As we mentioned in another article, while nearly 25% of teens in grade 12 smoked cigarettes daily in the early 2000s, this proportion is now around 2%. This drastic drop in youth smoking is of paramount importance, as more than 90% of regular adult smokers started smoking before the age of 18, during the experimentation period of adolescence. Such a low rate of smoking among young people will therefore necessarily translate into a significant reduction in the number of adult smokers over the next few years and a decrease in the incidence of the many diseases caused by tobacco, which is the ultimate goal of tobacco control.

However, this good news is rarely mentioned: instead of celebrating this decline in youth smoking, much more attention has been paid to the recent emergence of a new trend, namely the increase in the number of young people who have experimented with electronic cigarettes in recent years. According to a recent study by Dr. David Hammond’s group, e-cigarette use is indeed on the rise among young Canadians, with about 41% of 16-19-year-olds having tried these products at least once, compared to 29% in 2017 (Figure 1). This increase is correlated with the appearance on the market of e-cigarettes of the Juul type, extremely attractive and easy-to-use devices, which allow the absorption of a significant amount of nicotine (see our article on the subject).

Figure 1. Frequency of use of electronic cigarettes by 16-19-year-olds. Adapted from Hammond et al. (2020). Note that non-smokers represent less than 1% of total vapers.

However, it is important to note that the vast majority of this vaping is experimental in nature. While almost half of young people have used these products at least once in their life, this proportion decreases to 18% in the last month, 12% in the last week, eventually reaching just over 5% of regular vapers (20 or more times in the last month). Daily use of electronic cigarettes is therefore still a relatively uncommon phenomenon among young people and certainly does not reach “epidemic” proportions, as is often said. Not only do regular vapers remain a very small minority, but most (over 85%) of these young people already smoke cigarettes occasionally or regularly. Young people who have never smoked cigarettes represent less than 15% of regular vapers, which corresponds to less than 1% of all vapers (Figure 1, red rectangle).

Overall, these results paint a much more nuanced picture of the phenomenon of vaping among young people than what we regularly hear in the media: the vast majority of those who want to experience the effect of tobacco are now turning to new forms of nicotine such as electronic cigarettes, but even then the regular users of these products remain relatively few, and are mostly young people who are primarily attracted to tobacco.

Initially, the main concern raised by the increased use of electronic cigarettes by young people is that it could lead to an increase in smoking in this population. This is clearly not the case as the number of young smokers continues to decline each year, even since the introduction of the electronic cigarette, and studies even indicate that these products have led to an acceleration of this decline in the smoking rate. The study mentioned earlier observes the same phenomenon, i.e. that the increase in vaping observed over the past two years in Canada is directly correlated with a significant decrease (40%) in smoking among young people (Figure 2).

Figure 2. The increase in the percentage of young vapers is correlated with a decrease in the percentage of young smokers. From Hammond et al. (2020).

Instead of being a gateway to tobacco as was initially feared, the electronic cigarette therefore seems to represent more of an alternative to traditional cigarettes. The abandonment of cigarettes by young people in favour of this new technology is not so surprising when you consider the unpleasant smell of cigarettes, the exorbitant prices of tobacco, and the ban on smoking in almost all public places. In such a context, it is difficult to conceive why a user of electronic cigarettes might be tempted to turn to conventional tobacco products.

Obviously, everyone agrees that it would be better if young people did not use either electronic cigarettes or tobacco. But if we assume that adolescence is an intense period of experimentation, it is vastly preferable that this experimentation with the effects of nicotine be done in the form of vaping rather than of tobacco cigarettes.

It should be noted that with an electronic cigarette, the vaper inhales an aerosol containing nicotine, but without the multiple carcinogenic molecules, carbon monoxide and fine particles that are generated during the combustion of tobacco (at around 900 °C). This last point is the most important: it is the combustion products of tobacco cigarettes that cause health problems, not the nicotine. The latter is a drug that creates addiction to tobacco and pushes people to smoke, but it has no major effects on health and is especially not responsible for cardiovascular diseases or lung cancer that result from smoking. According to the British public health agency, Public Health England, the vapour generated by electronic cigarettes is much less toxic than the smoke produced by the combustion of tobacco, and therefore vaping presents considerably less risk to health than smoking.

It is also important to remember that while there is great concern about the increase in vaping among young people, electronic cigarettes are certainly not the main threat to their health. For example, surveys in the United States indicate that more than 15% of high school youth regularly drink large amounts of alcohol (binge drinking), an extremely harmful behaviour that is associated with an increased risk of accidents, violence and several serious diseases (stroke, cirrhosis, cancer). Although the consumption of alcohol is more socially acceptable than that of electronic cigarettes, it should be kept in mind that excessive alcohol consumption represents one of the main causes of death on a global scale and is therefore much more harmful to the health of youth than electronic cigarettes. Before considering banning vaping products under the pretext of “protecting our young people”, as is sometimes argued, we must take into account these relative risks and avoid any form of prohibition that could have the effect of leading them towards combustible tobacco products, which are much more harmful to health. Despite the often very alarmist reports, the transition from tobacco to e-cigarettes is a less worrying trend than it might appear at first glance and represents a typical example of harm reduction in public health.

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