E-cigarette use among Canadian Youth: A review of the literature using an interdisciplinary lens
Article Sidebar
Published:
Sep 4, 2020
Keywords:
E-cigarettes, Youth, Vaping, Interdisciplinary
Main Article Content
Abstract
Objective: The increasing use of e-cigarettes among Canadian youth is a concerning population health issue. Vaping, the act of using an e-cigarette, was initially marketed as a healthier alternative to smoking traditional cigarettes, however its use is having unintended negative consequences on those who use them. One of the most concerning consequences is the presence of “e-cigarette, or vaping, product use associated lung injury” (EVALI) which had led to hospitalization. Youth in particular are an overrepresented demographic affected by these negative consequences, likely as a result of both exposure to marketing, which is a well-established determinant of youth behavior as well as inadequate public policy. The purpose of this paper is to present a review of the literature surrounding the issue of e-cigarette use among youth from an interdisciplinary perspective. Method: A narrative review was conducted to summarize the state of e-cigarette use among young Canadians and conceptualize this problem from the perspective of public policy, followed by biomedicine, health economics and education. Results: The results of this review are a summary of the current state of the literature framed with an interdisciplinary perspective. Recommendations for how these interdisciplinary perspectives can be brought together to provide effective solutions for this population health issue are provided. Conclusion: Identifying and understanding this problem through an interdisciplinary approach has the potential to create effective and sustainable solutions. Partnerships between school boards and governmental bodies can enhance educational resource allocation and align messaging to youth through several platforms.
Article Details
Section
Review & Clinical Practice
- Authors publishing in the UOJM retain copyright of their articles, including all the drafts and the final published version in the journal.
- While UOJM does not retain any rights to the articles submitted, by agreeing to publish in UOJM, authors are granting the journal right of first publication and distribution rights of their articles.
- Authors are free to submit their works to other publications, including journals, institutional repositories or books, with an acknowledgment of its initial publication in UOJM.
- Copies of UOJM are distributed both in print and online, and all materials will be publicly available online. The journal holds no legal responsibility as to how these materials will be used by the public.
- Please ensure that all authors, co-authors and investigators have read and agree to these terms.
- Works are licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
1. Breland, A., Soule, E., Lopez, A., Ramôa, C., El-Hellani, A., & Eissenberg, T. Electronic cigarettes: What are they and what do they do? Annals of the New York Academy of Sciences. 2017 Jan; 1394(1), 5 30.
2. National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes. Washington DC: The National Academies Press. 2018.
3. Etter, J.-F. Should electronic cigarettes be as freely available as tobacco? Yes. BMJ, 346. 2013, June; 346: f3845.
4. Hajek, P. Electronic cigarettes have a potential for huge public health benefit. BMC Medicine. 2014, Dec; 12, 225.
5. Yuan, M., Cross, S. J., Loughlin, S. E., & Leslie, F. M. Nicotine and the adolescent brain. The Journal of Physiology. 2015, May; 593(16), 3397 3412.
6. US Department of Human Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. US Department of Human Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health. Atlanta, (GA), 2012.
7. Lovato, C., Linn, G., Stead, L. F., & Best, A. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. The Cochrane Database of Systematic Reviews, 2003, July; 4, CD003439.
8. Maloney, J. & McKay, B. Teen Vaping Didn’t Cool Juul’s Celebrity Push [Internet]. New York (NY): The Wall Street Journal. 2019, Sept 28. Available from https://www.wsj.com/articles/teen-vaping-didnt-cool-juuls-celebrity-push-11569643202
9. Kirkpatrick, M. G., Cruz, T. B., Goldenson, N. I., Allem, J.-P., Chu, K.-H., Pentz, M. A., et al. Electronic cigarette retailers use Pokémon Go to market products. Tobacco Control. 2017 Jan; 26(e2), e145 e147.
10. Huang, J., Kornfield, R., Szczypka, G., & Emery, S. L. A cross-sectional examination of marketing of electronic cigarettes on Twitter. Tobacco Control. 2014, June; 23(suppl 3), iii26 iii30.
11. Huang, J., Duan, Z., Kwok, J., Binns, A., Vera, L. E., Kim, Y., et al. Vaping versus JUULing: How the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market. Tobacco Control. 2018, May; 28, 146-151.
12. Allem, J.-P., Escobedo, P., Cruz, T. B., & Unger, J. B. Vape pen product placement in popular music videos. Addictive Behaviors. 2019, June; 93, 263 264.
13. Barone, T. (2019). Vaping isn't supposed to be marketed to youth. So why do I see 'ads' for it everywhere? [Internet]. Toronto (ON): CBC News; 2019 Sept 05. Available from: https://www.cbc.ca/news/canada/montreal/vaping-isn-t-supposed-to-be-marketed-to-youth-1.5264485
14. Potvin Kent, M., Pauzé, E. Monitoring and research framework on vaping promotions to youth and young adults. Ottawa (ON): Report submitted to Health Canada; 2019.
15. Cho, Y. J., Thrasher, J. F., Reid, J. L., Hitchman, S., & Hammond, D. Youth self-reported exposure to and perceptions of vaping advertisements: Findings from the 2017 International Tobacco Control Youth Tobacco and Vaping Survey. Preventive Medicine, 2019, Sept; 126, 105775.
16. Health Canada. Reducing youth access and appeal of vaping products. Consultation on potential regulatory measures [Internet]. Ottawa (ON): Government of Canada; 2019, Apr 11. Available from: https://www.canada.ca/en/health-canada/programs/consultation-reducing-youth-access-appeal-vaping-products-potential-regulatory-measures/document.html
17. Ackerman, J., & Leader-Post, R. Cancer society calling on province to ban promotion, advertising of e-cigarettes [Internet]. Toronto (ON): Regina Leader-Post; 2018, Dec 8. Available from: https://leaderpost.com/news/local-news/cancer-society-calling-on-province-to-ban-promotion-advertising-of-e-cigarettes
18. Weeks C. Ontario to allow marketing of vaping products [Internet]. Toronto (ON): The Globe and Mail; 2018, October 18. Available from: https://www.theglobeandmail.com/canada/article-ontario-to-allow-marketing-of-vaping-products/
19. CBC News. Advertising restrictions to curb vaping among youth, researchers say [Internet]. Toronto (ON): CBC News; 2019, Aug 27. Available from: https://www.cbc.ca/news/health/e-cigarette-advertising-1.5260652
20. Smart, A. ‘Serious danger’: B.C. school districts call for increased regulation of vaping [Internet]. Toronto (ON): CBC News; 2019, Oct 14. CBC News. Retrieved from https://www.cbc.ca/news/canada/british-columbia/bc-schools-vaping-regulation-1.5320721
21. CBC News. Vapes need same restrictions as tobacco, medical groups tell federal parties [Internet]. Toronto (ON): CBC News; 2019, Sept 19. Available from: https://www.cbc.ca/news/health/vaping-thursday-1.5289485
22. Government of Canada. Tobacco and Vaping Products Act (S.C. 1997, c.13) [Internet]. Ottawa (ON): Government of Canada; 2019, November 29. Available from: https://laws-lois.justice.gc.ca/eng/acts/t-11.5/page-6.html#h-449596
23. CBC News. Vaping and e-cigarette regulations across Canada [Internet]. Toronto (ON): CBC News; 2019, Oct 18. Available from: https://www.cbc.ca/news/canada/vaping-regulations-1.3812180
24. Hammond, D., Reid, J. L., Rynard, V. L., Fong, G. T., Cummings, K. M., McNeill, A. et al. Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: Repeat national cross-sectional surveys. BMJ. 2019 May; 365.
25. Goniewicz, M. L., Boykan, R., Messina, C. R., Eliscu, A., & Tolentino, J. High exposure to nicotine among adolescents who use Juul and other vape pod systems ('pods’). Tobacco Control. 2019 Sept; 28(6), 676 677.
26. Talih, S., Salman, R., El-Hage, R., Karam, E., Karaoghlanian, N., El-Hellani, A., et al. Characteristics and toxicant emissions of JUUL electronic cigarettes. Tobacco Control. 2019 Feb; 28(6), 678 680.
27. CBC News. Juul names new CEO, suspends all advertising in U.S.- but no change in Canada [Internet]. Toronto (ON): CBC News; 2019, Sept 25. Available from https://www.cbc.ca/news/business/juul-ceo-advertising-1.5296394
28. Health Canada. Notice of Intent – Potential Measures to Reduce the Impact of Vaping Products Advertising on Youth and Non-users of Tobacco Products [Internet]. Ottawa (ON): Government of Canada; 2019, Feb 26. Available from: https://www.canada.ca/en/health-canada/programs/consultation-measures-reduce-impact-vaping-products-advertising-youth-non-users-tobacco-products/notice-document.html
29. Chatham-Stephens, K., Roguski, K., Jang, Y., Cho, P., Jatlaoui, T. C., Kabbani, S., et al Characteristics of Hospitalized and Nonhospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury—United States, November 2019. MMWR. 2019 Nov; 68(46), 1076–1080.
30. Government of Canada. Severe lung illness related to vaping [Internet]. Ottawa (ON): Government of Canada; 2019, Nov 29. Available from: https://www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness.html
31. Blount, B. C., Karwowski, M. P., Morel-Espinosa, M., Rees, J., Sosnoff, C., Cowan, E., et al. Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury—10 States, August–October 2019. MMWR. 2019 Nov; 68(45), 1040–1041.
32. Lewis, N., McCaffrey, K., Sage, K., Cheng, C.-J., Green, J., Goldstein, L., et al. E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury—Utah, April–October 2019. MMWR. 2019 Oct; 68(42), 953–956.
33. Henry, T. S., Kanne, J. P., & Kligerman, S. J. Imaging of Vaping-Associated Lung Disease. New England Journal of Medicine. 2019 Oct; 381(15), 1486–1487.
34. Layden, J. E., Ghinai, I., Pray, I., Kimball, A., Layer, M., Tenforde, M., et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin—Preliminary Report. New England Journal of Medicine. 2020 Mar; 382:903-916
35. Gao, J.-W., Rizzo, S., Ma, L.-H., Qiu, X.-Y., Warth, A., Seki, N., et al. Pulmonary ground-glass opacity: Computed tomography features, histopathology and molecular pathology. Translational Lung Cancer Research. 2017 Feb; 6(1), 68–75.
36. Jatlaoui, T. C. Update: Interim Guidance for Health Care Providers for Managing Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, November 2019. MMWR. 2019 Nov; 68.
37. Siegel, D. A., Jatlaoui, T. C., Koumans, E. H., Kiernan, E. A., Layer, M., Cates, J. E., et al. Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019. MMWR. 2019 Oct; 68(41), 919–927.
38. Gotts, J. E., Jordt, S.-E., McConnell, R., & Tarran, R. What are the respiratory effects of e-cigarettes? BMJ. 2019 Sept; 366, l5275.
39. Government of Canada. Information update – Health Canada warns of potential risk of pulmonary illness associated with vaping products [Internet]. Ottawa (ON): Government of Canada; 2019, Oct 17. Available from: https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2019/70919a-eng.php
40. The Conference Board of Canada. The Costs of Tobacco Use in Canada. Ottawa (ON): The Conference Board of Canada; 2012, Oct. 16 p.
41. Centers for Disease Control and Prevention. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2019, Nov 21. Available from: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
42. Canadian Institute for Health Information. Care in Canadian ICUs. Ottawa (ON): Canadian Institute for Health Information; 2016 Aug. 36 p.
43. Cillers, R. Educators scramble to stomp out vaping in schools as teen use is soaring [Internet]. Hamilton (ON): The Hamilton Spectator; 2019, Apr 14. Available from: https://www.thespec.com/news-story/9283416-educators-scramble-to-stomp-out-vaping-in-schools-as-teen-use-is-soaring/
44. McQuigge, M. New Health Canada campaign warns youth about risks of vaping [Internet]. Toronto (ON): Global News; 2019, Jan 10. Available from https://globalnews.ca/news/4835469/health-canada-vaping-youth/
45. Health Canada. Consultation Summary: Notice of Intent – Potential Measures to Reduce the Impact of Vaping Products Advertising on Youth and Non-users of Tobacco Products [Internet]. Ottawa (ON): Government of Canada; 2019, Oct 31. Available from : https://www.canada.ca/en/health-canada/programs/consultation-measures-reduce-impact-vaping-products-advertising-youth-non-users-tobacco-products/notice-document/summary.html
46. Hunter, A. Sask. To ban vaping near schools and restrict advertising but allow flavours [Internet]. Toronto (ON): CBC News; 2019, Nov 5. Available from: https://www.cbc.ca/news/canada/saskatchewan/sask-rules-vaping-1.5348292
47. Government of Ontario. Ontario Agency for Health Protection and Promotion Act, 2007,
S.O. 2007, c. 10, Sched. K [Internet]. Ottawa (ON): Government of Canada; 2019, July. Available from: https://www.ontario.ca/laws/statute/07o10/v4
48. Ottawa Public Health. Outbreak reports in Ottawa Healthcare Institutions [Internet]. Ottawa (ON): Ottawa Public Health; n.d. Available from: https://www.ottawapublichealth.ca/en/professionals-and-partners/outbreak-reports-in-ottawa-healthcare-institutions.aspx#Responsibilities-of-Ottawa-Public-Health-OPH
49. Goodman, R., Buehler, J., & Mott, J. Defining Field Epidemiology Epidemic Intelligence Service [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2019, Sept 24. Available from https://www.cdc.gov/eis/field-epi-manual/chapters/Defining-Field-Epi.html
50. CBC News. Solution to vaping should be part of larger mental health strategy: B.C. school trustees [Internet]. Toronto (ON): CBC News; 2019, Oct 30. Available from: https://www.cbc.ca/news/canada/british-columbia/vaping-in-bc-schools-trustees-ask-for-federal-provincial-aid-1.5340740
2. National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes. Washington DC: The National Academies Press. 2018.
3. Etter, J.-F. Should electronic cigarettes be as freely available as tobacco? Yes. BMJ, 346. 2013, June; 346: f3845.
4. Hajek, P. Electronic cigarettes have a potential for huge public health benefit. BMC Medicine. 2014, Dec; 12, 225.
5. Yuan, M., Cross, S. J., Loughlin, S. E., & Leslie, F. M. Nicotine and the adolescent brain. The Journal of Physiology. 2015, May; 593(16), 3397 3412.
6. US Department of Human Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. US Department of Human Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health. Atlanta, (GA), 2012.
7. Lovato, C., Linn, G., Stead, L. F., & Best, A. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. The Cochrane Database of Systematic Reviews, 2003, July; 4, CD003439.
8. Maloney, J. & McKay, B. Teen Vaping Didn’t Cool Juul’s Celebrity Push [Internet]. New York (NY): The Wall Street Journal. 2019, Sept 28. Available from https://www.wsj.com/articles/teen-vaping-didnt-cool-juuls-celebrity-push-11569643202
9. Kirkpatrick, M. G., Cruz, T. B., Goldenson, N. I., Allem, J.-P., Chu, K.-H., Pentz, M. A., et al. Electronic cigarette retailers use Pokémon Go to market products. Tobacco Control. 2017 Jan; 26(e2), e145 e147.
10. Huang, J., Kornfield, R., Szczypka, G., & Emery, S. L. A cross-sectional examination of marketing of electronic cigarettes on Twitter. Tobacco Control. 2014, June; 23(suppl 3), iii26 iii30.
11. Huang, J., Duan, Z., Kwok, J., Binns, A., Vera, L. E., Kim, Y., et al. Vaping versus JUULing: How the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market. Tobacco Control. 2018, May; 28, 146-151.
12. Allem, J.-P., Escobedo, P., Cruz, T. B., & Unger, J. B. Vape pen product placement in popular music videos. Addictive Behaviors. 2019, June; 93, 263 264.
13. Barone, T. (2019). Vaping isn't supposed to be marketed to youth. So why do I see 'ads' for it everywhere? [Internet]. Toronto (ON): CBC News; 2019 Sept 05. Available from: https://www.cbc.ca/news/canada/montreal/vaping-isn-t-supposed-to-be-marketed-to-youth-1.5264485
14. Potvin Kent, M., Pauzé, E. Monitoring and research framework on vaping promotions to youth and young adults. Ottawa (ON): Report submitted to Health Canada; 2019.
15. Cho, Y. J., Thrasher, J. F., Reid, J. L., Hitchman, S., & Hammond, D. Youth self-reported exposure to and perceptions of vaping advertisements: Findings from the 2017 International Tobacco Control Youth Tobacco and Vaping Survey. Preventive Medicine, 2019, Sept; 126, 105775.
16. Health Canada. Reducing youth access and appeal of vaping products. Consultation on potential regulatory measures [Internet]. Ottawa (ON): Government of Canada; 2019, Apr 11. Available from: https://www.canada.ca/en/health-canada/programs/consultation-reducing-youth-access-appeal-vaping-products-potential-regulatory-measures/document.html
17. Ackerman, J., & Leader-Post, R. Cancer society calling on province to ban promotion, advertising of e-cigarettes [Internet]. Toronto (ON): Regina Leader-Post; 2018, Dec 8. Available from: https://leaderpost.com/news/local-news/cancer-society-calling-on-province-to-ban-promotion-advertising-of-e-cigarettes
18. Weeks C. Ontario to allow marketing of vaping products [Internet]. Toronto (ON): The Globe and Mail; 2018, October 18. Available from: https://www.theglobeandmail.com/canada/article-ontario-to-allow-marketing-of-vaping-products/
19. CBC News. Advertising restrictions to curb vaping among youth, researchers say [Internet]. Toronto (ON): CBC News; 2019, Aug 27. Available from: https://www.cbc.ca/news/health/e-cigarette-advertising-1.5260652
20. Smart, A. ‘Serious danger’: B.C. school districts call for increased regulation of vaping [Internet]. Toronto (ON): CBC News; 2019, Oct 14. CBC News. Retrieved from https://www.cbc.ca/news/canada/british-columbia/bc-schools-vaping-regulation-1.5320721
21. CBC News. Vapes need same restrictions as tobacco, medical groups tell federal parties [Internet]. Toronto (ON): CBC News; 2019, Sept 19. Available from: https://www.cbc.ca/news/health/vaping-thursday-1.5289485
22. Government of Canada. Tobacco and Vaping Products Act (S.C. 1997, c.13) [Internet]. Ottawa (ON): Government of Canada; 2019, November 29. Available from: https://laws-lois.justice.gc.ca/eng/acts/t-11.5/page-6.html#h-449596
23. CBC News. Vaping and e-cigarette regulations across Canada [Internet]. Toronto (ON): CBC News; 2019, Oct 18. Available from: https://www.cbc.ca/news/canada/vaping-regulations-1.3812180
24. Hammond, D., Reid, J. L., Rynard, V. L., Fong, G. T., Cummings, K. M., McNeill, A. et al. Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: Repeat national cross-sectional surveys. BMJ. 2019 May; 365.
25. Goniewicz, M. L., Boykan, R., Messina, C. R., Eliscu, A., & Tolentino, J. High exposure to nicotine among adolescents who use Juul and other vape pod systems ('pods’). Tobacco Control. 2019 Sept; 28(6), 676 677.
26. Talih, S., Salman, R., El-Hage, R., Karam, E., Karaoghlanian, N., El-Hellani, A., et al. Characteristics and toxicant emissions of JUUL electronic cigarettes. Tobacco Control. 2019 Feb; 28(6), 678 680.
27. CBC News. Juul names new CEO, suspends all advertising in U.S.- but no change in Canada [Internet]. Toronto (ON): CBC News; 2019, Sept 25. Available from https://www.cbc.ca/news/business/juul-ceo-advertising-1.5296394
28. Health Canada. Notice of Intent – Potential Measures to Reduce the Impact of Vaping Products Advertising on Youth and Non-users of Tobacco Products [Internet]. Ottawa (ON): Government of Canada; 2019, Feb 26. Available from: https://www.canada.ca/en/health-canada/programs/consultation-measures-reduce-impact-vaping-products-advertising-youth-non-users-tobacco-products/notice-document.html
29. Chatham-Stephens, K., Roguski, K., Jang, Y., Cho, P., Jatlaoui, T. C., Kabbani, S., et al Characteristics of Hospitalized and Nonhospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury—United States, November 2019. MMWR. 2019 Nov; 68(46), 1076–1080.
30. Government of Canada. Severe lung illness related to vaping [Internet]. Ottawa (ON): Government of Canada; 2019, Nov 29. Available from: https://www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness.html
31. Blount, B. C., Karwowski, M. P., Morel-Espinosa, M., Rees, J., Sosnoff, C., Cowan, E., et al. Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury—10 States, August–October 2019. MMWR. 2019 Nov; 68(45), 1040–1041.
32. Lewis, N., McCaffrey, K., Sage, K., Cheng, C.-J., Green, J., Goldstein, L., et al. E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury—Utah, April–October 2019. MMWR. 2019 Oct; 68(42), 953–956.
33. Henry, T. S., Kanne, J. P., & Kligerman, S. J. Imaging of Vaping-Associated Lung Disease. New England Journal of Medicine. 2019 Oct; 381(15), 1486–1487.
34. Layden, J. E., Ghinai, I., Pray, I., Kimball, A., Layer, M., Tenforde, M., et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin—Preliminary Report. New England Journal of Medicine. 2020 Mar; 382:903-916
35. Gao, J.-W., Rizzo, S., Ma, L.-H., Qiu, X.-Y., Warth, A., Seki, N., et al. Pulmonary ground-glass opacity: Computed tomography features, histopathology and molecular pathology. Translational Lung Cancer Research. 2017 Feb; 6(1), 68–75.
36. Jatlaoui, T. C. Update: Interim Guidance for Health Care Providers for Managing Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, November 2019. MMWR. 2019 Nov; 68.
37. Siegel, D. A., Jatlaoui, T. C., Koumans, E. H., Kiernan, E. A., Layer, M., Cates, J. E., et al. Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019. MMWR. 2019 Oct; 68(41), 919–927.
38. Gotts, J. E., Jordt, S.-E., McConnell, R., & Tarran, R. What are the respiratory effects of e-cigarettes? BMJ. 2019 Sept; 366, l5275.
39. Government of Canada. Information update – Health Canada warns of potential risk of pulmonary illness associated with vaping products [Internet]. Ottawa (ON): Government of Canada; 2019, Oct 17. Available from: https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2019/70919a-eng.php
40. The Conference Board of Canada. The Costs of Tobacco Use in Canada. Ottawa (ON): The Conference Board of Canada; 2012, Oct. 16 p.
41. Centers for Disease Control and Prevention. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2019, Nov 21. Available from: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
42. Canadian Institute for Health Information. Care in Canadian ICUs. Ottawa (ON): Canadian Institute for Health Information; 2016 Aug. 36 p.
43. Cillers, R. Educators scramble to stomp out vaping in schools as teen use is soaring [Internet]. Hamilton (ON): The Hamilton Spectator; 2019, Apr 14. Available from: https://www.thespec.com/news-story/9283416-educators-scramble-to-stomp-out-vaping-in-schools-as-teen-use-is-soaring/
44. McQuigge, M. New Health Canada campaign warns youth about risks of vaping [Internet]. Toronto (ON): Global News; 2019, Jan 10. Available from https://globalnews.ca/news/4835469/health-canada-vaping-youth/
45. Health Canada. Consultation Summary: Notice of Intent – Potential Measures to Reduce the Impact of Vaping Products Advertising on Youth and Non-users of Tobacco Products [Internet]. Ottawa (ON): Government of Canada; 2019, Oct 31. Available from : https://www.canada.ca/en/health-canada/programs/consultation-measures-reduce-impact-vaping-products-advertising-youth-non-users-tobacco-products/notice-document/summary.html
46. Hunter, A. Sask. To ban vaping near schools and restrict advertising but allow flavours [Internet]. Toronto (ON): CBC News; 2019, Nov 5. Available from: https://www.cbc.ca/news/canada/saskatchewan/sask-rules-vaping-1.5348292
47. Government of Ontario. Ontario Agency for Health Protection and Promotion Act, 2007,
S.O. 2007, c. 10, Sched. K [Internet]. Ottawa (ON): Government of Canada; 2019, July. Available from: https://www.ontario.ca/laws/statute/07o10/v4
48. Ottawa Public Health. Outbreak reports in Ottawa Healthcare Institutions [Internet]. Ottawa (ON): Ottawa Public Health; n.d. Available from: https://www.ottawapublichealth.ca/en/professionals-and-partners/outbreak-reports-in-ottawa-healthcare-institutions.aspx#Responsibilities-of-Ottawa-Public-Health-OPH
49. Goodman, R., Buehler, J., & Mott, J. Defining Field Epidemiology Epidemic Intelligence Service [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2019, Sept 24. Available from https://www.cdc.gov/eis/field-epi-manual/chapters/Defining-Field-Epi.html
50. CBC News. Solution to vaping should be part of larger mental health strategy: B.C. school trustees [Internet]. Toronto (ON): CBC News; 2019, Oct 30. Available from: https://www.cbc.ca/news/canada/british-columbia/vaping-in-bc-schools-trustees-ask-for-federal-provincial-aid-1.5340740