Vaping may echo history of cigarettes, warn health experts

As cigarette use declines, health experts fear history is repeating itself with young people being drawn to vaping by the same tactics that once made smoking cool. 

When cigarettes started becoming widely available and accessible in the early 1920s, they were marketed as desirable, cool and even healthy, said Tammy Scott, a respiratory therapist in Halifax. It wasn’t until decades later that researchers began to uncover the dangers of smoking. 

“When you think back now, you think, ‘Obviously smoking is dangerous, how did they not know that?’ ” Scott told The Signal in an interview over Zoom. “But I think we’re watching that happen again with vapes.” 

When e-cigarettes were first legalized in Canada in 2018, they were introduced as a smoking cessation tool: a way for people addicted to nicotine to avoid the dangers of tobacco cigarettes.  

“They were invented with good intentions,” said Sanja Stanojevic, a respiratory epidemiologist at Dalhousie University.

“Then, about five years ago, we were all very blindsided. All of a sudden these devices started being used by young people who had never smoked tobacco cigarettes before.” 

This shift sent researchers into a scramble to uncover whether e-cigarettes were safe at all, while the rates of vaping in teenagers and young adults climbed.  

Statistics Canada’s most recent Canadian Tobacco and Nicotine Survey (CTNS) from 2022 found that rates of vaping in teenagers and young adults were rising, while rates of smoking were dropping. The study also revealed that teenagers and young adults vape more than people of any other age. 

Scott says she believes this popularity is largely due to the “culture” around vaping and e-cigarettes.  

“They were marketed to be less dangerous, but they were also marketed to be fun,” Scott said. “They had fun flavours, they were colourful, they were all over social media.” 

The “cool factor” is instrumental in influencing teenagers and young adults, Scott says, adding that the phenomenon is similar to when cigarettes first came out. 

South of the border, New York Attorney General Letitia James has also accused the vaping industry of using the same tactics used by the original cigarette companies. On Feb. 20, James announced a lawsuit against 13 e-cigarette companies.   

“The vaping industry is taking a page out of Big Tobacco’s playbook,” James said in a press release on Feb. 20. “They’re making nicotine seem cool, getting kids hooked, and creating a massive public health crisis in the process.” 

The lawsuit alleges the companies are using “old tactics for new products,” and fueling the youth vaping epidemic by marketing to children and teenagers.  

“It’s like history is repeating,” said Scott, “and that’s a culture we need to change before it is too late.” 

With cigarettes, there is about a 20-year lag after you start smoking before disease develops, Stanojevic explained. Only seven years into e-cigarette use, it is difficult to predict long-term effects, especially considering the differences between tobacco cigarettes and e-cigarettes 

Tobacco cigarettes burn tobacco to produce smoke, while e-cigarettes heat liquid to make vapour. In tobacco cigarettes, the inhaled particles are larger, and deposit in bigger airways, but with e-cigarettes, Stanojevic said, the vaporized particles are much smaller and reach further into the lungs, closer to where air exchange happens.  

“This is concerning for researchers. This is the silent zone, where it’s very difficult to measure the effects,” said Stanojevic. “The damage is happening on the periphery, and we don’t necessarily see those effects till much later.” 

With products like cigarettes and alcohol, people now know the risks and can make informed decisions, said Stanojevic. With e-cigarettes, that information is not available yet.  

“The messaging from our top public health officials is still very confusing,” said Stanojevic. “It doesn’t outwardly say e-cigarettes are bad for you. We’re couching around the uncertainty of the evidence because we just haven’t had the time to do these studies.” 

In her own peer-reviewed study, published in the European Respiratory Journal in 2024, Stanojevic used the lung clearance index, a novel method that measures how well air flows to all parts of the lungs, to determine the lung function of 93 participants aged 18 to 24. The study suggested that the participants who used e-cigarettes had worse lung function.  

“I don’t have a crystal ball to know what’s going to happen in 20 or 30 years,” said Stanojevic, “but the science behind it makes me very worried.”