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At least seven people in the United States have died and nearly 500 others have fallen ill with a serious lung disease tied to vaping products, prompting officials there to suggest people stop using e-cigarettes altogether. U.S. President Donald Trump has said the country will move to ban all e-cigarette flavours in response to the outbreak of lung disease tied to vaping products.

The first confirmed case in Canada was reported Wednesday by Ontario’s Middlesex-London Health Unit. The news came not long after Ontario Health Minister Christine Elliott ordered the province’s hospitals to report vaping-related cases of severe pulmonary disease. Health Canada and other officials have said they are watching the situation closely. Many health experts say the lung-disease outbreak is a potent reminder that e-cigarettes are not harmless. But the big question that needs to be answered is just how harmful they are.

How they work

E-cigarettes are typically operated by a battery that heats a liquid, which produces an aerosol that can be inhaled into the lungs. Nicotine-containing e-cigarettes were legalized in Canada last year and now a number of e-cigarette brands are available, including Vype and Juul.

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WHAT IS IN E-CIGARETTE AEROSOL?

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavourings and other chemicals that help to make the aerosol. It can be difficult for consumers to know what e-cigarette products contain, even if ingredients are listed. The substances in e-cigarette aerosols include nicotine, ultrafine particles, flavouring such as diacetyl (a chemical linked to a serious lung disease), volatile organic compounds, cancer-causing chemicals and heavy metals such as nickel, tin and lead

Flavouring such as diacetyl, a chemical linked to serious lung disease

Heavy metals such as nickel, tin and lead

Cancer-

causing

chemicals

Volatile organic

compounds

Ultrafine

particles

Nicotine

MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: Centers for Disease Control and Prevention

WHAT IS IN E-CIGARETTE AEROSOL?

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavourings and other chemicals that help to make the aerosol. It can be difficult for consumers to know what e-cigarette products contain, even if ingredients are listed. The substances in e-cigarette aerosols include nicotine, ultrafine particles, flavouring such as diacetyl (a chemical linked to a serious lung disease), volatile organic compounds, cancer-causing chemicals and heavy metals such as nickel, tin and lead

Flavouring such as diacetyl, a chemical linked to serious lung disease

Heavy metals such as nickel, tin and lead

Cancer-

causing

chemicals

Volatile organic

compounds

Ultrafine

particles

Nicotine

MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: Centers for Disease Control and Prevention

WHAT IS IN E-CIGARETTE AEROSOL?

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavourings and other chemicals that help to make the aerosol. It can be difficult for consumers to know what e-cigarette products contain, even if ingredients are listed. The substances in e-cigarette aerosols include nicotine, ultrafine particles, flavouring such as diacetyl (a chemical linked to a serious lung disease), volatile organic compounds, cancer-causing chemicals and heavy metals such as nickel, tin and lead

Heavy metals such as nickel, tin and lead

Flavouring such as diacetyl, a chemical linked to serious lung disease

Volatile organic

compounds

Cancer-

causing

chemicals

Ultrafine

particles

Nicotine

MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: Centers for Disease Control and Prevention

Juul is credited with creating a new generation of e-cigarettes that deliver a high concentration of nicotine without irritating the mouth or throat, a technology that other companies have also adopted.

Health Canada has proposed a series of regulatory measures to help reduce youth uptake, such as advertising restrictions and a health warning on product labels. But those changes won’t take effect for months, or even years.

Potential health risks

Vaping products are relatively new and there are still many unanswered questions about the risks they carry. However, there is a growing body of evidence that suggests vaping products could present serious health risks, particularly to young people.

Addiction

Nicotine is highly addictive and young people are more vulnerable to the risks because their brains are still developing. According to the U.S. Surgeon-General, nicotine can lead to permanent brain changes, including addiction, changes in attention and learning abilities, lowered impulse control and mood disorders.

The use of nicotine-containing e-cigarettes is also linked to a higher risk of cigarette use among young people and may lead to use of other drugs.

Data published earlier this year show that after nicotine-containing e-cigarettes were legalized, the number of Canadian teens who vape nearly doubled compared with the previous year. The number of 16- to 19-year-olds who said they had vaped in the previous week rose to 9.3 per cent in 2018 from 5.2 per cent in 2017. Monthly use rose to 14.6 per cent in 2018 from 8.4 per cent the year before.

The jump coincided with the first increase in smoking rates among Canadian teens in decades.

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Heart and lung

Use of vaping products is also linked to heart and lung problems, said Andrew Pipe, chair of the Heart and Stroke Foundation of Canada and a smoking-cessation expert. In an e-mail, Dr. Pipe said vaping solutions cause lung inflammation and tissue damage. But given how new they are, it is difficult to understand the long-term health consequences, he said.

Vaping solutions contain a number of chemicals and other substances that could also pose risks, such as ultrafine particles, cancer-causing chemicals, diacetyl, a flavouring chemical that has been linked to lung disease, heavy metals and volatile organic compounds, according to the U.S. Centers for Disease Control and Prevention.

Dr. Pipe added that some evidence shows vaping can also affect the heart, leading to vascular and blood-pressure changes, which could eventually lead to heart disease.

One of the complicating factors is that risks can vary greatly depending on the type of vaping products a person uses, said David Hammond, professor in the school of public health and health systems at the University of Waterloo.

Many of the people who have fallen ill in the United States were using vaping solutions containing tetrahydrocannabinol (THC). Vaping products that contain THC will become legal in Canada in December.

U.S. officials don’t yet know the cause of the lung illness. Many of those who have fallen ill are young, previously healthy people. Officials say the lung disease is not believed to be linked to an infectious agent and that a chemical exposure is likely to be the cause.

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A safer alternative?

Despite the fact vaping is believed to be less harmful than smoking, the public needs to know it is not safe and the many young Canadians who are using e-cigarettes could be seriously damaging their health.

“We know enough to say if you aren’t using these products to quit smoking, you shouldn’t be using them at all,” Dr. Hammond said.

Earlier this week, the U.S. Food and Drug Administration issued a warning letter to Juul for marketing activities that claimed its products were safer than tobacco products despite not providing evidence this is the case.

According to Health Canada, vaping is less harmful than smoking. Many of the cancer-causing chemicals found in tobacco are formed when cigarettes are burned. Vaping products don’t involve burning and don’t produce smoke, which means users are only exposed to a fraction of the chemicals that are found in traditional cigarettes.

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