MONDAY, June 29, 2020 (HealthDay News) -- Canadian provinces that allow retail displays promoting e-cigarettes had nearly three times the teen vaping rate, a new study found.
Until May 2018, e-cigarettes weren't widely available in Canada and it was illegal to advertise those containing nicotine. When the law changed, Quebec and Manitoba adopted their own restrictions, including bans on retail displays and ads for e-cigarettes and other tobacco products.
Study author David Hammond, a professor of public health at the University of Waterloo in Ontario, said this situation set up a "unique natural experiment" for researchers as Canada went from ban to a more open market.
"It allowed us to answer the hypothetical question: Would lifting the restrictions make a difference in teen e-cigarette use?" he said.
The answer? "E-cigarette marketing does make a difference," Hammond said. "It does reach minors. What our study says is that regulating marketing limited the amount of vaping."
He said trends are similar to those in the United States -- advertisers appear to be targeting a younger audience.
"There's social media marketing, digital media and retail stores themselves," Hammond said. "Retail stores are one of the most common areas of exposure -- you go in for a bag of chips or some milk, and you're confronted with product supplies and ads."
While Canada requires retailers to keep traditional cigarettes out of sight, many now have e-cigarette displays or large ads featuring them.
"Where cigarettes were, there are now e-cigarettes and ads that promote flavored e-cigarettes. Suddenly, you're standing in front of a 4-by-4 wall ad of an exploding strawberry," Hammond said. Other flavors he's seen promoted include bubble gum, peanut butter and jam and one called unicorn horn.
Regulators allow e-cigarette makers to tout the taste of their products but forbid advertising them as aids to help tobacco smokers quit, he said.
"This is not about wishing these products away," Hammond said. "These products can help some smokers to quit, but they need to be targeted to the group they can benefit. Adults could be targeted through direct mail, magazines and in places where only adults are allowed, like bars or vape shops."
The study included survey responses from 12,000 16- to 19-year-olds in Canada.
It revealed that rates of teen vaping more than doubled -- from 8.4% in 2017 to 17.8% in 2019 -- after e-cigarette laws were relaxed.
Exposure to teen vaping ads was more common in provinces with fewer ad restrictions. Teens who said they noticed the ads were more likely to have used e-cigarettes. Provinces with fewer ad restrictions had higher rates of teen vaping, the study found.
"In Canada, like in the U.S., vaping rates have doubled, but there's been little change in the rates of vaping for adult smokers trying to quit [tobacco cigarettes]," Hammond said.
In response to the rise in teen vaping, Canada's health minister has proposed a ban on promoting and advertising vaping products online, in public spaces and convenience stores.
Dr. Ben Hoffman, a pediatrician at Oregon Health and Science University's Doernbecher Children's Hospital in Portland, reviewed the findings.
He said they are exactly what experts have known about tobacco products and have expected for vaping. The more evidence they can cite about the bad effects of e-cigarettes, the more likely they can keep advertising and products away from kids, Hoffman said.
"For so long with vaping, it's been the Wild West," he said. "Vaping hasn't fallen under jurisdiction of the U.S. Food and Drug Administration, so it's been left to a hodgepodge of local and state officials who have tiptoed around it. No one has taken responsibility as they should."
Hoffman wants to see vaping ads banned entirely. "We saw the impact ad restrictions had on teen smoking, we should be following the lessons learned," he said.
As long as these ads are around, Hoffman said parents need to teach their kids to be smart consumers of media. Teach them to spot claims that are too good to be true and that an "influencer" on social media is likely getting paid to pitch a product, he said.
Hoffman said kids need to be educated about these products, particularly about the level of nicotine they contain, but that responsibility shouldn't fall on parents.
"It would be much more effective to try to remove the appealing ads that kids see," he said.
The study was published online June 29 in Pediatrics.
Learn more about vaping and teens from the U.S. Surgeon General.
SOURCES: David Hammond, Ph.D., professor and CIHR/PHAC Applied Public Health Chair, School of Public Health and Health Systems, University of Waterloo, Ontario, Canada; Ben Hoffman, M.D., pediatrician, and medical director, Tom Sargent Safety Center, Doernbecher Children's Hospital at Oregon Health and Science University, Portland, and chairman, American Academy of Pediatrics Council on Injury, Violence and Poison Prevention; Pediatrics, online, June 29, 2020