Surveys of students in two Canadian provinces have led scholars to warn that e-cigarettes, also called vaping, are causing cigarette uptake in high school students.

This will be a surprise to American and British public health officials, who know cigarette smoking has plummeted and even among those who get hooked, vaping is considered a viable harm reduction and smoking cessation alternative.

What is Canada doing so wrong?  Dr. David Hammond, in the School of Public Health and Health Systems at University of Waterloo, says e-cigarettes may help to re-normalize smoking before conceding that the association between e-cigarettes and smoking may simply reflect common factors rather than a causal effect: basically, the same individual and social risk factors that increase the likelihood of youth smoking may cause them to also take up e-cigarettes.

In other words, young people sometimes do stupid things like smoke cigarettes. So why does he claim his survey provides "strong evidence" that e-cigarettes are associated with smoking initiation when he can't show evidence the association is clear? That's the kind of mystery that science can't help explain. It's suggested as causal in their press release but the paper shows nothing of the kind. Instead, the survey shows only that 4,163 students in Grades 9-12 at 89 schools in Ontario and Alberta, Canada, who participated in the ongoing COMPASS study who used e-cigarettes in the 30 days prior to the start of the study were more likely to start smoking cigarettes and to continue smoking after 1 year. 

Credit: Gianluca Rasile

But the prevalence of smoking decreased over time in Canada just like it did in the US so how are e-cigarettes linked to more uptake of smoking? If anything, they are reducing smoking. No, speculates Hammond, they are probably trying them and then moving to smoking, rather than smoking and then trying e-cigarettes as either a replacement or a cessation tool. 

He suggests it may be because Canadian merchants are unethical and sell vaping liquid to youths whereas the penalty for selling cigarettes is too high.