Increased E-cigarette Use in High Schools

South Saskatchewan River in Medicine Hat, Alberta. (Dr. Noorali Bharwani)
South Saskatchewan River in Medicine Hat, Alberta. (Dr. Noorali Bharwani)

Cigarette smoking is dangerously addictive and lethal. Now there are new concerns with the introduction of electronic cigarettes or e-cigarettes.

E-cigarettes are cigarette-shaped canisters used to simulate the action of cigarette smoking.
The e-cigarettes are fluid-filled cartridges that contain varying concentrations of flavouring agents, propylene glycol, glycerine, water and other chemicals. The batteries within the canisters heat up contents of the e-cigarette.

Some e-cigarettes contain nicotine. The cartridge content varies widely according to the manufacturer and distributor. The act of smoking an e-cigarette is called “vaping,” because the user inhales vapour, not smoke.

A new study by Khoury and colleagues published in the Canadian Medical Association Journal (CMAJ August 9, 2016) reports that 10 per cent of a representative sample of grade 9 students in Ontario had tried electronic cigarettes (e-cigarettes).

An editorial in the CMAJ says this finding is likely an underestimate of rates across Canada. For example rates in Quebec are double those in Ontario.

Usually smokers start using e-cigarettes to kick the smoking habit. But Khoury and colleagues found that most smokers were motivated to try e-cigarettes by their novelty and “coolness” – rarely did youth use e-cigarettes to quit smoking.

The study found e-cigarette use was highest among the most vulnerable youth who are in poor health, high stress or low socioeconomic status. The study also confirmed that most were not substituting e-cigarettes for cigarettes: instead, the odds of e-cigarette use were 12-fold higher in youth who also smoked cigarettes (i.e. “dual users”).

Evidence shows increasing use of e-cigarettes in Canada and U.S. A recent study in the US involving youth found that those who did not smoke from grades 11 to 12 and used e-cigarettes, had six fold higher odds of becoming cigarette smokers a year and a half later when they reached the legal age to purchase tobacco. The typical fruit and candy flavourings of e-cigarette liquids are the number one reason they appeal to youth.

What is the government doing about this?

In Canada, governments have begun to take action to protect our youth from e-cigarettes. Ontario and seven other provinces have now passed or tabled legislation that treats e-cigarettes similarly to tobacco products – including a prohibition on selling or supplying them to minors, says the CMAJ editorial.

There is no good reason for youth – or any non-smokers – to be using e-cigarettes. Nothing good can come of providing vulnerable individuals with a more appealing way to become addicted to nicotine, says the editorial.

Some of the things the government can do are: prohibit flavourings in e-cigarettes and introduce advertising restrictions currently in place for tobacco products.

Parents and teachers have an important role to play in engaging our youth in a conversation about the harms of e-cigarettes, lest we lose the progress against tobacco that we have worked so hard for decades to achieve, says the editorial.

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Electronic Cigarettes are Not Regulated in Canada

A walk in the park is healthier than smoking cigarettes. (Dr. Noorali Bharwani)
A walk in the park is healthier than smoking cigarettes. (Dr. Noorali Bharwani)

Those who smoke cigarettes know quite well how addictive nicotine is. Over the years many methods have been used to help smokers quit smoking. But the success rate is not that great. The struggle continues.

The latest effort in this struggle is the development of electronic cigarettes, also known as e-cigarettes. An article in the Canadian Medical Association Journal (CMAJ November 5, 2013) says, “Electronic (e-) cigarettes are cigarette-shaped canisters used to simulate the action of cigarette smoking.”

The e-cigarettes are fluid-filled cartridges that contain varying concentrations of flavouring agents, propylene glycol, glycerine, water and other chemicals. The batteries within the canisters heat up contents of the e-cigarette.

Some e-cigarettes contain nicotine. The cartridge content varies widely according to the manufacturer and distributor, says the article. The act of smoking an e-cigarette is called “vaping,” because the user inhales vapour, not smoke.

E-cigarettes are not approved for sale in Canada. But that does not mean you cannot get them. They are readily available online. Smokers who use e-cigarettes may think that they are safe but they should remember e-cigarettes have not been evaluated for their safety. We don’t even know that they are superior to other methods used to help people stop smoking.

The CMAJ article concludes by saying that several pharmacologic and behavioural interventions have been found to improve smoking cessation rates. These strategies help patients manage nicotine withdrawal symptoms, learn behavioural self-regulation skills and provide instrumental social support.

Smokers wishing to stop smoking should discuss their options with their family doctor. As has been said before, if there is a will, there is a way.

What does a fish smoke? Sea weed. Talk to you again soon.

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There is a Price to Pay for Physical Inactivity

An overweight man sitting on a bench with take-out food. (Digital Vision/Thinkstock)
An overweight man sitting on a bench with take-out food. (Digital Vision/Thinkstock)

An article in the Lancet (July 21 2012) says worldwide mortality rate of inactivity is about one per cent which is same as mortality from smoking.

It says exercise has been called a miracle drug that can benefit every part of the body and substantially extend lifespan. Yet it receives little respect from doctors or society. This passive attitude towards inactivity, where exercise is viewed as a personal choice, is anachronistic, and is reminiscent of the battles still being fought over smoking.

Inactivity in our society is reaching pandemic proportion and has far reaching health, economic, environmental and social consequences, says the Lancet paper.

Is it too difficult to exercise two hours and thirty minutes a week? That is the recommended amount of time we should be physically active each week. Would you be surprised if I say only 15 per cent of the Canadians meet this goal? Yes, that is true. Only 15 per cent of us are physically active for two-and-half hours each week.

An average Canadian spends more than two hours watching television every day. Come to think of it, physical activity can be as easy as watching television. You can incorporate physical activity in your daily routine – going shopping, walking your children to school, delivering newspapers and visiting a friend. These are just a few examples. You can do more if you can. The more you do the better it is.

In 2005, Time magazine did a survey to see what kind of physical activity Americans like to do. The survey revealed 69 per cent take a brisk walk, 35 per cent use exercise machine, 32 per cent lift weights, 30 per cent ride a bike, 27 per cent jog or run, 22 per cent do aerobic exercise, 21 per cent swim, 19 per cent dance, 18 per cent play some kind of sport like soccer, 18 per cent go hiking, eight per cent play golf, seven per cent do yoga and seven per cent bowl.

Physical activity has many benefits. We know that. Smoking is harmful. We know that too. Yet we continue to be couch potatoes and we continue to smoke. What is the solution? Let us keep moving and stop smoking. Isn’t that easy?

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Steve Jobs – a Victim of Pancreatic Cancer

Pancreatic cancer has taken another life. The prognosis for pancreatic cancer is dismal. The overall five year survival rate is less than two percent, the worst of any cancer. Only 20 percent of the patients will be diagnosed at a stage where surgery may offer hope.

Last time I wrote about pancreatic cancer was in 1996. That was the year my sister, Gulshan, age 60, passed away within three months of diagnosis of pancreatic cancer. Steve Jobs was 56. He lived for four years after having had a diagnosis of pancreatic cancer. He also received a liver transplant.

It has been 15 years since my sister died. Has anything changed to improve the prognosis of patients diagnosed with pancreatic cancer?

Before we look into that, let us look at some numbers. The Canadian Cancer Society’s document “Canadian Cancer Statistics 2010” says that in 2010, Canada will continue to see an increase in the number of individuals diagnosed with and dying from cancer. Every hour of every day, an average of 20 people will be diagnosed with some type of cancer and eight people will die from cancer.

Fifty per cent of the newly diagnosed cancer patients will be suffering from lung, colorectal, prostate and breast cancers. Cancer of the pancreas is 12th on the list of estimated number of new cases. About 4,000 new cases will be diagnosed – this will be equally divided amongst males and females. Almost the same number of people will die of pancreatic cancer each year. Death from pancreatic cancer is fifth on the list after lung, colorectal, breast and prostate.

An article in the Scientific American (January 2011) says that one of the reasons why the prognosis is so dismal in pancreatic cancer is that the disease is not typically diagnosed until 15 years after the first cancer-causing mutations appear, by which point the cancer has spread and become highly aggressive.

What does that mean? That means there may be plenty of time for doctors to intervene before pancreatic cancer becomes lethal. Then the tumour can be successfully removed and the prognosis can be improved with appropriate chemotherapy and radiotherapy, if indicated.

The article says researchers from John Hopkins found that cancer cells appear 10 years after the first cancer-causing mutation arises and that another five years pass before the cancer cells spread and become deadly. Research like this and many others gives hope for the future. In the last two years scientists have brought screening techniques for pancreatic cancer closer to reality.

The article says that these technologies are not available commercially but progress is expected to increase in the next decade. In the meantime, doctors should consider using CT and MRI scans to screen patients who are at high risk because of family history of the disease. Is that practical or economically feasible? There is no defined protocol for this and there are advantages and disadvantages of using CT or MRI scans as a screening tool in otherwise healthy individuals.

What causes pancreatic cancer? The precise cause is unknown. Smoking and chronic inflammation are suspected in the causation of the disease. An estimated 5-10 percent of pancreatic cancers are inherited and additional 10-20 percent may have other significant genetic influence. Most patients present with jaundice, abdominal pain, weight loss, or no appetite. By that time it is too late.

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