Where there’s smoke, there’s fire: The harms of vaping and British Columbia’s efforts to tackle this growing issue

E-cigarettes, commonly referred to as vapes, entered the Canadian market in 2004. Subsequently, there has been a surge in their use, notably among children and youth. The 2023 BC Adolescent Health Survey revealed that 26% of youth in BC had tried vaping, and 15% had vaped within the past 30 days.[1] Notably, 72% of youth who had vaped started before their 15th birthday.[1] Colorful packaging and dessert-like flavoring accelerated uptake in this younger population.[2]

To counteract these trends and penalize corporations for their role in influencing nicotine addiction in children and youth, the BC government enacted Bill 24, the Vaping Product Damages and Health Care Costs Recovery Act, in December 2025. This legislation enables the provincial government to sue e-cigarette manufacturers to recover public health care costs associated with their products.[3] E-cigarette manufacturers and consumer advocacy groups have openly criticized the Act, arguing that vaping is considered by some to be a method for smoking cessation and a form of harm reduction. Conversely, health care organizations are raising concerns about the cessation efficacy and safety of e-cigarettes. The Canadian Lung Association and the Canadian Thoracic Society report that no vaping product has been approved as a safe and effective smoking cessation aid.[4] The Canadian Task Force on Preventive Health Care recommends against the use of e-cigarettes for smoking cessation due to a lack of evidence that they reduce smoking habits, as well as their serious health effects.[5]

Continued research on vaping indicates harmful impacts on cardiovascular and respiratory health, as well as potential carcinogenesis. Cardiovascular effects include increased heart rate, blood pressure, platelet activity, and risk of stroke.[2] Respiratory harms include cytotoxicity, acute and chronic inflammation, impaired immune response, mucociliary dysfunction, oxidative stress, and increased airway hyper-responsiveness.[6] Vaping has been found to be associated with chronic obstructive pulmonary disease,[6] and users also face a 30% increased relative risk of developing asthma.[2] From an oncological perspective, e-cigarettes induce oxidative stress, mitochondrial toxicity, and DNA damage by pathological pathways similar to those of tobacco smoke, including deregulation of cancer-related molecular signaling.[7] Additional harms include periodontal disease, nicotine dependence in nonsmokers, device malfunction burns, and vaping-associated acute lung injury, a syndrome associated with e-cigarettes containing tetrahydrocannabinol.[2]

The solution to the public health challenge posed by vaping will likely require more than what BC’s new Act is structured to accomplish. While litigation will play a role in deterring harmful industry practices and recovering health care costs, it should be complemented by proactive, evidence-based interventions, such as multifaceted educational campaigns that communicate the health risks of vaping. In parallel, regulatory strategies that have proven effective in reducing cigarette use—such as plain packaging, restrictions on product appeal, and prominent health warnings on devices—should be applied to vaping products. Together, legislative and regulatory measures, along with public education, may offer a more comprehensive approach that prioritizes prevention and informed decision making.
—Hamza Ballouk, MD, FRCPC
Council on Health Promotion Member
—Aven Poynter, MD, FRCPC
Council on Health Promotion Member
—William Liu, BHSc
Council on Health Promotion Member

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This article is the opinion of the authors and not necessarily the Council on Health Promotion or Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.

References

1.    McCreary Centre Society. The big picture: An overview of the 2023 BC adolescent health survey provincial results. 2024. Accessed 5 January 2026. https://mcs.bc.ca/pdf/2023_bcahs_the_big_picture.pdf.

2.    Kaur J, Goel S, Shabil M, et al. Health impacts of electronic nicotine delivery systems: An umbrella review of systematic reviews. BMJ Open 2025;15:e100168. https://doi.org/10.1136/bmjopen-2025-100168.

3.    Government of British Columbia. New law will hold vape manufacturers accountable for public health costs [news release]. 8 October 2025. Accessed 5 January 2026. https://news.gov.bc.ca/releases/2025AG0058-000975.

4.    Canadian Lung Association. Position statement on vaping. March 2020. Accessed 24 December 2025. www.lung.ca/position-statement-vaping.

5.    Thombs BD, Traversy G, Reynolds DL, et al. Recommendations on interventions for tobacco smoking cessation in adults in Canada. CMAJ 2025;197:E846-E861. https://doi.org/10.1503/cmaj.241584.

6.    Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the prevention, diagnosis, and management of COPD: 2026 report. Accessed 24 December 2025. https://goldcopd.org/2026-gold-report-and-pocket-guide/.

7.    Petrella F, Rizzo S, Masiero M, et al. Clinical impact of vaping on cardiopulmonary function and lung cancer development: An update. Eur J Cancer Prev 2023;32:584-589. https://doi.org/10.1097/CEJ.0000000000000797.