by Stacey J Butler
Graphic design by Emily Tjan
Today it seems inconceivable that people once smoked cigarettes in restaurants, or in cars with children, and even on airplanes. The negative health effects related to cigarette smoking were known to researchers in the early 1900s but were not officially recognized until a report was released from the United States Surgeon General in 1964. 1 Another 50 years went by before Canada implemented smoking bans.2 Since then, smoking rates have been steadily declining in Canada.3 However, a new public health concern has taken its place: vaping, or use of e-cigarettes. Vaping is particularly common among youth. Individuals between the ages of 15 to 24 have the highest rates of vaping in Canada.3 Dr. Michael Chaiton, an Associate Professor in the Institute of Medical Sciences (IMS) is dedicated to answering two important questions; 1) why are youth in Canada vaping? and 2) what is the impact of new regulations on e-cigarettes and vaping products in Canada?
Dr. Chaiton uses a population-based approach to study vaping and the impact of health policies. His interest in public health policy and epidemiology began through his work with a non-governmental organization (NGO) where he was working on a project related to the negotiation of the Framework Convention on Tobacco Control. Meeting epidemiologists in this role inspired him to pursue a Master’s and PhD in Epidemiology at the University of Toronto. His graduate work sought to better understand the role of nicotine dependence in smoking cessation, as well as the relationship between smoking and depression in adolescents. During these graduate programs, he gained a better understanding of epidemiology and methods that can be used to study smoking-related behaviours at the population level. Dr. Chaiton is currently a scientist at the Centre for Addiction and Mental Health (CAMH) where he has been conducting large cohort studies and studying the impact of public policies on mental health and addictions.
Government regulations and public policies are unique interventions because they have the potential to impact health for the entire population. For example, Dr. Chaiton has studied the impact of Canada’s recent ban on the sale of menthol cigarettes, demonstrating improvements in smoking cessation rates.4 Their study also projected the impact a menthol ban would have in the United States (US), finding that implementing the menthol ban in the US would be expected to lead to over a million people quitting smoking. This work has been cited by the US Food and Drug Administration (FDA) in support of new regulations on cigarette products.
Currently, his team is following a ‘vaping dependence cohort’ of ~3,300 Canadian youth to study the natural history of vaping and the impact of new vaping regulations that have been put into place over the last few years. These regulations have limited the amount of nicotine in e-cigarettes, prohibited the sale of e-cigarette products to youth, and restricted the sale of flavoured products.5 There has been little research on the potential effects of these bans. This is particularly important because of the potential substitution of cigarettes and e-cigarettes, where even if these regulations may reduce vaping initiation and lead some people to quit vaping, the regulations may encourage others to switch to cigarettes instead. To help youth and young adults quit vaping, Dr. Chaiton’s team has been developing digital apps, websites and school-based programs. For example, the ‘Stop Vaping Challenge’ is a free app that encourages youth and young adults to quit vaping together with their friends. The app was co-designed by youth who were trying to, or had successfully quit vaping. The app helps users better understand the effects of their vaping dependence so that they can more easily quit and also provides local resources and support to quit vaping. To build upon this model, Dr. Chaiton is also developing the ‘Stop Cannabis Challenge’ which is aimed at youth and young adults who are starting to be concerned about their cannabis use.
Dr. Chaiton is also interested in improving youth mental health and understanding why there has been such a large increase in mental health conditions among this demographic over the past decade. This is especially important given that the COVID-19 pandemic has exacerbated the mental health crisis in Canada. He is currently using a randomized invitation trial to evaluate a digital platform called ‘Wellness Together, Canada’ (https://www.wellnesstogether.ca/en-CA) which has features to track your mood and well-being and also provides mental health and substance use support from professionals.
Dr. Chaiton also recognizes the potential use of machine learning and artificial intelligence to study health at the population level. He is leveraging these novel techniques to identify predictors of behaviour change and use this information to guide interventions. His team is also committed to reaching populations that have been marginalized and highlight issues that have been otherwise ignored.
Since joining the IMS, Dr. Chaiton has had the opportunity to work with many talented graduate students. He advises current graduate students in the IMS to be resilient, stating that “the world of academics is 90% failure, doing a PhD or pursuing a career in academics is about being able to accept the failure and continue moving on”. Dr. Chaiton admits that he fell into his career by accident and that a little bit of luck in academia can go a long way.
The ‘Stop Vaping Challenge’ app is available for free on the Apple App Store and Google Play.
- Proctor RN. The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global toll: Table 1. Tob Control 2012; 21: 87–91.
- Statistics Canada. Smoking ban legislation in Canadian provinces and municipal bylaws in selected cities, https://www150.statcan.gc.ca/n1/pub/82-003-x/2006008/article/smoking-tabac/t/4060721-eng.htm (accessed 26 January 2023).
- Canadian Public Health Association. Tobacco and Vaping Use in Canada: Moving Forward, https://www.cpha.ca/tobacco-and-vaping-use-canada-moving-forward.
- Fong GT, Chung-Hall J, Meng G, et al. Impact of Canada’s menthol cigarette ban on quitting among menthol smokers: pooled analysis of pre–post evaluation from the ITC Project and the Ontario Menthol Ban Study and projections of impact in the USA. Tob Control 2022; tobaccocontrol-2021-057227.
- Health Canada. Regulating tobacco and vaping products: Vaping products regulations, https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/product-safety-regulation.html (5 January 2023, accessed 28 February 2023).
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