Cannabis vaping: Understanding the health risks of a rapidly emerging trend.

The rapid emergence of youth vaping has completely changed the landscape of adolescent substance use in Canada and has become a pressing public health issue of our time. While nicotine remains the most common substance encountered in vaping devices, cannabis vaping is now reported by one-third of youth who vape. Though cannabis vaping is thought to generate fewer toxic emissions than cannabis smoking, it has been associated with several cases of acute lung injury and often involves high-potency forms of cannabis, exposing youth to several acute and long-term health risks. The low perceived riskiness of cannabis as a substance and of vaping as a mode of consumption may bring a false sense of security and be particularly appealing for youth who may be looking for a 'healthier way' to use substances. While research is still lacking on how best to support youth who may have already initiated cannabis vaping, concerted efforts among paediatric providers, public health experts, schools, communities, and families are urgently needed to limit the spread of cannabis vaping among Canadian youth.

Frequent marijuana use and driving risk behaviours in Canadian youth.

BACKGROUND: A better understanding of the relations between patterns of marijuana use and driving risks in young adulthood is needed. METHODS: Secondary analyses of self-report data from the Victoria Healthy Youth Survey. Youth (baseline ages 12 to 18; N=662; 52% females) were interviewed biannually (on six occasions) from 2003 to 2013 and classified as abstainers (i.e., used no marijuana in past 12 months), occasional users (i.e., used at most once per week), and frequent users (i.e., used more than once a week). RESULTS: In the frequent user group, 80% of males and 75% of females reported 'being in a car driven by driver (including themselves) using marijuana or other drugs in the last 30 days', 64% of males and 33% of females reported that they were 'intoxicated' with marijuana while operating a vehicle and 50% of males and 42% of females reported being in a car driven by a driver using alcohol. In addition, 28% of occasional users and also a small proportion of abstainers reported 'being in a car driven by a driver using marijuana or other drugs in the last 30 days'. INTERPRETATION: The high frequency of driving risk behaviours, particularly for frequent users, suggest that plans for legalization of recreational use should anticipate the costs of preventive education efforts that present an accurate picture of potential risks for driving. Youth also need to understand risks for dependence, and screening for and treatment of marijuana use disorders is needed.

HISTORIQUE: Il est nécessaire de mieux comprendre les liens entre les habitudes de consommation de marijuana et la conduite à risque chez les jeunes adultes. MÉTHODOLOGIE: Les auteurs ont procédé à des analyses secondaires de données autodéclarées tirées du sondage sur la santé des jeunes de Victoria. Dans ce sondage, les jeunes (de 12 à 18 ans en début d'étude, n=662; 52 % de filles) ont participé à une entrevue tous les deux ans (à six reprises) entre 2003 et 2013. Ils ont été classés comme abstinents (aucune consommation de marijuana dans les 12 mois précédents), consommateurs occasionnels (consommation maximale d'une fois par semaine) et consommateurs fréquents (consommation plus d'une fois par semaine). RÉSULTATS: Dans le groupe des consommateurs fréquents, 80 % des garçons et 75 % des filles ont déclaré « avoir été dans une voiture conduite par une personne (y compris eux-mêmes) qui avait consommé de la marijuana ou d'autres drogues dans les 30 jours précédents ¼, 64 % des garçons et 33 % des filles ont affirmé avoir déjà été « intoxiqués ¼ par la marijuana lorsqu'ils conduisaient une voiture et 50 % des garçons et 42 % des filles ont indiqué avoir été dans une voiture conduite par quelqu'un qui consommait de l'alcool. De plus, 28 % des consommateurs occasionnels et une petite proportion d'abstinents ont déclaré « avoir été dans une voiture conduite par une personne qui avait consommé de la marijuana ou d'autres drogues dans les 30 jours précédents. ¼. INTERPRÉTATION: Compte tenu de la forte fréquence de conduite à risque, notamment chez les consommateurs fréquents, le projet de légaliser la consommation récréative devrait tenir compte des coûts de mesures d'éducation préventive qui présenteront un portrait précis des risques potentiels liés à la conduite. Les jeunes doivent également comprendre les risques de dépendance. Enfin, il est important de procéder au dépistage et au traitement des troubles liés à la consommation de marijuana.

E-cigarettes: Are we renormalizing public smoking? Reversing five decades of tobacco control and revitalizing nicotine dependency in children and youth in Canada.

An electronic cigarette (e-cigarette) is a battery attached to a chamber containing liquid that may (or may not) contain nicotine. The battery heats the liquid and converts it into a vapour, which is inhaled, mimicking tobacco smoking. The e-cigarette does not rely on tobacco as a source of nicotine but, rather, vaporizes a liquid for inhalation. E-liquids are often flavoured and may contain nicotine in various concentrations, although actual amounts are seldom accurately reflected in container labelling. The deleterious effects of nicotine on paediatric health are well established. The use of e-cigarettes in the paediatric age group is on the rise in Canada, as are associated nicotine poisonings. E-devices generate substantial amounts of fine particulate matter, toxins and heavy metals at levels that can exceed those observed for conventional cigarettes. Children and youth are particularly susceptible to these atomized products. Action must be taken before these devices become a more established public health hazard. Policies to denormalize tobacco smoking in society and historic reductions in tobacco consumption may be undermined by this new 'gateway' product to nicotine dependency.

La cigarette électronique (vapoteuse) est une batterie fixée à un réservoir rempli d'un liquide qui peut (ou non) contenir de la nicotine. La batterie réchauffe le liquide et le convertit en vapeur, qui est inhalée afin d'imiter le tabagisme. La source de nicotine de la vapoteuse ne provient pas du tabac, mais le dispositif vaporise un liquide en vue de son inhalation. Ces e-liquides, souvent aromatisés, peuvent contenir de la nicotine sous diverses concentrations, mais leur quantité réelle est rarement bien indiquée sur l'emballage. Les effets délétères de la nicotine sur la santé sont bien établis dans le groupe d'âge pédiatrique. Le vapotage est en hausse au sein de ce groupe au Canada, de même que les intoxications à la nicotine qui y sont associées. Les vapoteuses produisent de grandes quantités de particules fines, de toxines et de métaux lourds, à des taux qui peuvent dépasser ceux de la cigarette conventionnelle. Les enfants et les adolescents sont particulièrement susceptibles à ces produits atomisés. Il faut agir avant que ces dispositifs deviennent un danger mieux établi en santé publique. Cette nouvelle « porte d'accès ¼ à la dépendance à la nicotine pourrait saboter les politiques visant à « dénormaliser ¼ le tabagisme dans la société, ainsi que les réductions historiques de consommation du tabac.

Transformational change: short-term gain for long-term pain?

Transformational change as envisioned by Millar and colleagues forecasts a closer relationship between public health and primary care. In this commentary, public health readiness and the fiscal feasibility of the suggested model are examined from a pragmatic perspective based upon past and current experience. In the face of finite resources and compelling evidence on the merits of public health retaining its traditional involvement with community partners, the utility of late-stage secondary prevention collaboration with primary care is queried. Pursuing partnerships motivated by alleviating pressures in the healthcare system may be superficially attractive but might have a long-term negative impact on the health of the overall population.

Banning children and youth younger than 18 years of age from commercial tanning facilities.

Cutaneous malignant melanoma has increased more than three-fold in the past 35 years. Because damage is cumulative, exposure to ultraviolet radiation early in life elevates a risk that is increased further as individuals use artificial sources of ultraviolet radiation. The full impact and scope of damage caused by year-round indoor tanning may take years to appreciate given the long latency period for most skin cancers. Teenagers are frequent visitors to tanning parlours, with girls being more frequent and sustained users. The tanning industry disputes the World Health Organization's and the International Agency for Research on Cancer's classification of their product as a Class 1 physical carcinogen. Tanning parlours have sought to establish and maintain a client-base among teenagers. Consequently, the Canadian Paediatric Society is joining other prominent health organizations in support of a ban on the use of commercial tanning facilities by Canadian children and youth younger than 18 years of age.

American Academy of Pediatrics Recommendations for the Prevention of Pediatric ATV-Related Deaths and Injuries.

Since all-terrain vehicles (ATVs) were introduced in the mid-1970s, regulatory agencies, injury prevention researchers, and pediatricians have documented their dangers to youth. Major risk factors, crash mechanisms, and injury patterns for children and adolescents have been well characterized. Despite this knowledge, preventing pediatric ATV-related deaths and injuries has proven difficult and has had limited success. This policy statement broadly summarizes key background information and provides detailed recommendations based on best practices. These recommendations are designed to provide all stakeholders with strategies that can be used to reduce the number of pediatric deaths and injuries resulting from youth riding on ATVs.

Protecting the public from exposure to secondhand cannabis smoke and vapour following legalization.

The adverse effects of direct cannabis use are well described in the literature; however, researchers are now beginning to expose the health consequences of secondhand exposure. Given the commitment by the federal government to legalize cannabis in Canada by summer 2018, public health officials must build on the successes of existing smoke-free programs and work with provinces and municipalities to develop policies that protect the public from secondhand exposure to cannabis smoke and vapour. While harmonization with existing tobacco laws may offer the simplest approach, other alternatives may allow stricter control of public consumption by different levels of government. Further research will be needed to assess the health implications of secondhand cannabis exposure, as well as the population impacts of legalization.

Building the capacity of health authorities to influence land use and transportation planning: Lessons learned from the Healthy Canada by Design CLASP Project in British Columbia.

OBJECTIVES: The main objective of the Healthy Canada by Design CLASP Initiative in British Columbia (BC) was to develop, implement and evaluate a capacity-building project for health authorities. The desired outcomes of the project were as follows: 1) increased capacity of the participating health authorities to productively engage in land use and transportation planning processes; 2) new and sustained relationships or collaborations among the participating health authorities and among health authorities, local governments and other built environment stakeholders; and 3) indication of health authority influence and/or application of health evidence and tools in land use and transportation plans and policies. PARTICIPANTS: This project was designed to enhance the capacity of three regional health authorities, namely Fraser Health, Island Health and Vancouver Coastal Health, and their staff. These were considered the project's participants. SETTINGS: The BC regions served by the three health authorities cover the urban, suburban and rural spectrum across relatively large and diverse geographic areas. The populations have broad ranges in socio-economic status, demographic profiles and cultural and political backgrounds. INTERVENTION: The Initiative provided the three health authorities with a consultant who had several years of experience working on land use and transportation planning. The consultant conducted situational assessments to understand the baseline knowledge and skill gaps, assets and objectives for built environment work for each of the participating health authorities. On the basis of this information, the consultant developed customized capacity-building work plans for each of the health authorities and assisted them with implementation. Capacity-building activities were as follows: researching health and built environment strategies, policies and evidence; transferring health evidence and promising policies and practices from other jurisdictions to local planning contexts; providing training and support with regard to health and the built environment to health authority staff; bringing together public health staff with local planners for networking; and participating in land use planning processes. OUTCOMES: The project helped to expand the capacity of participating health authorities to influence land use and transportation planning decisions by increasing the content and process expertise of public health staff. The project informed structural changes within health authorities, such as staffing reallocations to advance built environment work after the project. Health authorities also forged new relationships within and across sectors, which facilitated knowledge exchange and access of the public health sector to opportunities to influence built environment decisions. By the end of the project, there was emerging evidence of a health presence in land use policy documents. CONCLUSIONS: The project helped to prioritize, accelerate and formalize the participating health authorities' involvement in land use and transportation planning processes. In the long term, this is expected to lead to health policies and programs that consider the built environment, and to built environment policies and practices that integrate population health goals, thereby reducing the risk of chronic diseases.