Brief Original ReportWho is using e-cigarettes in Canada? Nationally representative data on the prevalence of e-cigarette use among Canadians
Introduction
Electronic cigarettes (e-cigarettes) are a diverse set of products that heat liquid to deliver a vapour, typically composed of propylene glycol and/or glycerin, additives such as flavourings, and sometimes nicotine (Britton and Bogdanovica, 2014, Hajek et al., 2014). E-cigarettes have rapidly gained popularity in recent years, both globally and within Canada (Britton and Bogdanovica, 2014, Hajek et al., 2014, Arrazola et al., 2015, King et al., 2015, Gravely et al., 2014), and their regulation varies by jurisdiction (Shiplo et al., 2015, Czoli et al., 2015a). In Canada, e-cigarettes containing nicotine are regulated as drugs/drug delivery devices and require pre-market authorisation before they can be imported, marketed or sold (Health Canada, 2009); to date, e-cigarettes containing any level of nicotine have not been approved. In contrast, e-cigarettes that do not contain nicotine and do not make health claims are legal. Nevertheless, both nicotine- and non-nicotine-containing e-cigarettes are widely available in Canada, regardless of approval status (Hammond et al., 2014, Geller, 2014).
Recent Canadian surveys suggest that trying e-cigarettes was fairly common among younger adults (aged 16–30), at approximately one in six overall (Czoli et al., 2014), and even more common among smokers, with estimates ranging from 4% in 2010/11 to 27–35% more recently (Shiplo et al., 2015, Czoli et al., 2014, Adkison et al., 2013). Studies in some provinces indicate similar and even higher levels of ever trying e-cigarettes among youth: 15% of Ontario high school students (43% of past-year tobacco users and 7% of never-smokers) (Hamilton et al., 2014), and 34% of Quebec secondary students (90% of smokers and 28% of non-smokers) (Canadian Cancer Society, 2014). Past-month use of e-cigarettes was lower but still prevalent among adolescent smokers (35% in Ontario and Alberta (Czoli et al., 2015b) and 30% in Quebec (Canadian Cancer Society, 2014)), but reported by few non-smokers (~ 4%) (Canadian Cancer Society, 2014, Czoli et al., 2015b).
The comprehensive tobacco control environment in Canada, as well as the mixed e-cigarette market (nicotine and non-nicotine products), makes it a unique context in which to examine population trends. Much of the existing Canadian evidence relies upon non-representative surveys with limited geographic scope, and is focused primarily on young people. The current study examines prevalence and some sociodemographic correlates of e-cigarette use in a nationally representative sample of the Canadian population.
Section snippets
Methods
Secondary analysis was conducted using data (n = 14,565) from the 2013 Canadian Tobacco, Alcohol and Drugs Survey (CTADS), conducted by Statistics Canada (Canada, 2013). Data were collected from February to December 2013, using computer-assisted random-digit-dialled telephone interviews. The target population included all persons living in Canada who were 15 years of age and over with the exception of those living in the territories and those living full-time in institutions. The sample was
Results
In 2013, 8.5% of all Canadians aged 15 and older (approximately 2.5 million) reported having ever tried an e-cigarette, including 1.8% (~ 521,000) who had used an e-cigarette in the past 30 days. Among current smokers, 37.3% (~ 1.6 million) had ever tried an e-cigarette, and 9.6% (~ 405,000) used one in the past 30 days. Among former smokers, 5.1% (~ 381,000) ever tried, while 0.9% (~ 65,000) used in the past 30 days. Lastly, among never-smokers, 3.0% (~ 514,000) had ever tried, while 0.3% (~ 52,000)
Discussion
The current study presents the first nationally-representative, comprehensive data on e-cigarette use in Canada. Estimates indicate that while a substantial number of Canadians had tried an e-cigarette (8.5%), fewer had used one within the past month (1.8%). These figures are similar to recent prevalence estimates among adults in the United States of 8.5% ever use and 2.6% past-month use of e-cigarettes. (King et al., 2015)
Prevalence of use was similar among males and females, but varied
Conclusions
E-cigarette use in the Canadian population appears to be concentrated among smokers and young people. While experimentation with e-cigarettes is common among both smokers and young non-smokers, regular use is much less prevalent. Continued monitoring of e-cigarette use and its relationship with smoking should be a priority, particularly given the rapidly-evolving nature of e-cigarette design, as well as the implementation of policy measures in a number of Canadian provinces that seek to reduce
Contributors
DH and JR conceived of the analysis, and VLR conducted the analysis. All authors contributed to interpretation of the data and drafting the manuscript; all approved the final version.
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgments
This study analysed public-use data collected by Statistics Canada. The results and views expressed in this paper are those of the authors and not Statistics Canada.
This research was supported by the Canadian Cancer Society grant #2011-701019, through the Propel Centre for Population Health Impact. Additional support was provided by a CIHR New Investigator Award (DH), a CIHR Public Health Agency of Canada Chair in Applied Public Health (DH), and a CIHR Vanier Canada Graduate Scholarship (CDC).
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