Elsevier

Preventive Medicine

Volume 81, December 2015, Pages 180-183
Preventive Medicine

Brief Original Report
Who is using e-cigarettes in Canada? Nationally representative data on the prevalence of e-cigarette use among Canadians

https://doi.org/10.1016/j.ypmed.2015.08.019Get rights and content

Highlights

  • This study reports the first nationally-representative e-cigarette data in Canada.

  • 8.5% of Canadians had ever tried an e-cigarette; 1.8% used one in the past month.

  • E-cigarette use varied by smoking status and age, highest among youth/young adults.

  • Dual use was common; the majority of e-cigarette users also smoked cigarettes.

  • Older users were mostly smokers; youth users included more never-smokers.

Abstract

The current study examined prevalence and correlates of electronic cigarette (e-cigarette) use in the Canadian population, using data from the nationally representative 2013 Canadian Tobacco, Alcohol and Drugs Survey (n = 14,565). Sociodemographic correlates of e-cigarette use (ever, and in the past 30 days) were examined using logistic regression models. Overall, 8.5% of Canadians aged 15 and older reported having ever tried an e-cigarette; 1.8% had used one in the past 30 days. E-cigarette use was particularly high among smokers and young people. Overall, prevalence did not differ between males and females, for ever (P = 0.24) or past 30-day use (P = 0.30). Smoking status was the strongest correlate of e-cigarette use (ever and in the past 30 days, P < 0.0001): 37.3% of current smokers had ever tried an e-cigarette (9.6% used in the past 30 days), compared to 3.0% of never-smokers (0.3% past 30-days), and 5.1% of former smokers (0.9% past 30-day). E-cigarette use also varied by age (P < 0.0001): prevalence was highest among youth aged 15–19 (19.8% ever; 2.6% past 30-day) and young adults aged 20–24 (20.1% ever; 3.9% past 30-day), and decreased with age. Among youth, the majority of e-cigarette users were never-smokers, while the majority of adult users were smokers. In Canada, e-cigarette use is particularly high among smokers and young people. Dual use with cigarettes was common, with most e-cigarette users also smoking conventional cigarettes. Continued monitoring of e-cigarette use and its relationship with smoking should be a priority, given the rapidly-evolving e-cigarette market and implementation of new policy measures.

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).

References (18)

  • S.E. Adkison et al.

    Electronic nicotine delivery systems. International Tobacco Control Four-Country Survey

    Am. J. Prev. Med.

    (2013)
  • D.R. Camenga et al.

    Trends in use of electronic nicotine delivery systems by adolescents

    Addict. Behav.

    (2014)
  • S.L. Carroll Chapman et al.

    E-cigarette prevalence and correlates of use among adolescents versus adults: a review and comparison

    J. Psychiatr. Res.

    (2014)
  • R.A. Arrazola et al.

    Tobacco use among middle and high school students—United States, 2011–2014

    MMWR Morb. Mortal. Wkly Rep.

    (2015)
  • J. Britton et al.

    Electronic Cigarettes. A Report Commissioned by Public Health England. Public Health England Publications Gateway Number: 2014079. May 2014

  • Statistics Canada

    Canadian Tobacco, Alcohol and Drugs Survey (CTADS)

  • Canadian Cancer Society

    The Canadian Cancer Society's exclusive study: 5000 Children Have Already Tried an Electronic Cigarette in Grade 6! One in Three High School Students Have Already Smoked It (142,000 youths). 13 August 2014

  • C.D. Czoli et al.

    Electronic cigarettes in Canada: prevalence of use and perceptions among youth and young adults

    Can. J. Public Health

    (2014)
  • C.D. Czoli et al.

    E-cigarettes in Canada—Tobacco Use in Canada: Patterns and Trends, 2015 Edition, Special Supplement

    Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo

    (2015)
There are more references available in the full text version of this article.

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