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Background: Prevalence of youth nicotine vaping has increased, heightening concerns around negative health effects. This study aimed to compare self-reported respiratory symptoms among youth by vaping behaviours. Methods: Participants (n = 39,214) aged 16–19 from the 2020 and 2021 International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Surveys (Canada, England, US). Weighted multivariable logistic regression assessed associations between reporting any of five respiratory symptoms in the past week (shortness of breath, wheezing, chest pain, phlegm, cough) and: past 30-day smoking and/or vaping; lifetime/current vaping. Among past-30-day vapers (n = 4644), we assessed associations between symptoms and vaping frequency, use of nicotine salts, usual flavour and device type(s). Results: Overall, 27.8% reported experiencing any of the five respiratory symptoms. Compared with youth who had only vaped, those who had only smoked had similar odds of symptoms [adjusted odds ratio, OR (95% confidence interval, CI): 0.97 (0.85–1.10)], those who both smoked and vaped had higher odds [1.26 (1.12–1.42)], and those who had done neither, lower odds [0.67 (0.61–0.72)]. Compared with those who had never vaped, past use, experimentation and current regular or occasional use were all associated with higher odds. Reporting usually using nicotine salts was associated with higher odds of symptoms [1.43 (1.22–1.68)] than non-salt but was often uncertain. Compared with tobacco flavour (including with menthol), menthol/mint and sweets flavours were associated with similar odds; fruit [1.44 (1.07–1.93)], multiple [1.76 (1.30–2.39)] and 'other' [2.14 (1.45–3.16)] flavours with higher odds. All device types were associated with similar odds. Conclusions: Among youth, vaping was associated with increased reporting of past-week respiratory symptoms. Among those who vaped, some flavour types and potentially nicotine salts were associated with respiratory symptoms. [ABSTRACT FROM AUTHOR]

Youth vaping is a public health concern in Canada. Researchers have explored factors associated with vape use, but rarely differentiated between types of use. This study estimates the prevalence and correlations among past-month nicotine vaping, nicotine-free vaping, and dual-use vaping (nicotine and nicotine-free) in grades 9–12 high school students. Data came from the 2019 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS). The total sample consisted of 38,229 students. We used multinomial regression to assess for the correlations among different categories of vape use. Approximately 12% of the students reported past-month vape use exclusively with nicotine, 2.8% reported exclusively nicotine-free vape use, and 14% reported both nicotine vaping and nicotine-free vaping. Substance use (smoking, alcohol, cannabis) and being male were associated with membership in every category of vape use. Age was associated with vape use, but in different directions. Grade 10 and 11 students were more likely than grade 9 students to vape exclusively with nicotine (aOR 1.36; 95% CI: 1.05, 1.77 and aOR 1.46; 95% CI: 1.09, 1.97), while grade 9 students were more likely than grade 11 and 12 students to vape with both nicotine and nicotine-free vapes (aOR 0.82; 95% CI: 0.67, 0.99 and aOR 0.49; 95% CI: 0.37, 0.64). The prevalence of nicotine and nicotine-free vaping is high, with many students reporting the use of both. [ABSTRACT FROM AUTHOR]

Introduction: The e-cigarette market in Canada has rapidly evolved following the implementation of the Tobacco and Vaping Products Act in May 2018, which liberalized the promotion and sale of vaping products. To date, there is little data on the market profile of key product attributes, including nicotine content, labelling practices and flavours. Methods: An online scan of vaping product retailers (manufacturer, two national, five provincial) was conducted in 2020 to assess the e-liquids available on the Canadian market. Data were extracted from websites and product images regarding the nicotine content, labelling and flavours of e-liquids. Results: We identified 1746 e-liquids, with a total of 4790 different nicotine concentrations. Approximately half of the e-liquids were offered with salt-base nicotine (46.6%) and half with freebase nicotine (53.2%); the remainder were hybrids (0.2%). The mean nicotine concentration of salt-base e-liquids (3.4%) was higher than freebase e-liquids (0.5%) (p < 0.001). Labels indicating the presence of nicotine were visible on twothirds of e-liquid packaging displayed online (63.2%) while three-quarters of packaging displayed the nicotine concentration (73.7%), and more than half of packaging displayed health warnings (58.9%). A variety of flavours were also identified, with fruit being the most common (43.6%), followed by candy/desserts (27.6%) and non-alcoholic drinks (12.5%). Conclusion: Findings demonstrate the diversity of the online e-cigarette market in Canada, including the availability of higher-concentration salt-base nicotine products. Flavour restrictions have the potential to dramatically reduce the number of e-liquid flavours on the market, while restricting nicotine concentrations to < 20 mg/mL will predominantly restrict salt-based e-liquids. [ABSTRACT FROM AUTHOR]

Introduction: Changes to federal legislation allowed nicotine-based e-cigarettes legal entry into the Canadian market in 2018. This included pod-type e-cigarettes (pods), such as JUUL, that were later found to be associated with steeply increasing prevalence and greater frequency of e-cigarette use among US and Canadian youth. Multiple studies of risk factors of JUUL use and use initiation have been conducted among various population groups in the US, but little evidence exists pointing to similar risk factors of pod use among Canadian youth and young adults. Understanding these risk factors can inform use prevention and intervention strategies in Canadian and other jurisdictions. Methods: A total of 668 Canadian youth and young adults recruited by the 2018-19 Youth and Young Adult Panel Study were provided a baseline survey 3 months before and a follow-up survey 9 months after the relaxation of federal nicotine e-cigarette regulations. We used multivariable logistic regression to understand and rank importance of baseline predictors of future pod use among respondents. Results: Past-month cannabis use (OR [odds ratio] = 2.66, 95% CI: 1.66-4.21, p < 0.001), established cigarette use (OR = 3.42, 1.53-7.65, p < 0.01), past cigarette experimentation (OR = 2.40, 1.34-4.31, p < 0.01), having many friends who vaped (OR = 2.15, 1.37-3.34, p < 0.001), age below 18 compared to age over 22 (OR = 5.26, 2.63-10.00, p < 0.001) and male sex (OR = 1.69, 1.16-2.50, p < 0.01) were significant and the most influential predictors of future pod use. Conclusion: Similar factors drove pod use among Canadian and US youth and young adults. Appropriate preventive strategies can benefit from considering polysubstance use among high school-aged youth. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to explore demographic and clinical characteristics of vaping-associated lung illness (VALI) cases reported in Canada from September 2019 to December 2020; compare the epidemiology of VALI cases in Canada to e-cigarette or vaping product use-associated lung injury (EVALI) cases in the US; and examine possible explanations for differences between the two countries. Methods: A federal/provincial/territorial task group developed a national outbreak definition, minimum dataset and case report form for identification and surveillance of VALI cases in Canada. Descriptive analysis explored the characteristics and epidemiology of reported VALI cases. Results: Of the 20 VALI cases reported, none resulted in a death. Of all cases, 5 (25%) involved youth aged 15 to 19 years, 10 (50%) adults aged 20 to 49 years and 5 (25%) aged 50 years and older. Sixty percent of patients were men. Half (50%) required breathing assistance. Three-quarters (75%) reported using nicotine-containing vaping products, and 40% reported use of cannabis-containing vaping products; of those who reported frequency of vaping, most (71%) reported vaping daily. VALI cases were reported at a lower prevalence (0.9 per million) than EVALI (8.5 per million). Demographics and vaping behaviour also differed. Conclusion: VALI cases were reported in Canada between September 2019 and December 2020; however, there was a much lower prevalence and they may have been caused by different factors from the EVALI outbreak in the US. The factors influencing VALI in Canada are complex and multifactorial. Research is needed to understand the short- and long-term health effects of nicotine and cannabis vaping. [ABSTRACT FROM AUTHOR]

Background: E-cigarette use represents a contemporary mode of nicotine product use that may be changing the risk profile of participating adolescents. Understanding differences in sociodemographic characteristics of adolescents engaging in contemporary e-cigarette use and traditional cigarette use is important for effectively developing and targeting public health intervention programs. The objective of this study was to identify and compare sociodemographic risk profiles for exclusive e-cigarette use and dual-product use among a large sample of Canadian youth., Methods: A survey of 46,666 secondary school students in the 2021-22 wave of the COMPASS study measured frequency of past month e-cigarette and cigarette use as well as age, sex, gender, racial or ethnic background, spending money, relative family affluence, and having one's own bedroom. Rates of cigarette-only, e-cigarette-only, and dual product use were calculated, and separate classification trees were run using the CART algorithm to identify sociodemographic risk profiles for weekly dual-product use and weekly e-cigarette-only use., Results: Over 13% of adolescents used only e-cigarettes at least weekly, 3% engaged in weekly dual e-cigarette and cigarette use, and less than 0.5% used only cigarettes. Available spending money was a common predictor of dual-product and e-cigarette-only use. Gender diverse youth and youth with lower perceived family affluence were at higher risk for dual-product use, while white and multiethnic adolescents were at greater risk of e-cigarette-only use. Two high-risk profiles were identified for e-cigarette-only use and four high-risk profiles were identified for dual product use., Conclusions: This study used a novel modelling approach (CART) to identify combinations of sociodemographic characteristics that profile high-risk groups for exclusive e-cigarette and dual-product use. Unique risk profiles were identified, suggesting that e-cigarettes are attracting new demographics of adolescents who have not previously been considered as high-risk for traditional cigarette use., (© 2024. The Author(s).)

Background: Electronic nicotine delivery systems (ENDS), such as the JUUL system, are nicotine products for adults who currently smoke cigarettes but are looking for an alternative to combustible cigarettes. Sales of ENDS products were legislatively acknowledged and authorized federally in Canada with the Royal Assent of the Tobacco and Vaping Products Act in 2018., Methods: With the unique dataset from a major chain retailer in Canada, we evaluated the impacts of JUUL market entry on cigarette sales across Canada from January 2017 to August 2019 using two-way fixed effects panel regression models by leveraging on the entry time variation at the city level. We conducted various robustness checks and a permutation test to validate our results., Results: Our estimates suggested that JUUL market entry was, on average, significantly correlated with a 1.65% per-month decrease in cigarette sales during the initial months, and with a potentially larger impact on urban areas. Our results were robust across various specifications and tests. These findings implied that JUUL and combustible cigarettes act as economic substitutes during the study time period in Canada., Conclusions: These results suggested that local availability of ENDS products, such as JUUL, has the potential to reduce local cigarette consumption., (© 2023. The Author(s).)

Introduction: Polysubstance use--the use of multiple substances on the same or different occasions--is a risk factor for substance use disorder. However, national surveillance of substance use in Canada has often focused on use of a single substance. To better understand and address polysubstance use, this study characterized the use of vaping products, cigarettes, inhaled cannabis, and alcohol among Canadians aged 15 years and older., Methods: Nationally representative data from the 2020 Canadian Tobacco and Nicotine Survey were analyzed. Polysubstance use was assessed as use of at least two of the following in the past 30 days: smoking cigarettes, using vaping products (containing nicotine or flavours), using cannabis (in smoked and/or vaped form) and drinking alcohol (daily or weekly frequency)., Results: In 2020, past-30-day use of the examined substances was 4.7% for vaping products (1.5 million), 10.3% for cigarettes (3.2 million), 11.0% for inhaled cannabis (3.4 million), and 37.6% for weekly or daily use of alcohol (11.7 million). Polysubstance use was reported by 12.2% of Canadians (3.8 million) and was more prevalent among young Canadians, men and those who vaped. The most common combination of substances among polysubstance users included inhaled cannabis and weekly or daily use of alcohol (29.0%, or 1.1 million)., Conclusion: The use of vaping products, cigarettes, inhaled cannabis, and alcohol-individually and in combination-is substantial among Canadians. Frequent consumption of alcohol was most prevalent overall and, in contrast to the other examined substances, was common among Canadians of all ages. Findings may inform a polysubstance use approach for prevention policies and programs.

Background: Robust surveillance of vaping product use (with or without nicotine) in Canada has been limited by the use of multiple tools with varying designs and content. The objective of the current study was to examine trends over time in vaping prevalence and to examine associated factors using data from the Canadian Community Health Survey (CCHS)., Data and Methods: Trends in the prevalence of past-30-day vaping over time were examined using data available from optional modules of the CCHS for Ontario from 2015 to 2018 and for Quebec from 2017 to 2019. Multiple logistic regression models were used to examine correlates of vaping in Quebec (2019) and Ontario (2018)., Results: Vaping increased in Quebec from 3.4% (233,000) in 2017 to 4.2% (296,000) in 2018 and 4.7% (333,000) in 2019. In Ontario, vaping remained stable in the years 2015 (3.1% or 357,000), 2016 (2.7% or 311,000) and 2017 (2.7% or 309,000), then increased in 2018 (3.4% or 404,000). Increases in vaping in both provinces were driven by youth. Vaping was significantly associated with young age and cigarette smoking in both provinces, as well as with cannabis use in the past 12 months among Quebec respondents., Interpretation: In both provinces, increases in youth vaping were observed in recent years, and this is consistent with national trends. Study findings further our understanding of vaping behaviour and highlight the utility of the CCHS as an additional tool for surveillance of vaping product use among Canadians.

Background: Vaping is more prevalent among younger than older Canadians. While vaping is less harmful than combustible tobacco, it is not without health risk., Data and Methods: Data from the 2019 Canadian Health Survey on Children and Youth were used to estimate vaping prevalence. Logistic regression models assessed the association of sociodemographic, youth, parenting and peer factors with vaping. The 2020 Canadian Community Health Survey identified adolescents who reported vaping before tobacco smoking. Data from the 2019 Canadian Tobacco and Nicotine Survey were used to examine vaping of e-liquids containing nicotine and flavours., Results: Vaping rates for 15- to 17-year-olds were nearly four times (21.3%) higher than those of 12- to 14-year-olds (5.4%). Two-thirds (66.1%) of 12- to 17-year-olds who had used both tobacco and e-cigarettes reported trying e-cigarettes first. E-liquids containing nicotine were used by 89.3% of 15- to 19-year-olds who reported vaping in the past 30 days; comparable with older adults. For both younger and older adolescents, having friends who engaged in negative behaviours, having been employed, and having consumed alcohol increased the odds. For 12- to 14-year-olds, attention deficit hyperactivity disorder was a risk factor, whereas having parents who usually knew who they were with and higher relatedness scores were protective. Among older adolescents, being male, being Canadian-born, having lower grades, and using tobacco or cannabis increased the odds of vaping., Interpretation: An adolescent's risk of vaping was most strongly correlated with other substance use, although other youth, parenting and peer characteristics also mattered. Because most of the data presented were collected before the COVID-19 pandemic and new vaping regulations, ongoing monitoring remains important.