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Indicators of dependence and efforts to quit vaping and smoking among youth in Canada, England and the USA
  1. David Hammond1,
  2. Jessica L Reid1,
  3. Vicki L Rynard1,
  4. Richard J O'Connor2,
  5. Maciej L Goniewicz2,
  6. Megan E Piper3,
  7. Maansi Bansal-Travers2
  1. 1School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  2. 2Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
  3. 3Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
  1. Correspondence to Dr David Hammond, School of Public Health & Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; dhammond{at}


Objective The current study examined indicators of dependence among youth cigarette smokers and e-cigarette users in Canada, England and the USA, including changes between 2017 and 2019.

Methods Data are from repeated cross-sectional online surveys conducted in 2017, 2018 and 2019 with national samples of youth aged 16–19 years, in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Measures included perceived addiction to cigarettes/e-cigarettes, frequency of experiencing strong urges to smoke/use an e-cigarette, plans to quit smoking/using e-cigarettes and past attempts to quit. Logistic regression models were fitted to examine differences between countries and changes over time.

Results The proportion of ever-users who vaped frequently was significantly higher in 2019 compared with 2017 for all outcomes in each country. Between 2017 and 2019, the proportion of past 30-day vapers reporting strong urges to vape on most days or more often increased in each country (Canada: 35.3%, adjusted OR (AOR) 1.69, 95% CI 1.20 to 2.38; England: 32.8%, AOR 1.55, 1.08 to 2.23; USA: 46.1%, AOR 1.88, 1.41 to 2.50), along with perceptions of being ‘a little’ or ‘very addicted’ to e-cigarettes (Canada: 48.3%, AOR 1.99, 1.44 to 2.75; England: 40.1%, AOR 1.44, 1.03 to 2.01; USA: 53.1%, AOR 1.99, 1.50 to 2.63). Indicators of dependence among smokers were consistently greater than e-cigarette users, although differences had narrowed by 2019, particularly in Canada and the USA.

Conclusions Prevalence of dependence symptoms among young e-cigarette users increased between 2017 and 2019, more so in Canada and the USA compared with England. Dependence symptom prevalence was lower for e-cigarettes than smoking; however, the gap has narrowed over time.

  • electronic nicotine delivery devices
  • priority/special populations
  • addiction
  • cessation
  • surveillance and monitoring

Statistics from


  • Contributors DH designed study with input from all authors. JLR helped to design the survey and had primary responsibility for the data collection. VLR led the analysis with assistance from JLR and DH. DH was the primary author; all other authors contributed to the writing of the manuscript and approved the final version.

  • Funding This work was supported by the US National Institutes of Health (grant number 1P01CA200512-01). DH is also supported by a Canadian Institutes of Health Research-Public Health Agency of Canada Applied Public Health Research Chair.

  • Competing interests DH has served as a paid expert witness in legal challenges against tobacco companies.

  • Patient consent for publication Not required.

  • Ethics approval This study was reviewed and received ethics clearance through a University of Waterloo Research Ethics Committee (ORE#21847) and the King’s College London Psychiatry, Nursing & Midwifery Research Ethics Subcommittee.

  • Data availability statement Data are available upon reasonable request. Deidentified data will be made available to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal. Proposals should be submitted to David Hammond (

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