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Trends in e-cigarette brands, devices and the nicotine profile of products used by youth in England, Canada and the USA: 2017–2019
  1. David Hammond1,
  2. Jessica L Reid1,
  3. Robin Burkhalter1,
  4. Richard J O'Connor2,
  5. Maciej L Goniewicz2,
  6. Olivia A Wackowski3,
  7. James F Thrasher4,
  8. Sara C Hitchman5
  1. 1School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  2. 2Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
  3. 3School of Public Health, Rutgers, The State University of New Jersey, Piscataway Township, NJ, USA
  4. 4Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
  5. 5Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  1. Correspondence to Dr David Hammond, School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada; dhammond{at}uwaterloo.ca

Abstract

Background The e-cigarette market has rapidly evolved, with a shift towards higher nicotine concentration and salt-based products, such as JUUL; however, the implications for youth vaping remain unclear.

Methods Repeat cross-sectional online surveys were conducted in 2017, 2018 and 2019, with national samples of youth aged 16–19 years recruited from commercial panels in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Regression models examined differences between countries and over time in the types of e-cigarette products used (design and nicotine content), reasons for using brands and differences in patterns of use, sociodemographics and dependence symptoms by brand/nicotine content.

Results In 2019, the use of pod- or cartridge-style e-cigarettes was greater in Canada and the USA than England, with Smok and JUUL the leading brands in all countries. In 2019, youth vapers in England were less likely to report using e-cigarettes with ≥2% nicotine (12.8%) compared with Canada (40.5%; adjusted OR (AOR)=4.96; 95% CI 3.51 to 7.01) and the USA (37.0%; AOR=3.99, 95% CI 2.79 to 5.71) and less likely to report using nicotine salt-based products (12.3%) compared with Canada (27.1%; AOR=2.77, 95% CI 1.93 to 3.99) and the USA (21.9%; AOR=2.00, 95% CI 1.36 to 2.95). In 2019, self-reported use of products with higher nicotine concentration was associated with significantly greater frequency of vaping, urges to vape and perceived vaping addiction (p<0.05 for all).

Conclusions The use of high-nicotine salt-based products is associated with greater symptoms of dependence, including JUUL and other higher-nicotine brands. Greater use of high-nicotine salt-based products may account for recent increases in the frequency of vaping among youth in Canada and the USA.

  • nicotine
  • electronic nicotine delivery devices
  • priority/special populations

Data availability statement

Data are available on 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 DH (dhammond@uwaterloo.ca).

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Data availability statement

Data are available on 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 DH (dhammond@uwaterloo.ca).

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Footnotes

  • Contributors DH designed study with input from all authors. JLR helped to design the survey and had primary responsibility for the data collection. RB 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). DH is also supported by a Canadian Institutes of Health Research-Public Health Agency of Canada Applied Public Health Research Chair.

  • Competing interests DH and JT have served as paid expert witnesses in legal challenges against tobacco and vaping companies. MLG has received research grants from Pfizer and served as a member of a scientific advisory board to Johnson&Johnson. The other authors have no competing interests relevant to this article to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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