Background Preventing uptake of nicotine products among youth remains a central objective of tobacco control policy. Comparing trends in the use of nicotine across countries provides an opportunity to identify emergent product trends and to evaluate ‘natural experiments’ in policies.
Methods Repeat cross-sectional data were analysed from eight waves of the International Tobacco Control Youth Tobacco and Vaping Survey, conducted between 2017 and 2022. Non-probability samples of youth aged 16–19 years in Canada, England and the USA (N=104 473) completed online surveys including measures on vaping, smoking and use of other nicotine products. This paper summarises findings across the 5-year period of the study, as part of a comprehensive report on key indicators of youth vaping in the three countries.
Results The youth nicotine market has rapidly evolved across the three countries, with different patterns of combustible and non-combustible product use in Canada, the USA and England. These changes are primarily attributable to trends in youth vaping: following declines during the initial COVID-19 pandemic period, by 2022, vaping prevalence neared pre-pandemic levels in the USA and Canada, and reached record highs in England. Notable shifts also occurred in the types of vaping products used by youth, including increased use of disposable, nicotine salt-based products. Additional findings are reported on a range of policy-relevant indicators, including for vaping products, promotions and purchasing.
Conclusions Patterns of nicotine use among youth have rapidly evolved in recent years due to the proliferation of nicotine products, the COVID-19 pandemic and the emerging impact of policy measures.
- Electronic nicotine delivery devices
- Priority/special populations
- Surveillance and monitoring
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Presented at Some of the findings in this paper have been previously presented at the Society for Research on Nicotine and Tobacco Annual Meeting in 2023 (Hammond D, Reid J, Bansal-Travers M, Cummings KM, Goniewicz M, East K, Fong G, Hyland A, Thrasher J. Trends in Vaping among Youth and Young Adults in Canada, England, and The United States Between 2017 and 2022: Recent Changes in Patterns of Use, Vaping Products, and Indicators of Dependence. Presented at SRNT 29th Annual Meeting, San Antonio; March 2023. https://cdn.ymaws.com/www.srnt.org/resource/resmgr/conferences/2023_annual_meeting/documents/SRNT23_Abstracts022423.pdf).
Contributors DH conceived of the study and design. JLR coordinated data collection. DH and JLR supervised analysis, interpreted results and drafted the manuscript.
Funding The ITC Youth Tobacco and Vaping Survey annual waves 1, 2, 3, 4 and 6 were supported by a P01 grant (P01CA200512) from the US National Institutes of Health. Waves 3.5, 4.5 and 5 were funded by a contribution from Health Canada’s Substance Use and Addictions Program (SUAP). Oversamples in some US states were supported by the Roswell Park Comprehensive Cancer Center and National Cancer Institute (NCI) (grant P30CA016056) and by the Roswell Park Alliance Foundation. Oversamples in BC were supported by the British Columbia Ministry of Health/Canadian Cancer Society.
Disclaimer The views expressed here do not necessarily represent the views of the funders.
Competing interests DH has testified as a paid expert witness on behalf of public health authorities in response to legal challenges from tobacco, vaping and cannabis companies.
Provenance and peer review Not commissioned; externally peer reviewed.
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