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E-cigarettes remain a contentious topic in public health, with debates focussing on their benefits as a smoking cessation aid1–3 versus potential increases in nicotine use among non-smoking young people.4 Accordingly, the public health impact of e-cigarettes will be determined by who is using them and for what purpose.
To date, most studies exploring the prevalence of vaping have been conducted among either youth5–10 or adults,11–13 with little evidence on overall populations of vapers. Specifically, evidence is lacking regarding the relative contribution of youth and adults, smokers and never smokers, and how these groups have contributed to overall increases in vaping at the population level.
Evidence is also required to evaluate the impact of e-cigarette policies on patterns of vaping among these different groups. Canada represents an interesting case study given recent shifts in the regulatory framework for e-cigarettes.14 Prior to May 2018, e-cigarettes containing nicotine could not be sold or marketed without approval; although no products were approved for legal sale, they were widely available.15 In May 2018, the Tobacco and Vaping Products Act (TVPA) permitted the sale of nicotine-containing e-cigarettes, as well as wider advertising and promotion of e-cigarettes, which increased retail accessibility and the presence of international brands.14 Studies have highlighted increases in youth vaping following implementation of the TVPA,5 6 although there are few estimates on changes in vaping at the population level in Canada.
This study uses data from nationally representative surveys to examine how smoking and vaping evolved at the population level in Canada following the implementation of the TVPA.
Methods
Data are from the 2019 Canadian Tobacco and Nicotine Survey (CTNS),16 a national monitoring survey in Canada. Briefly, the CTNS is a probability-based sample of the general population of Canada aged 15 years or older (n=8600) …
Footnotes
Contributors DH developed the research questions. KAE led the analysis, with input from JLR and DH. All authors jointly led the write-up and approved the final version of the manuscript.
Funding The 2019 Canadian Tobacco and Nicotine Survey and the 2017 Canadian Tobacco, Alcohol and Drugs Survey were funded by Health Canada.
Competing interests DH has served as a paid expert witness in legal challenges against tobacco and vaping companies.
Provenance and peer review Not commissioned; externally peer reviewed.
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