Restrictions on the sale and marketing of e-cigarettes containing nicotine are less strict in Canada and the United States compared with England.
Researchers examining vaping and/or smoking among youth aged 16 to 19 rose in prevalence among Canada and the United States but not so in England, where e-cigarettes are subject to stricter regulation than the other 2 countries, according to a research letter published in JAMA Pediatrics Monday.
In a 2019 study, 1 in 5 US high school sophomores and a quarter of high school seniors reported using e-cigarettes in the past 30 days, the authors noted, leading to concerns about vaping in North America. And in Canada in 2018, restrictions were loosened for the sale and marketing of e-cigarettes that contained nicotine.
Investigators from the University of Waterloo in Ontario, Canada conducted a series of online surveys in order to determine changes in prevalence of vaping among teens aged 16 to 19 years. The surveys were conducted 3 times: July and August 2017, August and September 2018, and August and September 2019 in Canada, England, and the United States. Over 33,000 participants were recruited for the study.
The participants self-reported e-cigarette use and cigarette smoking measures, and the investigators further categorized that use into groups: use within the past 30 days, the past week, and on at least 20 of the past 30 days.
The investigators found that the prevalence of vaping increased between 2018 and 2019 in all 3 countries. They also determined that vaping was substantially more prevalent in Canada and the United States compared with England.
Vaping was found to be higher among youths who reported smoking than other respondents in all 3 countries. The study authors also determined that between 2017 and 2019, vaping increased in the United States and Canada among those who reported never smoking, smoking experimentally, and currently smoking.
The proportion of teens who ever vaped and/or smoked increased from 2017 to 2019 in Canada and the United States, but not in England, the study authors observed. They also learned that there were significant increases for teens who reported vaping and/or smoking more recently and frequently in Canada and the United States over the past 30 days, in the past week, and on 20 or more days in the past month.
In the United States, the rate of teens who reported smoking and/or vaping in the past 30 days was 16% in 2017 and jumped to 21% by 2019. In the past week, teens reported smoking and/or vaping in the past week at a rate of 11% in 2017, which rose to 15% in 2019. And finally, teens reported smoking and/or vaping on 20 or more days of the past month at a rate of 5% in 2017, which increased to 8% in 2019.
The number of teens who vaped in the past week or more frequently has at least doubled between 2017 and 2019 in Canada and the United States, the authors wrote. They commented that the increases observed in vaping or smoking in North America are consistent with the increase in the popularity of nicotine salt products such as Juul.
“Given that e-cigarette use among adults has decreased over the same period, the findings suggest the growth of the U.S. and Canadian e-cigarette markets since 2017 may have been driven primarily by consumption by young people,” the authors concluded, suggesting that the effect of the regulatory environment in England on lower vaping rates there deserves closer attention.
Hammond D, Rynard VL, Reid JL. Changes in prevalence of vaping among youths in the United States, Canada, and England from 2017 to 2019 [published online May 4, 2020]. JAMA Pediatr. doi:10.1001/jamapediatrics.2020.0901.