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Changes in the prevalence of vaping and smoking among youth in Canada, England and the United States: repeat national cross-sectional surveys

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David Hammond, Jessica Reid, Vicki Rynard, Geoffrey T Fong, K Michael Cummings, Ann Denise McNeill, Sara Christine Brenda Hitchman, James F Thrasher, Maciej L. Goniewicz, Maansi Bansal-Travers, Richard J O'Connor, David T. Levy, Ron Borland, Christine M. White

Original languageEnglish
JournalBritish Medical Journal
Publication statusAccepted/In press - 17 Jun 2019


King's Authors


Objectives: To examine differences in youth vaping and smoking in Canada, England, and the United States (US). There is currently little cross-country evidence on vaping and smoking, despite changing nicotine markets, including more permissive vaping regulations in Canada and a new generation of nicotine salt-based e-cigarettes, such as JUUL, with higher concentrations of nicotine. Design: Repeat cross-sectional surveys. Setting: Online surveys in Canada, England, and the US. Participants: National samples of 16- to 19-year-olds in 2017 and 2018, recruited from commercial panels in Canada (n=7891), England (n=7897), and the US (n=8140). Main outcome measures: Prevalence of vaping and smoking was assessed for use ‘ever’, in the past 30 days, in the past week, and on 15 or more days in the past month. Use of JUUL and usual vaping brands were also assessed. Logistic regression models examined differences in vaping and smoking between countries and over time. Results: The prevalence of vaping in the past 30 days, past week, and on 15 or more days in the past month increased in Canada and the US between 2017 and 2018 (p<.0001 for all), including among non-smokers and experimental smokers, with no changes in England. Smoking prevalence increased in Canada (p<.001 for all measures), with modest increases in England, and no changes in the US. The percentage of ‘ever’ vapers who reported more frequent vaping increased in Canada and the US (p<.01 for all), but not in England. The use of JUUL and other brands with nicotine salts increased in all countries, with the largest increases in the US, followed by Canada. Conclusions: Between 2017 and 2018, the prevalence of vaping increased among Canadian and US youth, as did smoking among Canadian youth, with few changes in England. The rapidly evolving vaping market and emergence of nicotine salt-based products warrant close monitoring.

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