With schools 'back to normal' what has happened to youth vaping rates in Canada?

This post provides an update on surveys of tobacco and vaping behaviour of Canadian youth. 

Annual results from U.S. school surveys on tobacco use

This week, American media are reporting monitoring efforts by the Center for Disease Control, which reports 1 in 7 high-schoolers in that country (14%) used a vaping product in the last school year (January to May 2022). Most of those kids  were using disposable devices (67%) with fruit-flavoured liquids. (68.5%) 

The U.S. results are encouraging when compared with the pre-pandemic situation uncovered by the same National Youth Tobacco Survey in 2019, when almost twice as many students were vaping (27.5%). There are no statistically comparable results for the pandemic years because olf methodological changes triggered by school closures. The modified on-line survey conducted in 2021 produced lower estimates of e-cigarette use than the in-class survey in 2022. 

These results are an important way to monitor the impact of a changing policy and evolving business practices. In 2019 and 2020, the U.S. government introduced a number of measures designed to curb youth vaping. These included raising the legal age to purchase vaping or tobacco products to 21 years, and banning the sale of certain types of flavoured products. In response to the results released yesterday, advocates are calling for more comprehesive flavour bans and the marketing of disposable products is coming under increased scrutiny.

Gaps and holes, but Canadian school survey data are on the way ...

The Canadian Student Tobacco, Alcohol and Drug Survey

The most recent national estimate of tobacco use among Canadian school students is now more than 3 years old. Results of the Canadian Student Tobacco Alcohol and Drug Survey (CSTADS) conducted in the 2018-2019 school year were made available in December 2019. The data was alarming - showing that by their senior high school years, 3 in 10 Canadian children were vaping. These results were used by Health Canada as support for its proposals to reduce nicotine levels and restrict flavours in vaping liquids.

Those results were the last assembled by a team at the University of Waterloo, which had administered the survey on behalf of Health Canada for several years. In 2020, a competitive process was launched to selecting a new agency to conduct the survey, causing an interruption to the traditional two-year cycle. No federal school surveys were taken in the 2019-2020 or 2020-2021 school years. In December 2020, a $1 million-dollar contract was awarded to CCI Research to continue the survey in the 2021-2022 school year. 

This cycle of the survey asks no questions about the types of vaping devices or brands that Canadian students are using, although such information had previously been sought.  No date for release of this next wave of survey data has been made public.

Other school-based surveys

Some provincial governments conduct school health surveys which include information on tobacco use:

* The bi-annual Ontario Student Drug Use and Health Survey, for example, is the longest ongoing survey of school health. In 2021 it conducted its 4th survey of e-cigarette use, finding a similar trend to that observed in the U.S: a dramatic increase in 2019, with usage falling during the pandemic. 

* B.C. runs an adolescent health survey every five years, with the next cycle in 2023. 

* Results for Quebec's school based health survey addressing tobacco and vaping, among other drug behaviours, were last released for 2019, with another survey on more comprehensive health behaviours in the field this fall.

* Compass is a school-focused health research project led by researchers at the University of Waterloo which provides longitudinal insights into local behaviours. The annual survey provides data that are used to assess factors that contribute to reduced e-cigarette use (i.e. ineffectiveness of school programming, the impact of COVID, relationship to other health behaviours, etc.)

Other (non-school surveys of adolescent health behaviours)

Other efforts to measure vaping by young Canadians include the annual Canadian Tobacco and Nicotine Survey, which was launched in 2019. The most recent results of that survey were released by Statistics Canada last April. The results, shown below, suggest some stability in past-month vaping behaviour over the past three years, but with increased daily vaping (unpublished data show that 1 in 5 Canadians aged 15-24 who had ever tried a vaping device was vaping daily in the winter of 2021-2022). 

Since 2021, the Canadian Community Health Survey includes questions on e-cigarette use. These results have not been proactively released and are not known to have been reported (other than those from a rapid-release component of the survey taken in 2020). Electronic cigarette use is not included among the standard health indicators reported by Statistics Canada from this survey. 

The ITC Youth Tobacco and Vaping Survey conducts annual national surveys in Canada and also in the US and England. This survey asks about the types of vaping products used, allowing comparison of product choices between countries and over time.

Continuing challenges

The long periods between cycles of government surveys, the preference of university-based surveyors for disseminating results through journal publications, the absence of mandatory reporting on manufacturers and the complexities of studying youth behaviours make it challenging for Canadian  health regulators to keep their finger on the pulse of youth nicotine use -- let alone to respond in a timely way.

In the meantime, the data that are available suggests that vaping remains a serious and widespread problem. 

Many upstream measures to protect youth are either not yet in effect (eg tax increases that don't hit retail until January 2023), not yet approved (eg flavour restrictions) or not even on the agenda (eg banning youth-focussed disposable products). Tobacco and nicotine companies continue to experiment: and there is nothing in place to prevent the explosion of disposable vaping products that has driven  increases in youth vaping in the United Kingdom, the United States and elsewhere. 

Until then, this health issue will likely continue to be managed as a downstream policing issue -- with the burden shifted to school administrators and sales-to-minors enforcement officials.