Monday 11 September 2023

Delays and missing details from the 4th wave of the Canadian Tobacco and Nicotine Survey.

 Today Statistics Canada released a few results of the fourth wave of the Canadian Tobacco and Nicotine Survey. This release confirms that without any new constraints on vaping marketing the youth vaping problem continues. 

What we know

The patterns of nicotine use are stable over the past 4 years. As shown in Statistics Canada's Infographic from the release, over the past 4 years, nicotine continues to capture new cohorts of teenagers. As these teenagers age into their twenties, young adult vaping continues to climb while smoking rates fall. Once blended into the larger population of Canadians, however, the use both products has not diminished. 

Overall, an additional 1% of Canadians are using vaping products in early 2023 than in late 2019 and 1% fewer Canadians reported smoking over the same period. 

The impact of policy change is imposed on youth. This survey was implemented after the federal government legalized the vaping market with the intention of providing adult smokers with access to vaping products while protecting youth from vaping.

When compared with data from the period before the change of law in May 2018, the failure to achieve those goals is made clearer. Over the 5 years period, adult use of vaping products has changed little, but youth use rose quickly and has stabilized at a high level.

More than 1 in 5 teenagers who tries a vaping product ends up using them every day. The probability of becoming a daily user of vaping products is high. One fifth of young people who had ever tried vaping products were doing so daily at the time of survey. Even among adults over 25, one-seventh of ever-vapers were vaping daily. 

Sexual orientation is associated with higher vaping rates. Vaping rates are twice as high among non-heterosexual Canadians as among those who identify as heterosexual (11.5% vs 5.5%). The pattern for cigarettes is less pronounced (12.4% vs 10.8%). 

What we still don't know

Frustratingly, very few results from the CTNS were released today. The survey questionnaire covers a wide range of issues related to tobacco and nicotine use. 

Among the data from the survey which is not yet available is that which will allow us to know:

  • the smoking status of Canadian vapers (e.g. how many are former smokers?)
  • rates of use of other tobacco products (e.g. chewing tobacco) and cannabis
  • patterns of co-use of tobacco, vaping and cannabis, and progression of use (e.g. which products are used first?)
  • relationship of indigeneity and other racial identity to the use of these products (e.g. which groups appear more vulnerable?).
  • use of flavourings in vaping products (e.g. who is using candy and fruit flavourings and why?)
  • source of supply of vaping and tobacco products (e.g. where do young people get their nicotine products from?)
  • the reasons that Canadians say they use vaping products (e.g. are these to help stop smoking, to reduce stress or to satisfy curiosity?)  
  • changes in the use of these substances in different regions of Canada. (e.g. are people in provinces with taxes or flavour restrictions or retail constraints less likely to use these products?)
  • the use of stop-smoking aids (e.g. what products are smokers using in their quit attempts - and which are associated with success?)
  • beliefs about the  harmfulness of e-cigarettes (e.g. do these beliefs seem to influence use?)

This information will only be available once results of an analysis are made available by federal government agencies, or once the data is made available to independent researchers.

Delaying data release

An important story from today's release is that it took so long to receive so little information. This survey should and could have been released in the spring, as it was in previous years.  By arranging for a delay of the data release, Health Canada was able to defer this bad news story. 

In 2020 and 2021 - despite the pressures of COVID - Statistics Canada released the data in March and made the PUMF file available at the same time. In 2022, the data was released in May, with the PUMF made available August. 

In each of those years, Health Canada made its analysis available many months later.  But because the raw data was available to researchers and other levels of government, the impact of this delay was lessened.

The Health Ministry appears to have objected to Statistics Canada's decision to make the data available to the public in advance of that department. In a memo to the Minister in July 2020, Health Canada officials complained "The Tobacco Control Directorate (TCD) was not aware that the data set was being made available to the public by Statistics Canada until after the fact." 

It appears that this year the intention was for both government departments to release information on the same date. In response to inquiries on the release, Statistics Canada officials informed us this summer that: "The CTNS master file release date for the 2022 reference year is currently planned for September 11, 2023. This is when the data become available to the public. This differs from previous cycles of CTNS, whose master files were released in the spring. Additionally, Health Canada will be releasing web summary tables on September 11. The PUMF for CTNS 2022 is tentatively planned to be released later in October." (emphasis added)

As it turns out, Health Canada does not seem have met this deadline. The last line in today's release notes that "Health Canada will also be releasing a detailed report from the latest cycle of the CTNS in September 2023."

Thursday 7 September 2023

Heart & Stroke takes its message to the streets: "Ban Vape Flavours"

When parliamentarians return to Ottawa mid-month, they will be greeted with graphic reminders of the need for regulatory action to end the sale of flavoured vaping liquids.

Heart & Stroke has commissioned the placement of small billboards on the perimeter of the parliamentary precinct and sandwiching the Prime Ministers Office. 

The campaign is simple and graphic. Each of the three executions of the campaign features flavourings in the context of the damage they can do to the cardio-vascular system. "Berry Blast can increase the risk of heart disease", "Mango Crush can increase the risk of stroke""Cool Mint can damage blood vessels."

The posters also appear in transit stops near Health Canada's headquarters. The campaign is also being delivered to decision-makers through news-services popular with political staff, like the Hill Times.

This is not the first advertising campaign by health organizations calling for federal action on flavours, but it is the most extensive to date. 



Through other communications, Heart & Stroke provides the public with advice and the health system with policy recommendations. These resources include:

They are calling on governments to implement comprehensive measures to protect youth, including the following recommendations:

  • eliminate flavours, which appeal to young people, including mint/menthol,
  • mandate plain and standardized packaging for all vaping products, 
  • add graphic and impactful health warnings to educate consumers on the risks of vaping, 
  • prohibit sales to those under 21 years of age.

This year, Heart & Stroke commissioned a public opinion poll of almost 4,000 Canadians which demonstrated very high levels of public support for such policies: 84% supported restrictions on flavourings, 84% supported plain packaging for vape products, 86% supported raising the minimum age for sale to 21.