For many decades, health regulators have focused on cigarette smoking as their indicator of tobacco and nicotine use. Around the world, statistical agencies ask variations of the questions "do you smoke cigarettes?" "when did you start smoking cigarettes?" "how many cigarettes do you smoke?" and use the answers to assess the success or failure of their tobacco control efforts.
This same approach has been grafted onto monitoring of vaping behaviour. Soon after these products appeared on the market (and long before they were legalized for sale), Health Canada included questions on e-cigarette use on its tobacco surveys.
Information on the use of many other nicotine products - like cigarillos, cigars, chewing tobacco/snuff, pipes and waterpipes - is also collected in Canada. For some other products - notably heated tobacco sticks - there is still no monitoring instrument in effect.
This post (and the accompanying data sheet) use data from recent tobacco surveys to show how including information on any form of tobacco or nicotine use provides additional insights on the health behaviour of Canadians.
Measuring the use of any nicotine product in Canada.
Over the past decade, the Canadian Tobacco, Alcohol and Drug Survey (2013, 2015 and 2017) and its replacement, the Canadian Tobacco and Nicotine Survey (annually in the late winters of 2019, 2020, 2021 and 2022) have produced estimates of the number of Canadians who report past-month use of 7 categories of nicotine products: cigarettes, little cigars, cigars, traditional pipe, oral tobacco/snuff, water-pipe, and electronic cigarettes. In addition to the tables provided on government web-sites, the survey results are also available in Public Use Microdata Files (PUMF).
These PUMF files allow the identification of survey respondents who reported using any of the 7 products identified above during the month before they were surveyed. (It also identifies those who use pharmaceutical nicotine, such as patches or gum and those who used tobacco when they were smoking cannabis, but these were not included in the results shown below).
The survey is not currently constructed to establish a measure of how many people use a nicotine-bearing product every day, although they do ask about daily use of cigarettes, e-cigarettes and some other products. Someone who uses either e-cigarettes or traditional cigarettes every day but who does not use either product on each day could not be identified as a "daily" user from the survey as it is now designed.
Ten years of changed nicotine use, but not much progress against it.
The number of Canadians using nicotine is as high in 2023 as it was in 2013. A decade ago, 5.18 million Canadians reported that the used either cigarettes, other tobacco products or vaping products in the past month. In 2023, the estimate was slightly higher (5.22 million Canadians).
Overall patterns of use have changed. In 2013, four in five (82%) of nicotine users reported using cigarettes, but this past winter only two-thirds did (67%). (In both cases, they may also have used other products). The number of nicotine users who were identified as never smokers (they had smoked fewer than 100 cigarettes in their lifetime) more than doubled - from 478,800 to 1,001,100 Canadians.
Young people make up the same proportion of nicotine users today as they did a decade ago. In 2013, about 1 in 5 nicotine users (18%) was under 25 years of age. In 2023 the proportion was almost the same (17%).
Because of population growth, there has been a slight decrease in the percentage of Canadians who use nicotine. The prevalence of Canadians using nicotine products in the past month dropped from 18% in 2013 to 16% in 2023. (No statistical test has been performed on these estimates).
- The lowest estimates in the number and percentage of Canadians using any nicotine product coincided with the first winter of COVID (December 2020 to January 2021).
- Many more men than women used these nicotine products in 2013 (21% vs 15%), and the gender gap remained a decade later (20% vs 13%).
- The decrease in cigarette use in younger age groups has been largely offsets by increased use of other nicotine products.
- In comparison with 2013, there was a small drop in the percentage of teenagers (aged 15 to 19) who used nicotine in 2023 (15% in 2023 vs 17% in 2013)
- Roughly one-quarter of young adults (aged 20 to 24) used in nicotine in 2013 (24%), as do their younger cousins a decade later (24% in 2023).
Implications for public health
Tobacco companies are steadily expanding the range of nicotine products they market. Over the past month alone, BAT began selling tobacco-less nicotine pouches in convenience stores in all provinces but Quebec. In other countries both BAT and Philip Morris have launched tobacco-less nicotine sticks intended for use in their heated tobacco devices.
Using cigarette smoking as a measure of tobacco use is out-dated. Using tobacco use as a measure of nicotine addiction is also out-dated.
It's time for health authorities to establish an indicator for nicotine use that can be used as a yardstick to measure the impact of changes in the nicotine market and also progress against nicotine use (a precursor to nicotine addiction, for which a separate indicator is likely also needed).
Tobacco surveys should collect information on the complete range of nicotine products on the market, and the summary tables produced from these surveys should provide information on the emerging patterns of use and co-use of products.
Data Sheet: Nicotine Users in Canada 2013 – 2023
