On December 27th, during the lull between Christmas and New Year, Health Canada quietly released the results of the Canadian Substance Use Survey. The material produced for this release includes a data sheet summary, a description of the methodology, and a very useful interactive data tool.
Notably missing from these communications products was a press release or any official statement about the context or impact of these results in the department's view. Also absent over the intervening 6 weeks is any comment or reaction from the federal Minister responsible for addressing the harms of substance use, the Hon. Ya'ara Saks.
This silence is all the more concerning, given the picture this survey provides of harmful substance use among young Canadians, with indicators of early dependence. Among teenagers aged 15-19, 17% vape daily, 12% use cannabis every day or nearly every day and one-in-twenty (5%) already meets the criteria for alcohol dependence.
This post reports on the findings of this survey with respect to tobacco and nicotine use.
Canadian Substance Use Survey (CSUS) 2023 estimates for cigarette and vaping prevalence
As shown in the figures above, the CSUS estimates that almost as many Canadians were using vaping products as smoking cigarettes: 10% were past month vapers and vs 13% were past-month smokers. They found 1 in 20 Canadians vapes daily (5%), compared with 1 in 12 who smokes cigarettes daily (8%).
When it comes to young Canadians (aged 15 to 24), past month cigarette smoking rates are similar to those in the general population (14% vs 13%). However, vaping rates are significantly higher: in the past month 1 in 3 teenagers (31%) and 1 in 4 young adults (26%) used a vaping device, compared with 1 in 14 adults over 25 (7%).
With respect to daily use of these products, CSUS found that in comparison with adults over 25, young people are much less likely to smoke daily (3% for 15-19 year olds, 4% for 20 to 24 year olds and 9% for those over 25), but much more likely to vape on a daily basis. About 1 in 6 (17%) teenagers aged 15-19 vapes daily, as do 1 in 7 (15%) young adults, compared with 1 in 25 adults over 25.
The figures shown above were extracted from the CSUS data tables. It should be noted that, unlike many other government surveys, CSUS includes in their estimate of daily cigarette use those who have smoked fewer than 100 cigarettes in their lifetime.
The CSUS estimates for overall smoking rates use are aligned with those from other government surveys .... but....
When comparing the estimates of overall population prevalence of cigarette smoking from this survey with those produced by other government surveys, the rates of cigarette use are largely consistent. The wave of the Canadian Community Health Survey (CCHS) conducted in 2023 identified 11.4% Canadians as "current smokers". The CSUS identified 11.8% who met the same criteria.
The results for other smoking variables were also aligned. CSUS estimates of those who had ever smoked 1 cigarette or who had smoked 100 cigarettes or more, or who had smoked in the past 30 days were very close to those produced by the CCHS (50% vs 52%; 37% vs 41%, 13% vs 12%). CCHS has historically covered the population of people over 12 years of age, but in 2023 was changed to cover only those 18 years and older.
The trend-line produced by CCHS, CSUS and two other Health Canada surveys of smoking are shown below. They do not suggest that there has been a substantial decrease in the rates of cigarette use over the past 4 years.
...CSUS estimates for smoking rates among youth and young adults are higher than indicated by previous surveys.
For young people, the CSUS produces higher estimates of current and daily smoking than did Health Canada's previous surveys (the Canadian Tobacco Alcohol and Drug Survey, CTADS, and the Canadian Tobacco and Nicotine Survey, CTNS).
The CTNS in 2022 estimated that 4% of youth aged 15-19 were current smokers, and 1% were daily smokers. The CSUS estimates in the following year were 8% and 3% respectively. For young adults aged 20 to 24 the 2022 CTNS estimates were 8% (current) and 3% (daily), which contrasts with the 2023 CSUS estimates of 10% and 4%. Estimates for those aged over 25 were substantially the same.
The CSUS estimates for vaping in Canada are the highest recorded to date.
Health Canada surveys which monitor vaping began in 2013 (the Canadian Tobacco Alcohol and Drug Survey), and were redesigned in 2019 (The Canadian Tobacco and Nicotine Survey) and then subsumed into other surveys in 2023, including CSUS (15+), the CCHS (18+) and the Canadian Health Survey on Children and Youth (CHSCY, not yet released).
The rates for ever use, past-month use and daily use of vaping products from available federal government surveys are shown below. Of theses, the CSUS has produced the highest estimates of youth use:
- half of youth (47%) and young adults (52%) have used an e-cigarette at least once
- one-third of youth (31%) and one-quarter of young adults (26%) have used them in the past month
- one-sixth of youth (17%) and one-seventh of young adults (15%) use them daily.
- for every three young Canadians who experiment with vaping devices, one has become a daily user.
Differences among surveys: CSUS vs. CCHS vs. CTNS vs CTADS vs .....
The methods used by the CSUS are not identical to those used in the previous surveys commissioned by Health Canada to assess substance use.
Because of these differences, the results from one instrument is not not intended to be used to evaluate changes over time in the behaviour. In the information attached to the CSUS release, Health Canada makes this clear: "The changes to the sampling methodology in 2023 may have impacted estimates of substance use. ... cell phone recruitment and oversampling of youth and young adults with the knowledge that the survey would be asking about substance use, may have resulted in an overestimation of substance use ... we recommend using CSUS 2023 data without comparison to previous iterations."
On this basis, we cannot infer that vaping rates have risen dramatically between 2022 and 2023. But can we infer that are problems with one or other survey sampling methods?
Of the four surveys identified above, CSUS is the only one which was not conducted by Statistics Canada. The work was contracted to Advanis, the public opinion firm which also manages the Health Canada's cannabis survey (The Canadian Cannabis Survey). This private sector research firm appears to have followed similar recruitment and selection methods in both surveys.
In the
technical notes which accompany these Advanis surveys, a rationale is provided for the decision to supplement traditional telephone recruitment with outreach to young people who participate in on-line panels and also for providing some financial incentives for certain youth respondents. This approach has not been included in the surveys conducted for Health Canada by Statistics Canada.
It seems evident that these sampling methods produced very different results for measuring youth substance use. What is less clear is how to interpret the results.
Implications for public health
Such dramatic differences in the measurements commissioned by Health Canada warrant reflection and action.
If the problem of youth vaping and other substance use is greater than previously thought, there is even more reason for the department to (finally!) step off the brakes and implement measures to stop manufacturers from inducing young people to use harmful and addictive products.
If the Minister and the department do not wish adjust their policies and programs in response to this new information, then they should explain this decision.
At the very least, there should be greater transparency and openness about how the federal government views the results and methods of its own surveys.
