Trends and Patterns of Tobacco and Nicotine Product Use Among Youth in Canada, England, and the United States From 2017 to 2019

Abstract

Purpose: The tobacco and nicotine market is diversifying. Implications for public health will depend on trends in use, including overall use, and who is using these products. This study examined differences over time (2017-2019), across countries (Canada, England, the United States (US)), and by smoking and vaping, in use of other tobacco/nicotine products and overall use.

Methods: The study includes online repeat cross-sectional surveys of youth aged 16-19 years in Canada (N = 11,714), England (N = 11,170), US (N = 11,838) in 2017, 2018, and 2019. Past 30-day use of tobacco/nicotine products (any, cigarette, e-cigarette, other combusted [cigars/cigarillos/waterpipe], other non-combusted [smokeless tobacco/nicotine replacement therapies) were examined by country, year, and, for other combusted and non-combusted products, past 30-day cigarette smoking and vaping. Use of emerging products (IQOS, nicotine pouches) was explored in 2018-2019.

Results: From 2017 to 2019, use of any product increased in Canada (17.1%-23.2%, AOR = 1.07 [95% CI = 1.04-1.09]) and the US (18.0%-24.0%, AOR = 1.06 [1.04-1.09]) but not England (20.8%-21.7%, AOR = 1.01 [.99-1.03]). Use of other combusted products (cigars/cigarillos/waterpipe) showed little change (Canada: 8.1%-7.8%; England: 6.3%-7.3%; US: 8.6%-8.5%; p ≥ .151). Use of other non-combusted products (smokeless/nicotine replacement therapies) increased in all countries (Canada: 1.5%-3.2%, AOR = 1.02 [1.01-1.02]; England: 1.4%-2.6%, AOR = 1.02 [1.01-1.03]; US: 3.3%-4.9%, AOR = 1.02 [1.01-1.02]). Vaping increased in all countries (Canada: 8.4%-17.8%; England: 8.7%-12.6%; United States: 11.1%-18.5%; all p < .001). Smokers and vapers reported greater use of other combusted and non-combusted products than those who neither smoked/vaped (p < .001). Emerging product use was rare (≤1.5%).

Conclusions: Youth past 30-day tobacco and nicotine product use increased from 2017 to 2019 in Canada and the United States, largely due to increases in vaping and other non-combusted products. "Other" tobacco/nicotine products were used predominantly by youth who smoked cigarettes and/or vaped.

Keywords: Adolescent; Electronic nicotine delivery systems; Nicotine; Prevalence; Smoking; Surveys and questionnaires; Tobacco products.

Figure 1.. Prevalence of past 30-day use of tobacco and nicotine products in Canada, England, and the US in 2017, 2018, and 2019. Data are weighted.

Sample sizes vary for each product due to pair wise deletion of ‘Don’t know’ and ‘Refused’ responses (see Appendix Table A1). *Included herbal or tobacco, †Without tobacco. NRT=Nicotine Replacement Therapy. Past-30-day use of nicotine pouches was not assessed in 2017 or 2018. Past-30-day use of IQOS was not assessed at 2017.

Figure 2.. Prevalence of past 30-day use of other combusted and other non-combusted tobacco and nicotine products in Canada, England, and the US by past 30-day cigarette smoking, past 30-day vaping, and past 30-day cigarette smoking/vaping. N=32,525.

% are derived from weighted data. N are derived from unweighted data. Other combusted: At least one of: cigars, little cigars/cigarillos, bidis, waterpipe. Other non-combusted: At least one of: smokeless tobacco, nicotine replacement therapy (NRT). Analyses for combined past 30-day cigarette smoking/vaping (final panel) were not pre-registered and are hence exploratory.