Background: The e-cigarette market has rapidly evolved, with a shift towards higher nicotine concentration and salt-based products, such as ; however, the implications for youth vaping remain unclear.
Methods: Repeat cross-sectional online surveys were conducted in 2017, 2018 and 2019, with national samples of youth aged 16-19 years recruited from commercial panels in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Regression models examined differences between countries and over time in the types of e-cigarette products used (design and nicotine content), reasons for using brands and differences in patterns of use, sociodemographics and dependence symptoms by brand/nicotine content.
Results: In 2019, the use of pod- or cartridge-style e-cigarettes was greater in Canada and the USA than England, with and the leading brands in all countries. In 2019, youth vapers in England were less likely to report using e-cigarettes with ≥2% nicotine (12.8%) compared with Canada (40.5%; adjusted OR (AOR)=4.96; 95% CI 3.51 to 7.01) and the USA (37.0%; AOR=3.99, 95% CI 2.79 to 5.71) and less likely to report using nicotine salt-based products (12.3%) compared with Canada (27.1%; AOR=2.77, 95% CI 1.93 to 3.99) and the USA (21.9%; AOR=2.00, 95% CI 1.36 to 2.95). In 2019, self-reported use of products with higher nicotine concentration was associated with significantly greater frequency of vaping, urges to vape and perceived vaping addiction (p<0.05 for all).
Conclusions: The use of high-nicotine salt-based products is associated with greater symptoms of dependence, including and other higher-nicotine brands. Greater use of high-nicotine salt-based products may account for recent increases in the frequency of vaping among youth in Canada and the USA.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9359003 | PMC |
| http://dx.doi.org/10.1136/tobaccocontrol-2020-056371 | DOI Listing |
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