The geographic distribution and community correlates of electronic cigarette use in Canada

Electronic cigarettes and other novel electronic nicotine delivery systems (ENDS) have grown rapidly in popularity and accessibility. In this study, we compiled a large sub-provincial dataset on smoking and vaping behaviour in Canada to inform targeted surveillance and prevention.

Twelve national-level survey datasets were concatenated. Multilevel models were used to derive precision-weighted estimates of census division-level smoking and ENDS use prevalence, adjusted for age, sex/gender, and data source. We developed visualizations of the geography of smoking and ENDS use across Canada and used Census Divisions for spatially explicit correlational analyses of community characteristics associated with vaping.

The age- and sex-adjusted prevalence of past-month (i.e., current) ENDS use in Canada was 4%, with higher estimates observed in several Atlantic provinces: New Brunswick (5.6%), Prince Edward Island (4.8%), Nova Scotia (4.7%), and Newfoundland and Labrador (4.5%) followed by Manitoba (4.1%). Estimates for the remaining provinces were below 4%. The prevalence of ENDS use varied considerably across CDs, even in provinces where vaping was generally uncommon. Suburban and exurban communities in Ontario and Quebec demonstrated especially high ENDS use. Spatial analyses revealed select correlations with community factors such as economic composition.

Sub-provincial data revealed geographical variability in ENDS use across Canada. Localized surveillance and prevention efforts may be improved by considering the community features associated with high rates of use, and benchmarking regional regulations on the advertising and sales of ENDS products to communities with lower estimated rates of use.