Longitudinal Vaper Panel Survey to Measure Attitudes and Behaviours regarding Vaping Products

PWGSC Contract Number: HT372-173602/001/CY
POR Registration Number: 047-17
Contract date: 2017-11-10
Report date: April 2018
Fieldwork dates: Wave 1: December 15-29, 2017; Wave 2: February 1-14, 2018

Prepared for:
Health Canada

Prepared by:
Environics Research Group

Ce rapport est aussi disponible en français

For more information on this report, please email:
hc.cpab.por.rop.dgcap.sc@canada.ca

PA 9706

Table of Contents

• Executive Summary
• 1. Introduction
• 2. Detailed findings
  • 2.1 Profile of ever vapers
  • 2.2 E-cigarette use
  • 2.3 Cigarette use
  • 2.4 Heat-not-burn Tobacco Products
  • 2.5 Comparison of Results Between Cross-sectional and RTS Waves
• Appendix A: Methodology
• Appendix B: Research instruments
  • Longitudinal Vaper Panel Survey – Wave 1 & 2 Genpop - English
  • Longitudinal Vaper Panel Survey – Wave 2 RTS only - English

Executive Summary

Background and objectives

The Government of Canada has introduced new legislation to regulate the manufacture, sale, labelling and promotion of vaping products in Canada. The goal is to protect youth and non-users of tobacco products from nicotine addiction and inducements to tobacco use, while allowing adults to legally access vaping products as a less harmful alternative to tobacco.

Vaping products have been in the North American market for approximately a decade. With only a few studies available, data are limited on the knowledge, attitudes and beliefs of Canadians as they relate to vaping products. Health Canada is interested in better understanding how Canadians are using vaping products and exploring changes over time in attitudes and behaviours of Canadians towards vaping products.

The main objective of this research was to gather information on the attitudes and behaviours of Canadian vaping product users and ever users aged 15 years and older with respect to vaping products. The specific objectives are to:

• Measure Canadian vaping product users’ and ever users’ level of awareness and knowledge of vaping products;
• Gather information on Canadian vaping product users’ and ever users’ behaviours with respect to vaping products;
• Understand any changes in the attitudes and behaviours of users and ever users over time; and,
• Test a longitudinal approach in terms of feasibility and impact (i.e., proof of concept).

Methodology

To address the research objectives, an online survey was conducted with Canadians aged 15 and over who have ever tried an e-cigarette (“ever vapers”), at two separate points in time:

• Wave 1: an initial measurement for benchmarking purposes, conducted with 1,312 ever vapers from December 15-29, 2017
• Wave 2: conducted with fresh sample (950 respondents who are unique from Wave 1 participants) and with return-to-sample (779 respondents who previously completed the Wave 1 study), from February 1-14, 2018

This approach allows for a cross-sectional analysis (comparing the fresh samples of respondents at Wave 1 and Wave 2) and a longitudinal analysis (following the same sample of respondents who completed both the Wave 1 and Wave 2 surveys). It should be noted that the two waves straddled the new year, which is traditionally a time when people make and attempt health-related resolutions like quitting smoking. There were no specific interventions (e.g., GC announcements) during the data collection period.

Survey respondents were drawn from among panels of individuals who have agreed to participate in online surveys. The data have been weighted to reflect the demographic composition of ever vapers in Canada. Because the sample is based on those who initially self-selected for participation in the panel, no estimates of sampling error can be calculated and the results cannot be described as statistically projectable to the target population. 

Cost of research

The cost of this research was $149,831.22 (HST included).

Key findings

The research revealed very few statistically significant changes in vapers’ behaviours and attitudes between Waves 1 and 2. This is true for both the cross-sectional (“fresh”) sample and for the longitudinal return-to-sample (RTS) group. While we might have expected a larger “New Years’ Resolution” effect, it may be that insufficient time passed between late December and early February for measurable behavioural or attitudinal shifts to take place.

Ultimately, the consistency and stability of the results for the cross-sectional and longitudinal samples indicate that either approach would be viable in the future. The higher-than-anticipated response rate for the RTS (a response rate of 25-30% was anticipated but ended up being 59%) suggests that respondents are willing to respond to two surveys at different points in time if they are interested in the topic and the research is properly designed. This includes informing panellists up front that their participation is required in both waves and providing incentives commensurate with their efforts. For these reasons, a longitudinal methodology will typically be costlier than a cross-sectional one, and thus is recommended primarily for when Health Canada wants to understand if an intervention (e.g., a new policy or program) has led to individual-level behaviour change. Where the focus is on understanding how the broader target audience is influenced by the intervention, a cross-sectional (pre-post) survey remains a satisfactory approach.

Aside from methodological implications, a key finding of the research is that there are important differences in vaping behaviours, experiences and preferences by age. The three principal groups compared in this research are youth vapers (15-19 years old), young adult vapers (20-24 years old) and adult vapers (25+ years old), with the largest differences evident between youth vapers (under 20) and the other two age groups. 

The following are the key findings of the research: 

E-cigarette use and attitudes

• E-cigarettes with nicotine have been more widely tried/used than varieties without nicotine (roughly three-quarters of vapers have used the former versus six in ten for the latter). Moreover, the frequency of e-cigarette use is higher among users of nicotine e-cigarettes (roughly two in ten are daily users of nicotine e-cigarettes, about double the proportion who use a non-nicotine variety). Overall, regardless of the type of e-cigarette, about one in five are daily vapers, and another third vape occasionally.
• Vapers typically learned about e-cigarettes from someone in their life (a friend, family member or co-worker), and rarely from online sources (less than 10%). The age at which vapers first tried an e-cigarette varies, but a majority (60%) started within the past five years.
• E-cigarette users are attracted primarily by the flavours and/or smell, but especially for adult vapers, by the perception that e-cigarettes can help them reduce or quit regular cigarette use. Perhaps because of their greater use of e-cigarettes as a substitute for regular cigarettes, adult vapers prefer smoking-related flavours (four in ten favour tobacco or menthol), while youth and young adult vapers prefer fruit and candy flavours (around half favour fruit, bubble gum or confectionary flavours).
• The most common source of devices and e-liquids is a physical store, typically a vape shop but also convenience stores. Youth vapers (under 20) rely more often on others to buy or give them devices and e-liquid than do older vapers.
• Many vapers have made efforts to cut back on vaping. Half of daily or occasional vapers have tried to reduce their use of e-cigarettes, and slightly fewer (around four in ten) have tried to stop outright. Looking to the future, a majority (57%) say they think they will stop using e-cigarettes at some point, although fewer than one in five say they will do so in the next 30 days.
• Generally speaking, vapers believe that e-cigarettes are less harmful than regular cigarettes and that they can help people quit smoking.
• One-quarter of vapers have received or accessed vaping promotional material in the past month through social media; the best recalled source is Facebook. While the majority (six in ten) say they needed to prove their age to access this material, this is far less common for youth vapers (only 49% said they needed to).

Cigarette use

• Most vapers (83%) smoke regular cigarettes or have at some point. The large majority (eight in ten) of these dual vapers and smokers tried cigarettes first, although this is less the case among youth (69%).
• Over half of people who both smoke and use e-cigarettes say they are vaping to try to quit/reduce cigarette use, and this is particularly true among adults (57%, vs. 45% of young adults and 39% of youth). Despite this, only a minority (one in three) say they are smoking fewer cigarettes since they started vaping.
• The vast majority of dual vapers and current smokers say they have tried to quit smoking in the past (eight in ten), and that they plan to quit regular cigarettes at some point (almost nine in ten). However, only around one-quarter say they will do so in the next month, suggesting a firmer commitment to the goal.
• Six in ten smokers who made previous quit attempts used a cessation aid, most commonly a nicotine patch, although e-cigarettes are almost as prevalent. Smokers who are planning to quit most commonly say they’ll use e-cigarettes (both with and without nicotine).

Political neutrality statement and contact information

I hereby certify as a Senior Officer of Environics Research that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not contain any reference to electoral voting intentions, political party preferences, standings with the electorate, or ratings of the performance of a political party or its leader.

Sarah Roberton
Vice President, Corporate and Public Affairs
sarah.roberton@environics.ca
613-699-6884
Supplier name: Environics Research Group
PWGSC contract number: HT372-173602/001/CY
Original contract date: 2017-11-10

Introduction

Background

The Government of Canada has introduced new legislation to regulate the manufacture, sale, labelling and promotion of vaping products in Canada. The goal is to protect youth and non-users of tobacco products from nicotine addiction and inducements to tobacco use, while allowing adults to legally access vaping products as a less harmful alternative to tobacco.

Vaping products have been in the North American market for approximately a decade. With only a few studies available, data are limited on the knowledge, attitudes and beliefs of Canadians as they relate to vaping products. Health Canada is interested in better understanding how Canadians are using vaping products. Further, the study intends to explore changes over time in attitudes and behaviours of Canadians towards vaping products.

Research objectives

The main objective of this research is to gather information on the attitudes and behaviours of Canadian vaping product users and ever users aged 15 years and older with respect to vaping products. The specific objectives are to:

• Measure Canadian vaping product users’ and ever users’ level of awareness and knowledge of vaping products;
• Gather information on Canadian vaping product users’ and ever users’ behaviours with respect to vaping products;
• Understand any changes in the attitudes and behaviours of users and ever users over time; and,
• Test a longitudinal approach in terms of feasibility and impact (i.e., proof of concept).

About the report

This report begins with an executive summary outlining key findings and conclusions, followed by a detailed analysis of the survey data. The data is presented in two main ways:

• A cross-sectional analysis comparing the results of Wave 1 and Wave 2 with “fresh” (unique) respondents;
• A longitudinal analysis following respondents who completed both the Wave 1 and Wave 2 surveys (i.e., Return to Sample, or RTS).  

In addition, the Wave 1 and 2 cross-sectional samples have been merged in places to provide a robust overall sample size for analysis by demographic and other segments of the population (e.g., age, smoking status); these instances are noted throughout the report.

Statistically significant differences between the Wave 1 and 2 surveys and amongst subgroups are bolded where they exist. Although the survey was identical for the cross-sectional sample of “new” respondents, the Wave 2 RTS questionnaire was modified in a number of places to ask about changes in the past month and to add or remove certain questions. These changes are noted where their results are presented.

Three age groups are discussed throughout the report and defined as follows: youth vapers (15-19 years old), young adult vapers (20-24 years old) and adult vapers (25+ years old).

Provided under a separate cover are three sets of detailed “banner tables” presenting the results for all questions by population segments (including by region, demographics and vaping/smoking behaviours). There is one set which contains results for the two general population waves, one set for the responses from Wave 1 of the RTS respondents and one set for the Wave 2 responses from the RTS respondents. These tables are referenced by the survey question in the detailed analysis.

A detailed description of the methodology used to conduct this research is presented in Appendix A.

Throughout the report, results are expressed as percentages unless otherwise noted. Where base sizes are reported in tables and charts, they reflect the actual number of respondents who answered the question. Results may not add to 100% due to rounding or multiple responses. Net results cited in the text may not exactly match individual results shown in the charts due to rounding.

Detailed findings

A. Profile of ever vapers

The table below presents an overall picture of what ‘ever vapers’ look like regionally and demographically. The first table compares Census data for the Canadian 15+ population to the population of ever vapers (aged 15 or older). Ever vapers differ from the population at large most strikingly in terms of age and gender: ever vapers are more likely to be male and to be younger (under 25). Proportionally, Ontario has fewer ever vapers than other provinces.

Comparison between Census and Ever Vapers

Base: Respondents from Wave 1 and Wave 2.

B. E-cigarette use

Nicotine/non-nicotine e-cigarette usage

Ever vapers are more likely to use/have tried varieties with nicotine than without. Nicotine e-cigarettes are more popular among older vapers and current smokers of regular cigarettes.

Ever vapers were asked about their experience with nicotine and non-nicotine varieties of e-cigarettes. It is most common for ever vapers to have tried both nicotine and non-nicotine e-cigarettes, followed by nicotine varieties only.

Between Wave 1 and Wave 2 of the cross-sectional samples, the proportion reporting that they had tried both non-nicotine and nicotine e-cigarettes increased significantly (up eight percentage points), while the proportion reporting that they had only tried nicotine e-cigarettes decreased. This may reflect the ongoing popularity of e-cigarettes and the greater likelihood that, over time, people will try more of the available options.

Interestingly, the proportion of Return to Sample (RTS) respondents who were not sure which type of e-cigarette they have used increased in Wave 2 (up seven percentage points, to 15%). This increase was evident across all demographic subgroups, indicating no single segment is driving this change.

Type of e-cigarette use

Age is an important factor for many variables around e-cigarette usage. In this case, use of nicotine e-cigarettes increases with age, from more than six in ten 15-19-year-olds, to three-quarters of 20-24-year-olds and eight in ten aged 25 or older.

Type of e-cigarette use by age group

Base: Respondents from Wave 1 and Wave 2 general population samples combined.

The type of e-cigarettes that people tend to use is also connected to whether they are, or have been, smokers of regular cigarettes. A large majority of ever vapers have smoked at some point, and a majority still do (55%).

Cigarette smoking status

Base: Respondents from Wave 1 and Wave 2.

Most current smokers (whether daily or occasional) have tried nicotine e-cigarettes and are unlikely to use/have tried non-nicotine varieties. A majority of both former and never smokers have also tried nicotine e-cigarettes, but both groups are more likely than current smokers to only use/have tried non-nicotine versions.

Type of e-cigarette use by regular smoking status

Base: Respondents from Wave 1 and Wave 2.

Frequency of e-cigarette usage

About one in five ever vapers use e-cigarettes daily, and another third do so occasionally. Frequency of use is higher among users of nicotine e-cigarettes than among those who use non-nicotine varieties.

E-cigarettes with nicotine are used more frequently than e-cigarettes without nicotine, by their respective groups of users. Roughly two in ten nicotine e-cigarette users use them daily, compared to roughly one in ten who use non-nicotine varieties. Youth are the least likely to be daily users regardless of whether they use e-cigarettes with nicotine or without.

In Wave 2 of the RTS, there was a decline in the proportion of non-nicotine e-cigarette users who said they use an e-cigarette every day (down from 12% in Wave 1 to 8%).

Those who do not know whether the e-cigarette they used had nicotine or not are predominantly infrequent or one-time users.

Frequency of e-cigarette usage by e-cigarette type (Nicotine)

Frequency of e-cigarette usage by e-cigarette type (Non-nicotine)

Frequency of e-cigarette usage by e-cigarette type (Unknown)

The table below summarizes the usage information from the different types of e-cigarettes. E-cigarette usage is classified as: daily user (use any type of e-cigarette daily), occasional users (used any type of e-cigarette within the past 30 days but not daily), infrequent users (has not used any type of e-cigarette in the past 30 days) and one-time users (have only used any type of e-cigarette once). Overall, the largest group of e-cigarette users are those who use them occasionally (roughly one in three). Close to two in ten are daily users. The remainder use them infrequently or are one-time users only.

Frequency of e-cigarette usage

The table below profiles the demographic characteristics of ever vapers by vaping frequency. Daily users tend to skew older and male compared to less frequent users and are marginally more likely than others to live in Quebec.

Demographic characteristics of ever vapers by frequency

Base: Respondents from Wave 1 and Wave 2.

Sources of learning about e-cigarettes

Ever vapers hear about e-cigarettes through personal contacts, and rarely from online sources. For those in the youngest age group, the source is almost always a friend.

The majority of those who have ever used an e-cigarette first became aware of them through interaction with someone in their day-to-day life such as a friend, family member or co-worker. Internet sources (including social media and YouTube) seem to play less of a role in making people aware of vaping.

How vapers first learned/heard about e-cigarettes

Although personal contact is the most common way of hearing about e-cigarettes regardless of age, friends are more likely to be a major source for youth vapers than for young adult or adult vapers, for whom family members, co-workers and the news media are relatively more important. Even among youth vapers, social media and YouTube do not play a larger role than for those in older age groups.

How vapers first learned/heard about e-cigarettes by age group

Base: Respondents from Wave 1 and Wave 2.

Other than age, there are relatively few differences by other population segments. Females (20%) are more likely than males (13%) to have learned about e-cigarettes from a family member.

Age started using e-cigarettes

The age at which people first tried an e-cigarette varies, but most started within the past five years.

The age at which people first tried an e-cigarette varies considerably based on the age of the respondent. Given that e-cigarettes are a relatively new technology (first appearing in Canada in 2004), they are different from regular cigarettes in that there is a maximum time frame in which people could have started. For this reason, it is potentially more useful to consider the length of time since respondents first tried vaping. From this perspective, a majority (60%) of vapers first tried an e-cigarette within the last 5 years. Youth are much more likely to have first tried an e-cigarette within the past year or two while adults (regardless of age) are more likely to have first tried them three or more years ago.

Age when first tried an e-cigarette

Length of time since first trying an e-cigarette by age

Base: Respondents from Wave 1 and Wave 2.

Reasons for using e-cigarettes

E-cigarette flavours/smells are the most commonly given reason for using them, but using e-cigarettes to reduce use of or quit regular cigarettes is also a major reason – especially for adult vapers.

Reasons for trying an e-cigarette. One-time users of e-cigarettes were asked their main motivation for trying them (from a list provided). Responses selected by the highest proportion of one-time users include simply because it was offered to them, that their friends were vaping or that they liked the flavours/smell.

Reasons for trying an e-cigarette

Reasons for using e-cigarettes. When asked a similar question about why they use e-cigarettes, those who use them at least infrequently most commonly say it is because they like the flavours/smells. Beyond this however, concerns around harm reduction and using vaping as an alternative to smoking cigarettes are common. Around a third each say they vape because it is less harmful than smoking or to help them reduce the amount they smoke. Another quarter said that vaping helped them to quit smoking.

Reasons for using e-cigarettes

Age plays a role in the reasons people select for why they use e-cigarettes. Youth and young adult vapers are more likely than adult vapers to be motivated by flavours/smells; youth vapers are also more likely than others to say that e-cigarettes are cool. Young adult and adult vapers are more likely to select reasons to do with quitting/reducing cigarette use.

Reasons for using e-cigarettes by age group

Base: Respondents from Wave 1 and Wave 2.

Locations where e-cigarettes are used

Home is the most common location for e-cigarette use for those over 19, but teenagers are more likely to use them at parties or at school.

When asked where they tend to use e-cigarettes (from a list provided), vapers typically say they use them at home or while they are walking somewhere. Other common settings for e-cigarette use include social situations such as parties and while driving.

Where e-cigarettes are used

Vapers of different ages use e-cigarettes in locations that reflect their different lifestyles and routines. Older vapers are more likely to use e-cigarettes at home, at work and while driving, while younger vapers use them more often while walking, at parties and at school.

Where e-cigarettes are used by age group

Base: Respondents from Wave 1 and Wave 2.

In addition to the differences outlined in the paragraphs above, other notable differences include:

• Males are more likely than females to vape while walking (38% to 31%) and at work (25% to 21%).
• The likelihood of vaping at home decreases as household income increases, from 62 percent among those under $40,000 per year to only 46 percent among those $150,000 or more.
• Daily vapers are more likely than occasional vapers to use e-cigarettes in every location except for parties (35%) and at school (14-15%), where both groups are equally likely to vape.
• Reported vaping while driving is significantly higher among daily cigarette smokers compared to those who smoke cigarettes less often or who have never smoked.

E-cigarettes flavours and devices

Older e-cigarette users prefer flavours that are related to smoking (tobacco or menthol) whereas younger users prefer flavours such as fruit and candy.

Preferences for e-cigarette flavours vary (selected from a list of options), but fruit flavours are chosen the most often, following closely by tobacco flavour and mint/menthol. There is a difference in flavour preferences by age, with youth and young adult vapers (under 25) more likely to prefer fruit flavours and adult vapers (25 and older) more likely to prefer tobacco and mint/menthol, likely due to this latter group’s greater use of e-cigarettes as a substitute for regular cigarettes.

Preferred e-cigarette flavour

Preferred e-cigarette flavour by age group

Base: Respondents from Wave 1 and Wave 2.

The majority of daily or occasional vapers use an e-cigarette that allows them to control settings such as temperature and airflow. Among those who do, the overwhelming majority prefer this type.

E-cigarette device type

E-cigarette device type preference

Where e-cigarette devices and e-liquids are purchased

Patterns of e-cigarette device and liquid purchases are very similar, with most daily or occasional vapers buying them in a physical store. Teenagers depend more often on others to get both devices and e-liquids.

Daily or occasional vapers most commonly purchase their e-cigarette devices themselves, usually from a vape shop or a convenience store. Around one in five purchase them for themselves online. Less commonly, people get their devices from someone else – a friend either gives/lends it to them or they buy it from a friend/someone else.

Where e-cigarette devices are obtained

*Note: The wording of this question was different for Wave 2 RTS sample: “Q15A. From where did you get your e-cigarette devices in the past month?” In addition, no statistical testing comparison was performed on the differences between Wave 1 and Wave 2 RTS.

Those who vape at least occasionally obtain e-liquid in similar ways, mainly from a vape shop or a convenience store. However, vapers are more likely to report purchasing e-liquids than devices from online sources.

Where e-liquid is obtained

*Note: The wording of this question was different for Wave 2 RTS sample: “Q15B. From where did you get your e-liquid in the past month?” In addition, no statistical testing comparison was performed on the differences between Wave 1 and Wave 2 RTS.

There are differences by age in the sources that daily/occasional vapers use for their e-cigarette devices and e-liquid. Youth (aged 15-19) are more likely to get both their devices and e-liquid from someone else - whether it’s given to them or purchased from someone. It is also common for this age group to ask someone to buy it for them. Young adults (20-24) are more likely than others to report buying their vaping supplies online.

Where e-cigarette devices & e-liquid are obtained by age group

Base: Respondents from Wave 1 and Wave 2.

In addition to the differences outlined in the paragraphs above, other notable differences include:

• Vape shops are a more commonly used source of devices and e-liquids in Quebec than in BC and Ontario.
• Ontario vapers are the most likely to buy both devices and e-liquid off the internet.
• Females are more likely than males to say they buy e-liquid from a friend, that a friend gives/lends it to them or that someone else gives/lends it to them (this pattern does not exist for devices).

Spending on e-cigarettes devices and e-liquids

Vapers tend to spend more than $20 each on devices and e-liquid in a typical month.

Monthly spending on e-cigarette devices and all other components among daily/occasional e-cigarette users is typically more than $20; the same is true for e-liquid. In both cases, sizeable proportions say they do not know how much they spend. Daily vapers spend only slightly more per month on vaping devices but significantly more on e-liquid than those who vape only occasionally. There is no consistent difference in spending by gender, but Ontario vapers spend the most on devices and are tied with Quebec for spending the most on e-liquid.

Spending on e-cigarette devices per month

Spending on e-liquid per month

*Note: The wording of these questions was different for Wave 2 RTS sample: “Q16A/B. How much did you spend in the past month on e-cigarette devices (including each of its components) / on e-liquid?” No statistical testing comparison was performed on the differences between Wave 1 and Wave 2 RTS.

Attempts to quit using e-cigarettes

Half of daily/occasional vapers have tried to reduce their use of e-cigarettes, and slightly fewer have tried to stop outright. Roughly half of those who use nicotine e-cigarettes have tried to either switch to non-nicotine e-liquid or reduce the nicotine strength.

Fewer than half of daily/occasional e-cigarette users have tried to stop using them and only half have tried to reduce their use. Attempts to stop vaping declined between Wave 1 and 2 for the cross-sectional sample, possibly reflecting renewed interest in using e-cigarettes to quit regular cigarettes in the new year.  

Among daily/occasional vapers who use nicotine e-cigarettes, around half have tried switching to non-nicotine e-liquid and just over half have attempted to reduce the nicotine strength of their e-liquid.

Generally, daily cigarette smokers and former cigarette smokers are slightly more likely to have tried to quit or reduce e-cigarette or nicotine use. Otherwise, these measures do not vary significantly by other characteristics (e.g., age).

Attempts to quit/reduce e-cigarette use

Attempts to switch/reduce nicotine usage in e-cigarettes

Although over half of daily/occasional e-cigarette users say they think they will stop using them at some point, fewer than one in five say they will do so in the next 30 days. Another one in five say they do not think they will quit using e-cigarettes and a quarter say they are not sure. There are no meaningful differences by cigarette smoking status (daily vs. occasional); however, those who are planning to quit smoking cigarettes are also more likely to be planning to quit e-cigarettes.

Quitting e-cigarettes

Infrequent users using e-cigarettes again

A majority of infrequent and one-time vapers say they are unlikely to try e-cigarettes again, mainly because they are unappealing and/or unhealthy.

Among one-time and infrequent users, about one-third say they are likely (very or somewhat) to try an e-cigarette again in the future. A majority say they are unlikely to try one again, but infrequent users are much more likely to say they will again in the future than one-time users. The most common reasons given by those who said they are unlikely to use an e-cigarette again are that it was unappealing to them, that they know it is unhealthy, that the sensation was not satisfying and that they do not want to get addicted.

Likelihood of using e-cigarettes again

Reasons for not using an e-cigarette again

Some differences among other groups include:

• Overall likelihood of trying vaping again is higher among female one-time vapers (38%, vs. 31% of males). 
• Among those who say they are not likely to try e-cigarettes again, youth and young adults are more likely than adults to say it is because they know it is not healthy. Youth are also much more likely to cite a concern about getting addicted (29% vs. 15-16% for young adults/adults).

Attitudes about harm and smoking cessation using e-cigarettes

Vapers generally agree that e-cigarettes are less harmful than regular cigarettes and can be a useful cessation aid; these opinions are especially strong among those who vape more frequently.

Respondents were asked how much they agree or disagree with a series of statements about the harm associated with e-cigarettes and their ability to help people quit smoking regular cigarettes. The majority of ever vapers agree that e-cigarettes without nicotine are less harmful than regular cigarettes, and that e-cigarettes with or without nicotine can help people stop smoking regular cigarettes. Slightly fewer, but still a majority, agree that e-cigarettes with nicotine are less harmful than regular cigarettes.

Agreement that e-cigarettes can help people quit using regular cigarettes increased between Wave 1 and 2 for the cross-sectional sample. This increase was evident across all demographic subgroups (i.e., was not driven by any specific segments).

Agreement with statements about e-cigarette and nicotine safety and cessation

*Note: Strongly/Somewhat are combined into ‘agree’ and ‘disagree’

Agreement about e-cigarettes being less harmful than regular cigarettes and that they can help people stop smoking tends to be higher among young adults.

Agreement with statements by e-cigarette usage for cessation by age

*Note: Strongly/Somewhat are combined into ‘agree’ and ‘disagree’ Base: Respondents from Wave 1 and Wave 2.

Agreement with these statements differs when examining people by vaping frequency. Those who are one-time users are less positive about harm reduction and cessation than those who use them daily or occasionally.

Agreement with statements by e-cigarette usage for cessation by vaping frequency

*Note: Strongly/Somewhat are combined into ‘agree’ and ‘disagree’ Base: Respondents from Wave 1 and Wave 2.

E-cigarette promotional material

One-quarter of vapers have received/accessed vaping promotional material in the last month, consisting of online shopping and information about e-cigarettes, their use and health benefits/consequences. Although a majority of young adult and adult vapers say they had to confirm their age to access the materials, this is far less common for youth vapers.

One in four ever vapers say they have received or accessed promotional material through social media. The most commonly recalled materials (from a list provided) include links to online shopping for e-cigarettes, information about vaping in general or about particular brands, information on how to use e-cigarettes and information about both the health benefits and consequences of vaping.

Youth and young adult vapers are more likely to have encountered promotional material through social media than adult vapers; it is unclear the extent to which this may reflect a difference in how social media is used between these two age groups. There are no notable differences between age groups in terms of the promotional content they recall. Reported access to promotional materials is higher in Ontario and among those who use e-cigarettes more frequently.

Promotional material access

Promotional material access by age group

Base: Respondents from Wave 1 and Wave 2.

Promotional material types

*Note: The wording of these questions were different for Wave 2 RTS sample: “Q22. Have you received or accessed promotional material related to e-cigarettes or vaping through social media in the past month? / Q23. What promotional material did you receive or access in the past month?” No statistical testing comparison was performed on the differences between Wave 1 and Wave 2 RTS.

The most common platform for receiving promotional material is Facebook, followed by YouTube and Instagram. Twitter, Snapchat and Tumblr were selected less often. Youth and young adults mentioned Instagram, YouTube and Snapchat more often than adults.

Social media platform where vaping promotional material was accessed/received

The majority of those who did receive promotional material reported needing to prove their age in order to access it, but around a third say they did not. Youth were significantly less likely to report having to prove their age to access the materials. Across the country, requirements to prove their age were most commonly reported in Quebec (72%) and least commonly reported in BC (48%).

Proof of age to access vaping promotional material

Proof of age to access vaping promotional material by age group

C. Cigarette Use

Cigarette smoking

Most vapers have smoked cigarettes, with around half being daily/occasional smokers. The majority of ever smokers started smoking before they turned 17.

More than eight in ten vapers have been cigarette smokers at some point in their lifetime. Around one-third are daily smokers, one-quarter are occasional smokers and around three in ten are former smokers. Among daily cigarette smokers, a majority smoke 15 or fewer cigarettes a day and most daily/occasional smokers have their first cigarette within 30 minutes of waking up. The majority of vapers say that they had smoked their first cigarette before they turned 17.

Cigarette smoking history

Cigarette smoking frequency

Cigarette smoking behaviour

Age when smoked first cigarette

Youth ever vapers are much less likely than other age groups to have ever been cigarette smokers (53%, vs. 78% of young adults and 90% of adults).

Cigarette smoking history by age

Base: Respondents from Wave 1 and Wave 2.

Close to two thirds of former smokers report an improvement in their health after quitting, but around a quarter say that they did not notice a difference. Adults (25+) and males are more likely than others to say they saw an improvement after quitting. 

Change to health from quitting cigarettes

Interaction between e-cigarettes and cigarette smoking

The vast majority of those who vape and smoked at some point started with cigarettes. A majority of this group say they vape to quit/reduce smoking, although youths are more likely to link their vaping to being in social situations.

Most vapers who also smoked first tried regular cigarettes, however, the proportion of dual vapers and smokers who tried e-cigarettes first is higher among youth (29% aged 15-19). There are no significant differences by gender, but the proportion who tried e-cigarettes first is highest in Ontario (23%) and lowest in the Prairies (11%).

First e-cigarette & cigarette use

First e-cigarette & cigarette use by age

Base: Respondents from Wave 1 and Wave 2.

Overall, a majority of those who both smoke and vape say that they vape in order to quit/reduce their cigarette consumption; about one in three vape in certain social settings, while slightly fewer do it where cigarette smoking is restricted or not allowed. Again, there is a strong age effect: Adults 25 years of age or older are most likely to say they vape to reduce/quit cigarette smoking whereas teenagers are most likely to vape in social situations. There are no significant differences by region, gender or education/income.

Reasons for e-cigarette use

Reasons for e-cigarette use by age group

Base: Respondents from Wave 1 and Wave 2.

Reduction in smoking due to vaping

Vaping has helped a minority of dual vapers/smokers to smoke fewer cigarettes on fewer days per week, but many say it has not made a difference.

For around a third of vapers who are also occasional smokers, vaping has led them to smoke regular cigarettes on fewer days per week than before they started vaping. However, almost half say that they smoke about the same amount as before and a small proportion say vaping has led them to smoke more days per week.

The proportion who report that vaping has reduced the number of days on which they smoke is higher among females (43% vs. 29% of males) and those with lower incomes (those in the highest income group are more likely than others to say it has not made a difference).

Change in number of days smoke per week due to vaping

About one-third of vapers who smoke daily or occasionally have reduced the number of cigarettes they smoke per day compared to before they started vaping, but the largest group are those who say it has not influenced their daily total. Across the country, the proportion who report smoking fewer cigarettes per day is higher among those in Atlantic Canada (40%) and the Prairies (39%). It was also higher among those without a university degree and those with a household income of below $80k.

Change in number of cigarettes smoked per day due to vaping

*Note: The wording of this question was different for Wave 2 RTS sample: “Q41/Q42. Compared to a month ago, are you smoking…?” In addition, no statistical testing comparison was performed on the differences between Wave 1 and Wave 2 RTS.

Quitting smoking

Most smokers are planning to quit at some point and have tried to in the past, more often with the help of at least one cessation aid.

A large majority of those who smoke daily or occasionally say they are planning to quit at some point, but only a quarter or so have plans to quit within the next month. The remainder are looking at a longer timeframe of up to six months or beyond. Plans to quit in the next month are most common in Atlantic Canada (34%) and least common in B.C. (19%). There are no significant differences by age, gender or income.

Plans to quit smoking cigarettes

A large majority of daily/occasional smokers have also attempted to quit regular cigarettes at least once before. The older people are, they more likely they will report having tried to quit (ranging from youth at 62% to adults at 85%). Income is also a factor as those in the highest income group are much more likely to say they have not tried to quit (32%).

Attempts to quit smoking

Among smokers who have tried to quit, roughly six in ten said they used some sort of aid to help them. Although the nicotine patch is the most commonly used cessation aid, e-cigarettes are almost as prevalent, and more likely to have been used than nicotine gum or medications. E-cigarettes were the most commonly used aid in Atlantic Canada and Ontario and among youth and young adults (whereas adults and those in other regions were more likely to have used the nicotine patch).

Use of cessation aids

Cessation aids used

The chart below outlines the proportion of ‘ever vapers’ and their experience with smoking, their attempts to quit smoking and future plans to quit smoking. A large majority have smoked, with two thirds of those still smoking daily or occasionally. Most current smokers have tried quitting, and this group is much more likely to plan to quit in the next month than those who have never tried to quit before.

Smoking and past/future quitting attempts

Smoking and past/future quitting attempts - text description

The graphic is a flow chart that breaks out the total proportion of ever vapers on a series of distinctions. The totality of ever-vapers (100%) is first spilt between those who have ever smoked (83%) and those who have never smoked (17%). On the second level, those who have ever smoked is split between those who are current smokers (55%) and those who are former smokers (29%). The third level splits out current smokers into those who have tried quitting (44%) and those who have never tried quitting (10%). The final level first splits out those who have tried quitting into those planning on quitting within the next month (12%), those planning on quitting later (29%) and those who do not plan on quitting (4%). The final level also splits out those who have never tried quitting into those planning on quitting within the next month (2%), those planning on quitting later (6%) and those who do not plan on quitting (3%).

Base: Respondents from Wave 1 and Wave 2.

Spending on cigarettes

Vapers who also smoke at least occasionally spend approximately $120 per month on cigarettes.

Monthly spending on cigarettes varies considerably but is about $120 on average. Daily smokers spend a considerably higher amount than those who describe themselves as occasional smokers. Sizeable proportions in each wave could not estimate how much they spend in a regular month.

Monthly spending on cigarette smoking

*Note: The wording of this question was different for Wave 2 RTS sample: “Q31. How much did you spend in the past month on cigarettes?” No statistical testing comparison was performed on the differences between Wave 1 and Wave 2 RTS.

Smoking cessation aids

A majority of daily and occasional smokers who are planning to quit say they will use at least one cessation aid, with e-cigarettes being the most commonly cited.

When regular smokers who plan to quit smoking are asked how likely they are to use specific cessation aids (from a list), likelihood of use is highest for e-cigarettes (both with nicotine and without). Around half say they are likely to use nicotine gum/lozenges or patches while fewer say they are likely to use medication to help them quit. Likelihood to use an e-cigarette without nicotine is highest among youth.

A majority of those planning to quit say that they will use at least one cessation aid, and this is most widespread among adults aged 25 or older. 

The proportion who says they are likely to use e-cigarettes with or without nicotine to quit smoking increased between Wave 1 and 2 of the cross-sectional sample.

Likelihood of using products/aids to quit smoking

Number of products/aids likely to be used

Among those who said they will use one cessation aid to quit, the strongest likelihood is for using e-cigarettes with nicotine (23% very likely). Among those who will use two or more aids, likelihood is strongest for using e-cigarettes with nicotine (30%) and the nicotine patch (31%).

Likelihood of using products/aids to quit smoking by number of aids

Base: Respondents from Wave 1 and Wave 2.

While those who say they plan to quit within the next month represents a stronger commitment to quitting (by comparison to those whose plans are longer-term), this group is actually less likely to say they will use at least one cessation aid, which could possibly compromise their success.

Likelihood of using products/aids to quit smoking by quitting timeline

Base: Respondents from Wave 1 and Wave 2.

D. Heat-not-burn Tobacco Products

Awareness of heat-not-burn tobacco products is relatively low, and usage is limited.

Only around a quarter of ever vapers say that they are aware of ‘heat-not-burn’ tobacco products. Only a small proportion overall have used them in the past, however. Awareness of these products is higher in Ontario (31%), among young adults (29%) and those with a university degree (29%).

Awareness and usage of heat-not-burn tobacco products

Awareness and usage of heat-not-burn tobacco products by age

Base: Respondents from Wave 1 and Wave 2.

E. Comparison of Results Between Cross-sectional and RTS Waves

This research tested two methodologies to measuring change in the ever vaper population over time:

1. Cross-sectional – two waves of research were conducted at separate points in time, each with a fresh (unduplicated) sample of respondents, using the identical methodology and survey instrument.
2. Longitudinal – this approach follows a subset of the first wave general population respondents who agreed to also respond to a similar (but slightly altered) second wave survey (the Return to Sample, or RTS, group).

While both methodologies are designed to measure change over time, the main difference is that the second methodology ensures that the same identical sample of respondents is surveyed at both time periods.

The research revealed that there were very few statistically significant changes in vapers’ behaviours and attitudes between the two waves, regardless of the methodology. Given the brief time lag between the two waves (around a month), the only relevant “intervention” was that the two waves straddled the new year, traditionally a time when people attempt health-related resolutions like quitting smoking. There were no other major interventions, such as Government of Canada policy announcements or regulatory changes, during the data collection period. Thus, the consistency of the results (as would be expected) is encouraging as major shifts in either group would point to a potential issue with the replicability of the methodology in the future. The statistically significant differences that were observed (and discussed throughout the report) are examined below.

Cross-sectional comparison (General population Wave 1 and Wave 2)
Overall, the results from the two waves were very consistent, giving confidence that this approach can capture a reliable sample of ever vapers using conventional online panel sampling. This consistency was evident in both vaping behaviours/status and attitudes.

The only statistically significant difference in terms of the core underlying behaviours of ever vapers was a slight shift in Wave 2 towards having tried both nicotine and non-nicotine varieties of e-cigarettes and away from those who had only tried the nicotine variety (this could be due to the increasing likelihood over time that people will have tried more of the available varieties). In addition, regular cigarette smoking status was not statistically different between the two waves.

Other changes observed between the samples included: a slight increase in the frequency of use among those using nicotine e-cigarettes, a small increase in where people get their e-liquid (a family member gives/lends it to me) and fewer who have tried to stop e-cigarette use (although the proportion attempting to reduce their usage, rather than quit outright, was unchanged).

Two separate changes that may be connected to a “New Years effect” were also observed: a small increase in Wave 2 in agreement that e-cigarettes can help people stop smoking and in the proportion who reported receiving promotional material about health consequences of vaping.

Longitudinal results (RTS waves 1 and 2)
A demographic comparison of the Wave 1 general population sample (n=1,312) and the subgroup who subsequently responded to the RTS Wave 2 survey (n=779) indicates that RTS respondents were less likely to be from Quebec, and more likely to be male and in the adult (25+) age group (see Methodology section for details). That is, there was a differential response by age, gender and region in those who agreed to participate in the longitudinal Wave 2.

However, we had oversampled youth and young adults in the Wave 1 general population sample to have sufficient sample sizes of these important target audiences for analysis. Thus, the final RTS sample was considered representative of ever vapers by age, despite the drop-off in response rate for these younger audiences. (The RTS sample was also weighted by age, as well as province and gender, to correct any remaining imbalances). Ultimately, a key design decision for future longitudinal research is identifying which subgroups are less likely to participate in follow-up waves and oversampling them in the first wave.  

Another key consideration for longitudinal studies is the impact of survey completion on reported attitudes and behaviours. For example, exposure to Wave 1 questions about different varieties and flavours of e-cigarettes, or to attitudinal statements about harm reduction, could have affected responses to the same questions in Wave 2 (e.g., because they tried different flavours upon hearing they were available, or thought more harm reduction and changed their views accordingly).

One possible example is that RTS respondents in Wave 2 reported being less likely than in Wave 1 to have tried both nicotine and non-nicotine cigarettes, and more likely to have tried only the nicotine variety or to say they are unsure which variety they had tried. This difference could be due to respondents thinking more closely and carefully about exactly which varieties they had tried and answering differently (and possibly more accurately) when asked to consider it a second time.

Wave 1 survey participation did not seem to have much other impact on the Wave 2 responses, with few statistically significant differences in the results of questions which were common to both waves. The other differences observed were inconsistent and do not seem to imply real shifts in attitudes/opinions in the RTS population.

Overall
The consistency and stability of the results for the cross-sectional and longitudinal samples indicate that either approach would be viable in the future. The response rate for the RTS sample (59%) was higher than anticipated (25-30%), suggesting that respondents are willing to respond to two similar surveys at different points in time if they are interested in the topic and the research is properly designed. Steps were taken to maximize response including informing the panellists up front that their participation is required in both waves and providing incentives commensurate with that effort.

It is for these reasons that longitudinal methodologies are typically more expensive than a cross-sectional one. The RTS results validate that a longitudinal approach would also be effective in determining if an intervention (e.g., a new policy or program) has led to individual-level behaviour change. In general, where the focus is on understanding how the target audience is influenced by an intervention, both approaches are likely to be successful, but where this additional cost of a longitudinal approach could be prohibitive, a cross-sectional survey is the preferred option.

Appendix A: Methodology

The results of this research are based on an online survey conducted with Canadians aged 15 and older who have ever tried an e-cigarette (ever-vapers), at two separate points in time:

• Wave 1: an initial measurement for benchmarking purposes, conducted with 1,312 ever vapers from December 15-29, 2017
• Wave 2: conducted with fresh sample (950 respondents who are unique from Wave 1 participants) and with return-to-sample (RTS) (779 respondents who previously completed the Wave 1 study), from February 1-14, 2018

This approach allows for a cross-sectional analysis (comparing the fresh samples of respondents at Wave 1 and Wave 2) and a longitudinal analysis (following the same sample of respondents who completed both the Wave 1 and Wave 2 surveys).

Survey respondents were drawn from among panels of individuals who have agreed to participate in online surveys. The data have been weighted to reflect the demographic composition of ever vapers in Canada. Because the sample is based on those who initially self-selected for participation in the panel, no estimates of sampling error can be calculated, and the results cannot be described as statistically projectable to the target population.

Target population and sample design

The samples were designed to achieve completed surveys with 1,300 ever vapers in Wave 1 and 930 ever vapers in Wave 2. For the RTS, no set limit was assigned given that everyone who completed the survey in Wave 1 would be invited to complete the RTS phase, but it was estimated that roughly 25-30% of the Wave 1 respondents would also complete the Wave 2 survey.

The 2015 Canadian Tobacco, Alcohol and Drugs Survey (CTADS) provides detailed estimates on the demographic make-up of the vaping population in Canada in terms of age, gender and region. While younger Canadians make up a small proportion of vaping product users by virtue of their small overall population, their relatively high incidence of vaping use means they are an important subgroup to understand. Thus, quotas were used to obtain a sample stratified by age group to ensure adequate sample sizes for analysis of younger age groups:

For youth under 16 years of age, the invitation was sent to panellists who were profiled as parents of children aged 15-16. They were then asked to provide consent for their child’s participation before having their child complete the survey. For the RTS sample, parents were asked to provide consent at Wave 1 and again at Wave 2, since we did not have direct contact information for the child.

After the data was collected, weighting was used to ensure that each wave is representative of vapers in Canada, per the CTADS data. The same weighting targets were used for both the “fresh” sample and the RTS sample. This ensures that the Wave 1 and 2 “fresh” sample can be directly compared; it also ensures that demographic differences in the RTS group resulting from divergent response rates to the Wave 2 survey are eliminated.

Unweighted demographics by wave and weighting targets

Comparing the Wave 1 and Wave 1/2 RTS columns demonstrates the demographic differences between the total sample who initially participated in the survey and the Return-to-Sample respondents who chose to return and recomplete the survey in Wave 2.  The RTS respondents were less likely to be from Quebec (18%, vs. 25% of the original Wave 1 sample), more likely to be male (63%, vs. 58% originally) and more likely to be in the adult (25+) age group (both youths and young adults were less likely to respond to the second survey).

Questionnaire design

Environics worked with Health Canada to develop a questionnaire that ensured the research objectives were met and all questions were appropriately worded. Upon approval from Health Canada, the questionnaire was translated into French.

Health Canada developed a draft questionnaire for Wave 1, which was revised and finalized based on recommendations from Environics. The Wave 2 questionnaire was identical for the cross-sectional (“fresh”) sample; the Wave 2 RTS questionnaire was modified in a number of places to ask about changes in the past month and to add/drop certain questions. The questionnaires were designed to meet all of the research objectives set out for this project and adhere to Federal Government standards for public opinion research. The final study questionnaires are included as Appendix B.

Prior to finalizing the survey for field, a pre-test (soft launch) was conducted in English (65 completed) and French (12 completed). The pre-test assessed the questionnaires in terms of question wording and sequencing, respondent sensitivity to specific questions and to the survey overall, and to determine the survey length; standard Government of Canada pre-testing questions were also asked. No changes were required to either survey following the pre-test, and because of this, all of the pre-test interviews were kept as part of the final samples.

Fieldwork

The surveys were conducted by Environics using a secure, fully featured web-based survey environment.  The average length of time to complete the general population survey was 9-10 minutes. The wave 2 RTS survey was 8 minutes in length on average.

Environics’ data analysts programmed the questionnaires then performed thorough testing to ensure accuracy in set-up and data collection. This validation ensured that the data entry process conformed to the surveys’ basic logic. The data collection system handles sampling invitations, quotas and questionnaire completion (skip patterns, branching, and valid ranges).

All respondents were offered the opportunity to complete the surveys in their official language of choice. All research work was conducted in accordance with the Standards for the Conduct of Government of Canada Public Opinion Research – Online Surveys and the standards set by the Marketing Research and Intelligence Association (MRIA), as well as applicable federal legislation (Personal Information Protection and Electronic Documents Act, or PIPEDA). The survey was registered with the MRIA’s research registra­tion system, which permits the public to verify the legitimacy of a survey, inform themselves about the industry and/or register a complaint.

Completion results

The completion results are presented in the table below for the “fresh” sample for both waves:

Contact disposition

Prior to the start of the RTS phase of research, Environics anticipated a response rate of approximately 25-30% for the Wave 2 sample. Every effort was made to maximize the Wave 2 RTS response rate within the budget available, including informing panellists upfront that their participation is required in both time periods and providing panel incentives commensurate with their degree of effort. The response rate for the RTS wave was much higher than anticipated, and almost 800 of the original 1,300 cases responded to the invitation to complete the RTS wave (779 / 1,312 = 59%).

The response rate by age group was higher among the oldest group, but the response from those 15-19 years of age was slightly higher than that of 20-24-year-old respondents. This may be due to the influence of parents/guardians who encouraged their child to respond.

Response rate by age group

Respondent profile

The following table presents the weighted distribution of survey participants by education and income. The profiles here are not compared to the larger universe population as the CTADS data does not include information on these variables for ever vapers.

Appendix B: Research instruments

Environics Research
December 12, 2017

Health Canada

Longitudinal Vaper Panel Survey – Wave 1 & 2 Genpop - English

Final Questionnaire

LANDING PAGE

Please select your preferred language for completing the survey.

• 01 - English
• 02 - French

INVITATION FOR PARENTS AND LEGAL GUARDIANS OF 15-YEAR OLDS ONLY
As a parent of or legal guardian to a youth living in your household, we are requesting your permission for your 15-year old teenager to participate in an important survey being conducted for Health Canada.

The purpose of the survey is to understand the experiences and opinions of Canadians who use e-cigarettes. This feedback will be used by Health Canada to develop regulations related to e-cigarettes and to design public education materials.

The survey will take about 10 minutes to complete.

Since privacy is important while respondents answer this survey, we request that your child be able to complete the survey in a setting where his/her answers will not be seen by others. All answers will remain anonymous and confidential.

If you agree to allow your child to participate in this survey, please provide the survey link to him/her.  

Your child can access the survey using the URL from the email you received or by clicking on the "Continue" button below.

Thank you for your support of this important research.

LINK GOES TO “INTRODUCTION FOR ALL RESPONDENTS” BELOW

INTRODUCTION FOR ALL RESPONDENTS
Background information
Thank you for agreeing to take part in this short 10-minute survey being conducted on behalf of Health Canada.

The purpose of the survey is to understand the experiences and opinions of Canadians who use e-cigarettes. This feedback will be used by Health Canada to develop regulations related to e-cigarettes and to design public education materials.

[RECALL FOR 15 YEAR-OLD RESPONDENTS ONLY]: Your parent or legal guardian has given permission for you to participate in this very important study.  Your participation is voluntary, so it is up to you to decide whether you are willing to answer, but we hope you do!  You can do the survey on your computer, laptop, tablet or phone.  You can stop at any time if you feel uncomfortable, or choose not to answer certain questions.  Your answers will not be shown to your parent(s), legal guardian(s), teachers or anyone else, so please be as honest as you can.

[CONTINUE TO SCREENING]

Screening

1. Have you ever tried an electronic cigarette, also known as an e-cigarette?

   E-cigarettes are battery-powered vaping devices which are sometimes designed to look and feel like regular cigarettes. These devices are used to heat e-liquid into vapour that you can inhale.

   Note: The questions in this survey do not refer to THC or marijuana vaping.

   • 01 – Yes — CONTINUE
   • 02 – No — SCREEN OUT
   • 03 – Not sure — SCREEN OUT

2. In what year were you born?

   SCREEN OUT IF 2003-2017 (14 OR YOUNGER): Thank you for your interest in this survey but we are looking to speak to individuals who are 15 years of age or older

   Year Year 1918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002

3. In which province or territory do you live?

   Province/Territory Province/Territory Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

4. How do you identify your gender? (This may be different from the information noted on your birth certificate or other official documents)

   • 01 – Woman / girl
   • 02 – Man / boy
   • 03 – Or please specify:

E-cigarette use

5. E-cigarettes come in nicotine and non-nicotine varieties. Which of the following best describes your use of e-cigarettes with respect to their nicotine content?

   • 01 – I have only ever used/tried e-cigarettes with nicotine
   • 02 – I have used/tried both non-nicotine and nicotine e-cigarettes
   • 03 – I have only ever used/tried non-nicotine e-cigarettes
   • 04 – I’m not sure

6. [IF Q5=01,02] Which of the following best describes how often you use e-cigarettes WITH NICOTINE?

   • 01 – I use them every day
   • 02 – I use them at least once a week, but not daily

   SHOW IF SELECT CODE 2:

   • 03 – A couple times a week
   • 04 – Weekends only
   • 05 – Other (SPECIFY)
   • 06 – I have used them less than weekly, but at least once in the past 30 days
   • 07 – I have used them, but not in the past 30 days
   • 08 – I tried them once

7. [IF Q5=02,03] Which of the following best describes how often you use e-cigarettes WITHOUT NICOTINE?

   • 01 – I use them every day
   • 02 – I use them at least once a week, but not daily

   SHOW IF SELECT CODE 2:

   • 03 – A couple times a week
   • 04 – Weekends only
   • 05 – Other (SPECIFY)
   • 06 – I have used them less than weekly, but at least once in the past 30 days
   • 07 – I have used them, but not in the past 30 days
   • 08 – I tried them once

8. [IF Q5=04] Which of the following best describes how often you use e-cigarettes?

   • 01 – I use them every day
   • 02 – I use them at least once a week, but not daily

   SHOW IF SELECT CODE 2:

   • 03 – A couple times a week
   • 04 – Weekends only
   • 05 – Other (SPECIFY)
   • 06 – I have used them less than weekly, but at least once in the past 30 days
   • 07 – I have used them, but not in the past 30 days
   • 08 – I tried them once

9. How did you first learn or hear about e-cigarettes?

   SELECT ONE ONLY.

   • 01 - Friend
   • 02 - Family Member
   • 03 - Co-worker
   • 04 - Social Media – Facebook/Instagram/Twitter
   • 05 - YouTube
   • 06 - News – TV, radio, newspapers
   • 07 - Store sign/advertisement
   • 97 - Other (SPECIFY)
   • 99 - Not sure

10. How old were you when you first tried an e-cigarette?

    ENTER AGE ______(years) RANGE 0-99
    999 - I don't know

1-TIME USERS

11. Why did you try an e-cigarette?
    SELECT UP TO 2 REASONS

    RANDOMIZE LIST

    • 01 - It looked fun and exciting
    • 02 - My friends were vaping
    • 03 - It was offered to me
    • 04 - I liked the flavours and/or smell
    • 05 - To quit or reduce smoking cigarettes
    • 97 – Other [SPECIFY] [ANCHOR]
    • 99 – Not sure [ANCHOR AT BOTTOM, SINGLE PUNCH]

DAILY, OCCASIONAL AND INFREQUENT USERS

12. Why do you use e-cigarettes?
    SELECT ALL THAT APPLY

    RANDOMIZE LIST

    • 01 - I can use it in places where I cannot smoke
    • 02 - It helped me quit smoking
    • 03 - It's less harmful to my health than smoking
    • 04 - It's cheaper than smoking
    • 05 - I like the flavours and/or smell
    • 06 - It helps me reduce the amount I smoke
    • 07 - E-cigarettes are cool
    • 97 – Other [SPECIFY] [ANCHOR]
    • 99 – Not sure [ANCHOR AT BOTTOM, SINGLE PUNCH]

DAILY, OCCASIONAL AND INFREQUENT USERS

13. Where do you tend to use e-cigarettes?
    SELECT ALL THAT APPLY

    RANDOMIZE LIST

    • 01 - At home
    • 02 - While driving
    • 03 - At school
    • 04 - At work
    • 05 - At parties
    • 06 - While walking places/on the sidewalk
    • 07 - At bars
    • 08 - At movie theatres, pool halls, etc.
    • 97 – Other [SPECIFY] [ANCHOR]
    • 99 – Not sure [ANCHOR AT BOTTOM, SINGLE PUNCH]

DAILY, OCCASIONAL AND INFREQUENT USERS

14. What is your preferrred e-cigarette flavour?
    SELECT ONE ONLY

    RANDOMIZE LIST

    • 01 - Fruit
    • 02 - Bubble Gum
    • 03 - Candy floss
    • 04 - Coffee/cappuccino
    • 05 - Dessert
    • 06 - Candy/confectionary
    • 07 - Mint/menthol
    • 08 - Soft drinks/energy drinks
    • 09 - Cereal
    • 10 - Cookies
    • 11 - Tobacco flavour
    • 12 - Marijuana flavour
    • 13 - Alcohol
    • 97 – Other [SPECIFY] [ANCHOR]
    • 99 – Not sure [ANCHOR AT BOTTOM, SINGLE PUNCH]

DAILY AND OCCASIONAL USERS

15. From where do you usually get your e-cigarette devices and e-liquid?
    SELECT ALL THAT APPLY

    	E-cigarette devices	E-liquid
    I buy it myself at a convenience store	01	01
    I buy it myself at a vape shop	02	02
    I buy it myself online	03	03
    I buy it from a friend	04	04
    I buy it from someone else	05	05
    I ask someone to buy it for me	06	06
    A family members gives/lends it to me	07	07
    A friend gives/lends it to me	08	08
    Someone else gives/lends it to me	09	09
    Other (SPECIFY)	97	97
    Not sure	99	99

DAILY AND OCCASIONAL USERS

16. How much do you spend in a typical month on e-cigarette devices (including each of its components) and e-liquid?

    On devices $______per month  [RANGE $0-$700]
         999 - I don't know

    On liquid $______per month  [RANGE $0-$150]
         999 - I don't know

DAILY AND OCCASIONAL USERS

17. Have you ever tried to...?

    SHOW IN ORDER

    	Yes (01)	No (02)	Not sure (99)
    a. Stop using e-cigarettes?
    b. Reduce your use of e-cigarettes?
    c. [IF Q5=01,02] Switch to non-nicotine e-liquid?
    d. [IF Q5=01,02] Reduce the nicotine strength of your e-liquid?

DAILY AND OCCASIONAL USERS

18. Do you think you will stop using e-cigarettes?

    • 01 – Yes

    SHOW IF SELECT YES:

    • 03 – in the next 30 days
    • 04 – in the next 6 months
    • 05 – in the next year
    • 02 – No
    • 99 – Not sure

1-TIME AND INFREQUENT USERS

19. How likely are you to try an e-cigarette again?

    • 01 – Yes — SKIP TO Q21
    • 02 - Somewhat likely — SKIP TO Q21
    • 03 - Not very likely — ASK Q20
    • 04 - Not at all likely — ASK Q20
    • 99 - Not sure — SKIP TO Q21

20. [Q19=03-04] Why would you not use an e-cigarette again?
    SELECT UP TO 2 REASONS

    RANDOMIZE LIST

    • 01 - I know it’s not healthy
    • 02 - Using it hurt my throat
    • 03 - I got sick after using an e-cigarette
    • 04 - I didn’t like the smell
    • 05 - I don’t want to get addicted
    • 06 - Negative perception from others
    • 07 - The sensation was not satisfying
    • 08 - Not convenient for me
    • 09 - It’s generally unappealing to me
    • 97 – Other [SPECIFY] [ANCHOR]
    • 99 – Not sure [ANCHOR AT BOTTOM, SINGLE PUNCH]

ASK ALL

21. Please indicate how much you agree or disagree with each of the following statements.

    SHOW ONE AT A TIME (CAROUSEL) – RANDOMIZE ORDER

    	Strongly agree (4)	Somewhat agree (3)	Somewhat disagree (2)	Strongly disagree (1)	Not sure (99)
    a. E-cigarettes WITH NICOTINE are less harmful than regular cigarettes
    b. E-cigarettes WITHOUT NICOTINE are less harmful than regular cigarettes
    c. E-cigarettes WITH NICOTINE can help people stop smoking regular cigarettes
    d. E-cigarettes WITHOUT NICOTINE can help people stop smoking regular cigarettes

22. Have you ever received or accessed promotional material related to e-cigarettes or vaping through social media?

    • 01 – Yes — ASK Q.23
    • 02 - No — SKIP TO Q.26
    • 99 - Not sure — SKIP TO Q.26

23. [Q22=01] What promotional material did you receive or access?
    SELECT ALL THAT APPLY

    RANDOMIZE

    • 01 - information about vaping or e-cigarettes in general
    • 02 - how to use e-cigarettes
    • 03 - information about a particular brand of e-cigarette
    • 04 - information on health consequences of vaping or e-cigarettes
    • 05 - information on health benefits of vaping or e-cigarettes
    • 06 - links to on-line shopping for e-cigarettes
    • 07 - access codes for discounts on e-cigarettes
    • 97 – Other [SPECIFY] [ANCHOR]
    • 99 – Not sure [ANCHOR AT BOTTOM, SINGLE PUNCH]

24. [Q22=01] On which social media platform(s) did you receive or access this promotional material?
    SELECT ALL THAT APPLY

    RANDOMIZE

    • 01 - Facebook
    • 02 - Instagram
    • 03 - Twitter
    • 04 - YouTube
    • 05 - Snapchat
    • 06 - Tumblr
    • 97 – Other [SPECIFY] [ANCHOR]
    • 99 – Not sure [ANCHOR AT BOTTOM, SINGLE PUNCH]

25. [Q22=01] Did you have to prove your age in order to receive or access the promotional material?

    • 01 - Yes
    • 02 - No
    • 99 - Not sure

Cigarette use

ASK ALL

26. Have you ever smoked cigarettes (do not include e-cigarettes)?

    • 01 - Yes — EVER SMOKER
    • 02 - No — NEVER SMOKER

EVER SMOKER

27. [Q26=01] How old were you when you first smoked a cigarette?

    ENTER AGE _______(years) RANGE 0-99
    999 - I don't know

EVER SMOKER

28. In the past 30 days, how often did you smoke cigarettes?

    • 01 - Every day — DAILY SMOKER
    • 02 - Occasionally — OCCASIONAL SMOKER
    • 03 - Not at all — FORMER SMOKER

FORMER SMOKER

29. Since you stopped smoking, would you say your health has improved, stayed the same, or become worse?

    • 01 - Improved
    • 02 - The same
    • 03 - Worse
    • 99 - Not sure

DAILY SMOKER

30. How many cigarettes do you smoke per day on the days that you smoke?

    Number of cigarettes per day: _______ RANGE 0-99
    999 - I don't know

DAILY AND OCCASIONAL SMOKERS

31. How much do you spend in a typical month on cigarettes?

    $ _______ per month RANGE $0-$500
    999 - I don't know

DAILY AND OCCASIONAL SMOKERS

32. How soon after you wake up do you smoke your first cigarette?

    • 01 - Within 5 minutes
    • 02 - 6 to 30 minutes
    • 03 - 31 to 60 minutes
    • 04 - More than 60 minutes

DAILY AND OCCASIONAL SMOKERS

33. Are you planning to quit smoking cigarettes…?

    • 01 - Within the next month
    • 02 - Within the next 6 months
    • 03 - Sometime in the future beyond 6 months
    • 04 - I am not planning to quit — SKIP TO Q.36

IF PLANNING TO QUIT

34. [Q33=01-03] How likely are you to use each of the following to help you quit smoking cigarettes?

    SHOW ONE AT A TIME (CAROUSEL) – RANDOMIZE ORDER

    	Very likely (4)	Somewhat likely (3)	Not very likely (2)	Not at all likely (1)	Not sure (99)
    a. E-cigarettes WITH NICOTINE
    b. E-cigarettes WITHOUT NICOTINE
    c. Nicotine patch
    d. Nicotine gum or lozenge
    e. Medication (e.g. Zyban, Champix)

IF PLANNING TO QUIT

35. [Q33=01-03] The previous question listed several products available to help people quit smoking cigarettes, including e-cigarettes, the nicotine patch, nicotine gum or lozenge and medication (e.g., Zyban, Champix). Which of the following best describes what you will use to help you quit?

    • 01 - I won't use any products/aids
    • 02 - I will use only one product at a time
    • 03 - I will use two or more aids at the same time
    • 99 - Not sure

DAILY AND OCCASIONAL SMOKERS

36. Have you ever tried to quit smoking

    • 01 - Yes — ASK Q.37
    • 02 - No — SKIP TO Q.39

IF TRIED TO QUIT

37. [Q36=01] During your most recent quit attempt, did you use anything to help you?

    • 01 - Yes — ASK Q.38
    • 02 - No — SKIP TO Q.39

IF TRIED TO QUIT

38. [Q37=01] What did you use to help you quit?
    SELECT ALL THAT APPLY

    KEEP IN ORDER SHOWN

    • 01 - Telephone quit-line
    • 02 - Other help line
    • 03 - Nicotine patch
    • 04 - Nicotine gum or lozenge
    • 05 - Medication (e.g. Zyban, Champix)
    • 06 - E-cigarette
    • 07 - Reduce to quit
    • 08 - Made a deal with a friend or family member
    • 97 – Other [SPECIFY] [ANCHOR]
    • 99 – Not sure [ANCHOR AT BOTTOM, SINGLE PUNCH]

Dual use

EVER SMOKER

IF TRIED TO QUIT

39. [Q26=01] Which did you try first?

    • 01 - E-cigarettes
    • 02 - Regular cigarettes
    • 99 - Not sure

[DAILY, OCCASIONAL OR INFREQUENT E-CIG] AND [DAILY OR OCCASIONAL SMOKERS]

40. Which of the following best describes how you vape?
    SELECT ALL THAT APPLY

    RANDOMIZE

    • 01 – To try to quit/reduce cigarette use
    • 02 – I vape where smoking is restricted/not allowed
    • 03 - I vape in certain social settings
    • 97 – Other [SPECIFY] [ANCHOR]
    • 99 – Not sure [ANCHOR AT BOTTOM, SINGLE PUNCH]

[DAILY, OCCASIONAL OR INFREQUENT E-CIG] AND OCCASIONAL SMOKERS

41. Compared to before you started vaping, are you smoking…?

    • 01 - More days per week
    • 02 - About the same
    • 03 - Fewer days per week

[DAILY, OCCASIONAL OR INFREQUENT E-CIG] AND [DAILY OR OCCASIONAL SMOKERS]

42. Compared to before you started vaping, are you smoking…?

    • 01 – More cigarettes per day, on the days that you smoke
    • 02 - About the same
    • 03 - Fewer cigarettes per day, on the days that you smoke

Heat-not-burn tobacco products

ASK ALL

43. Have you ever seen or heard about “heat-not-burn” tobacco products (for example, iQOS® or Glo®)?

    • 01 - Yes — ASK Q.44
    • 02 - No — SKIP TO DEMOGRAPHICS

IF AWARE

44. [Q43=01] Have you ever used a “heat-not-burn” tobacco product, even one or two puffs?

    • 01 - Yes
    • 02 - No

Respondent Characteristics

• D1. What is the highest level of formal education that you have completed?

  • 01 - Some high school or less
  • 02 - High School diploma or equivalent
  • 03 - Registered Apprenticeship or other trades certificate or diploma
  • 04 - College, CEGEP or other non-university certificate or diploma
  • 05 - University certificate or diploma below bachelor's level
  • 06 - Bachelor's degree
  • 07 - Post graduate degree above bachelor's level
  • 99 – Prefer not to say

• D2. [ASK 16+ ONLY] Which of the following categories best describes your total household income? That is, the total income of all persons in your household combined, before taxes?

  • 01 – Under $20,000
  • 02 - $20,000 to just under $40,000
  • 03 - $40,000 to just under $60,000
  • 04 - $60,000 to just under $80,000
  • 05 - $80,000 to just under $100,000
  • 06 - $100,000 to just under $150,000
  • 07 - $150,000 and above
  • 99 – Not sure/Prefer not to say

Environics Research
January 29, 2018

Health Canada

Longitudinal Vaper Panel Survey – Wave 2 RTS only - English

Final Questionnaire

LANDING PAGE

Please select your preferred language for completing the survey.

• 01 - English
• 02 - French

INVITATION FOR PARENTS AND LEGAL GUARDIANS OF 15-YEAR OLDS ONLY
In December, you gave permission for your 15-year old teenager to participate in an important survey about e-cigarettes conducted for Health Canada. We very much appreciate their participation and would like to get further opinions from them on this topic.

As their parent or legal guardian, we are requesting your permission for your child to participate in this follow-up survey. As before, it is a short 10-minute survey. This feedback will be used by Health Canada to develop regulations related to e-cigarettes and to design public education materials.

Since privacy is important while respondents answer this survey, we request that your child be able to complete the survey in a setting where his/her answers will not be seen by others. All answers will remain anonymous and confidential.

If you agree to allow your child to participate in this survey, please provide the survey link to him/her.  

Your child can access the survey using the URL from the email you received or by clicking on the "Continue" button below.

Thank you for your support of this important research.

LINK GOES TO “INTRODUCTION FOR ALL RESPONDENTS” BELOW

INTRODUCTION FOR ALL RESPONDENTS
Background information
In December, you participated in a survey about e-cigarettes conducted on behalf of Health Canada. We thank you for your input and would like to get further opinions from you on this topic.

As before, this is a short 10-minute survey. This feedback will be used by Health Canada to develop regulations related to e-cigarettes and to design public education materials.

Some of these questions are similar or identical to the ones you have answered before. Please answer them based on what you think or do right now without thinking about your previous answers.

[RECALL FOR 15 YEAR-OLD RESPONDENTS ONLY]: Your parent or legal guardian has again given permission for you to participate in this very important study.  Your participation is voluntary, so it is up to you to decide whether you are willing to answer, but we hope you do!  You can do the survey on your computer, laptop, tablet or phone.  You can stop at any time if you feel uncomfortable or choose not to answer certain questions.  Your answers will not be shown to your parent(s), legal guardian(s), teachers or anyone else, so please be as honest as you can.