Executive Summary
May 2020
Prepared by:
Quorus Consulting Group Inc.
Prepared for:
Health Canada
Supplier Name: Quorus Consulting Group Inc.
Contract Award Date: January 20, 2020
Delivery Date: May 2020
Contract Amount (incl. HST): $174,871.29
Contract #: HT372-194121/001/CY
POR Number: 069-19
For more information on this report, please email:
Hc.cpab.por-rop.dgcap.sc@canada.ca
Ce rapport est aussi disponible en français.
Exploratory Research on Youth Vaping
Final Report
Prepared for Health Canada
Supplier name: Quorus Consulting Group Inc.
May 2020
This public opinion research report presents the results of focus groups conducted by Quorus Consulting Group on behalf of Health Canada. The research study was done using qualitative focus groups. The research entailed a total of 16 in-facility focus groups conducted with occasional and regular youth who vape and with educators. The research was conducted between March 2 and March 12, 2020.
This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from the Health Canada. For more information on this report, please contact the Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca or at:
Department of Health
200 Eglantine Driveway
A.L. 1915C
Ottawa, Ontario
K1A 0K9
Catalogue Number:
H14-347/2020E-PDF
International Standard Book Number (ISBN):
ISBN 978-0-660-34694-6
Related publications (registration number: POR 069-19):
H14-347/2020F-PDF (Final Report, French)
ISBN: 978-0-660-34695-3
© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2020
Political Neutrality Statement
I hereby certify as Senior Officer of Quorus Consulting Group Inc. that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Policy on Communications and Federal Identity and the Directive on the Management of Communications - Appendix C.
Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate or ratings of the performance of a political party or its leaders.
Signed:
Rick Nadeau, President
Quorus Consulting Group Inc.
Quorus Consulting Group Inc.
Contract Number: HT372-194121/001/CY
POR Registration Number: 069-197
Contract Award Date: January 20, 2020
Contracted Cost: $174,871.29
The Tobacco and Vaping Products Act (TVPA) came into force on May 23, 2018, to regulate the manufacture, sale, labelling and promotion of tobacco products and vaping products sold in Canada. The TVPA creates a new legal framework for regulating vaping products to protect young persons from nicotine addiction and tobacco use, while allowing adults to legally access vaping products as a less harmful alternative to tobacco.
Though scientific knowledge is still emerging, Health Canada recognizes that vaping products could bring public health benefits if they reduce tobacco-related death and disease by helping smokers quit or switch completely to a less harmful source of nicotine. However, vaping products could also bring public health harms.
This exploratory research was conducted to gain clarity and understanding regarding how youth are using vaping products, the behaviours of a youth vaper, as well as the differences between those who use products regularly versus those who use them occasionally. This research will be used to help inform policy and regulatory decision making in addition to helping Health Canada have a more fulsome understanding of the phenomenon of vaping among youth and among those around youth, namely educators.
This report is based on 16 in-person focus groups that Quorus completed between March 2 and March 12, 2020. Four focus groups were held in four cities, with one session in each city consisting of educators, one with young participants 13 to 15 years of age and two sessions with youth 16 to 19 years of age. The sessions with young participants consisted of individuals who occasionally or regularly vape, and of “experimenters” (i.e. they have vaped in the past and have not completely ruled out vaping in the future). Among youth, one session was with regular vapers and one with occasional vapers. In total, 103 youth 13 to 19 years old and 36 educators participated in the focus groups. English sessions were held in Regina, Vancouver, and Toronto and French sessions were held in Montreal. More details can be found in the Methodology section of the report.
Qualitative research is designed to reveal a rich range of opinions and interpretations rather than to measure what percentage of the target population holds a given opinion. These results must not be used to estimate the numeric proportion or number of individuals in the population who hold a particular opinion because they are not statistically projectable.
To begin each session with youth, the moderator explored what “life was like as a student/ a teenager these days.” Youth explained that life was challenging in many respects including facing pressure to perform at school, pressure to figure out their future, and social pressures, especially fitting in. Balancing schoolwork with other obligations (e.g. sports, a part-time job, etc.) was also a challenge for many. Participants often needed to be prompted to identify what was going well, which typically led youth to explain that they enjoy spending time with friends, the freedom they have as teenagers despite various obligations, and that they are going through a lifestage that allows them to discover and experiment.
When they think back to the first time they vaped, youth remembered that the opportunity to vape was almost always presented to them rather than being sought out. While most willingly went along, some needed to be asked a few times before they accepted. The invitation was quite often presented by someone well known to them (e.g. a friend, a sibling) and was often at a gathering of friends. If anything, youth decided to try vaping out of curiosity, to fit in, be cool or feel a little rebellious. Even though they did not know much about vaping at the time, most had seen it around them and few felt they were taking a big risk.
The first time was rarely a pleasant experience. Many remembered coughing, feeling ill or nauseated, or not feeling anything. Most admitted that they needed to learn how to vape and only then did they come to discover “what the hype was all about”, especially the head rush.
Most regular vapers would say that they vape at least once a day, with many vaping first thing in the morning. It is among regular vapers that we will find individuals who are most likely to consider themselves “addicts.” Some of the most frequent vapers will often create opportunities to vape (e.g. bathroom breaks, vape in the classroom). Nearly all these youth own a vape and will almost always be vaping a product with at least 50mg of nicotine. Regular vapers seemed just as likely to vape on their own as they would be with friends or socially.
Occasional vapers are, by and large, social and convenience vapers. They very rarely vape by themselves and most do not own their own vape. They vape if the opportunity presents itself or, if they vape very rarely, at a social gathering. What they vape will largely depend on whether they own their own vape. Those who do are almost always vaping a product with at least 50mg of nicotine. Those who do not will find themselves vaping whatever is offered. Because they don’t vape all that much anyway, these vapers are less concerned with what is in the vape.
It is among occasional vapers that we are most likely to find youth who are vaping lower levels of nicotine, who are vaping because they might enjoy the flavour or who are vaping mostly because they enjoy the activity and not because they feel they need to do it.
Most youth, especially regular vapers, vape at school. They will explain that students vape “everywhere,” including the classroom but especially in bathrooms and the yard, and that students are undeterred by any efforts by their school to control vaping. Circumventing rules is easy for them because of the increasingly compact size of vapes, they can inhale the vapour without letting any out, fruity or sweet odours are passed off as candy or gum, and vaping can happen very quickly.
Furthermore, many students believe that teachers are turning a blind eye to the behaviour because it is so common and it is not all that disturbing. They are not seeing many students being disciplined for vaping, leading most to believe that the rules are in place but they are not strictly enforced.
Regular vapers are more likely than occasional vapers to feel that vaping is important to them personally. Those who feel vaping is important to them personally are inclined to feel that it is about as important to them as eating and breathing and that if vaping were to disappear tomorrow, they would have trouble coping for a number of weeks. These youth acknowledge they rely on vaping and that if they do not vape regularly, they recognize a variety of withdrawal effects (e.g. irritability, difficulty concentrating). Similarly, some who place a high importance on vaping explained that it allows them to manage anxiety, manage stress, and cope in general. Some also explained that vaping is an important social enabler.
Those who do not believe that vaping is important to them personally explained that they vape so rarely that even if it were to disappear tomorrow, they would hardly notice it and that it would be quite easy for them to quit. To them, vaping is like a snack, a chocolate bar or dessert - they enjoy having it from time to time and it is an indulgence or a nice “treat” when it happens but they do not feel they need to have it to get by.
By far the “best thing about vaping” is the head rush. This underscores the importance many place on vaping products with 50mg of nicotine, which most recognize as being one of the highest levels of nicotine they can get in Canada. A distant second in terms of the best thing about vaping are the flavours, followed by “cool clouds / vape tricks”, and how convenient vaping is, especially compared to cigarettes.
Vaping makes most youth feel “relaxed,” but some also believe it makes them feel high and lightheaded while for others it made them feel lethargic. For another group, vaping seems to energize them.
For some, the best thing about vaping was having something in common with friends and fitting in, and vaping makes them feel like they are part of a community, cool or accepted.
All participants seemed to agree there is some element of risk to vaping; however, many were hesitant and vague when asked to explain what they saw as the exact risks. Many suspected that vaping is just generally unhealthy and that there is a risk of addiction but they were still left wondering: If it was so risky, why are so many people doing it?
Some youth are starting to see or feel effects on their health that they attribute to vaping, especially those who vape more regularly and among those who have tried to quit. One of the more recognizable effects is addiction, something they or someone they know were experiencing. The discussion revealed that some did not consider nicotine addiction as a significant threat to their health, and unlike being addicted to certain drugs or alcohol, they didn’t feel any stigma associated with being addicted to nicotine or vaping. Conversely, some were more concerned with addiction because they didn’t like the idea of becoming dependent on a substance, they were concerned with the physical and psychological impact that this dependence has on a person, and in the end, they were worried about the issues and difficulty often associated with trying to quit something to which one is addicted.
There was some awareness among youth that vaping had originally been positioned as a strategy to help smokers quit smoking, leaving them with the impression that vaping was “safer” or “healthier” when compared to smoking cigarettes. Something else that left some feeling that vaping was fairly safe was the lack of authoritative evidence proving that it is harmful. The only serious cases they might have heard about were incidents on the news or on Facebook, most of which referenced individuals in the United States. While some were left quite worried about these incidents, others seemed quite dismissive, arguing that they were isolated cases of people who probably vape far more than they do and that they were vaping questionable products. Some youth also argued that if vaping were harmful, there would be far more cases of users being hospitalized or getting sick.
In terms of other possible risks, a few noted getting caught and reprimanded by teachers and/or parents, letting their parents down, and, the financial costs of vaping.
When asked to rate how harmful various substances and activities might be to their health, vaping with nicotine was considered less harmful than smoking cigarettes and considered roughly as harmful as drinking alcohol. Vaping with nicotine was by far considered more harmful than vaping without nicotine, which, among the list of activities and substances listed, was rated by youth as one of the least harmful for their health.
A considerable amount of time was dedicated to exploring the types of devices that youth own and what types of products they vape, with a focus on nicotine levels and flavours.
Many youth, especially regular vapers, owned their own vaping device. The most common reasons for wanting to own a device are that they are easy to get, that it is popular and cool to own one’s own vape, they can vape what they want and when they want, and, that sharing is increasingly frowned upon because it is unhealthy, “mooching” is seen as socially unacceptable, and, those who own their own device are less inclined to share because products are so expensive.
Youth explained that, irrespective of their age, if they needed to get a device tomorrow, it would be “very easy,” something in which younger participants seemed to take pride. Strategies used or witnessed included buying one at a local retailer (especially convenience stores) who is not verifying proof of age, using a fake ID, asking an older friend, student at school or sibling to buy one, waiting outside stores and asking a stranger to buy one for them for a small “buyer’s fee”, buying it at school and finding one online or through social media.
When explaining why they might prefer one device over another, participants focused on ease of use, size, affordability of the device and the pods, how well it produces a head rush or clouds, if it is being used by their friends and if it is the latest style.
The topic of flavours came up at various points in each focus group. For a few, flavours (or their smell) were part of the initial appeal of vaping and enticed them to try it. As well, for some participants, flavours are one of, if not the best part, of vaping. If the taste of vaping were, overnight, to become bad, many believe they would definitely stop vaping, but if the taste were to be no worse than something neutral, then they would probably still vape because they value other aspects of vaping more than the taste, especially the head rush.
When it comes to the pods they are using, youth had no concerns whatsoever regarding their trustworthiness or safety, mostly because they are using store-bought products.
Nicotine, especially the head rushes it produces, was the main reason why youth vape. When they described how much they need to vape, youth fully acknowledge that they are actually addicted to or craving the nicotine in the vape above anything else. Youth are well informed regarding what the highest levels available are in Canada and almost unanimously use products with 50mg of nicotine.
Many in each group had heard of nicotine salts but few seemed to know enough about them to provide an explanation of what they are or what their opinion was of them. It would seem that many are probably using nicotine salts but may not even know.
There were mixed feelings among participants about whether vaping had led them to using other products like cigarettes or cannabis.
When it comes to smoking cigarettes, very few smoked cigarettes in addition to vaping and fewer still believe they started smoking after they had started vaping.
Many youth had already smoked cannabis at some point and most explained they would have ended up smoking cannabis irrespective of their vaping. However, a few did point out that learning how to vape allowed them to more easily learn how to “properly” smoke cannabis, and, for some long-time vapers, smoking cannabis was the next “thrill.”
Many youth occasionally used other substances when they vape (not in the vape itself), in particular alcohol, cannabis and other recreational drugs. By and large, multiuse of vaping with other substances happened at parties and at smaller gatherings of close friends. Participants explained that vaping improves the effects of cannabis and of other recreational drugs and that the head rush they got from vaping tended to be better when they had consumed alcohol.
The notion of vaping less had crossed the minds of many youth but it was only a priority for a small number of them. Many of those who did not see cessation as a priority tended to view vaping as a very casual activity that they could easily stop doing. Regular vapers not focused on cessation explained that their vaping was not a problem for them or for anyone around them and, seeing as they were enjoying it so much, did not see why they would need to curb their use.
However, some regular vapers did recognize that they were consuming too much or that they were even addicted and they were keen on vaping less or quitting outright. These participants tended to focus mostly on their health, in particular on concerns for their lungs. Some had also heard about cases in the news, some had felt their own health deteriorate because of their vaping and others did not like how they felt when they had not vaped for a while.
The extent to which youth succeeded in reducing their vaping varied. Two important barriers of quitting vaping were that their friends vape and the withdrawal effects.
Although most youth did not see cessation as a priority today, most expected that they will not be vaping “in the future.” They believed vaping was a by-product of their teenage lifestage and of the types of friends they have in high school and that this was not going to last as they reached adulthood.
Youth did not seem to recall having had many conversations about the risks associated with vaping, whether at home or at school. If any had been had, they were most likely to have been with a parent. Youth rarely found these conversations had much impact on their vaping since they did not provide sufficient evidence or sufficiently compelling evidence that vaping was harmful for their health.
If they were to search for information they could trust about the health effects of vaping, many would use Google while a few mentioned Health Canada, the FDA, or a teacher. Some indicated they would prefer to consult someone who has experience vaping or who has been vaping for a long time.
Government organizations like Health Canada were not however universally considered trustworthy or unbiased, with some sensing that the information from these types of organizations tends to be one-sided.
Overall, educators feel students are stressed and busy and that they lack motivation and resiliency. Educators believe youth are “addicted” to their smartphones and social media, which are distractions that challenge their mental health.
Educators are also quite united in thinking that parents are not parenting like they used to. They feel they are not as engaged in their children’s academic life as they would like, and that they are allowing their children to get away with more. All of this makes it harder for educators to motivate and discipline students.
While most educators may have had positive impressions of vaping when they first came across it many years ago, those impressions have completely reversed. They are now concerned with the extent of youth vaping, youth addiction to nicotine and news coverage of vaping.
Educators did not feel overly knowledgeable about vaping, with the exception of some student counselors and substance abuse counselors. Educators rarely talk about vaping with their colleagues and only a few have had conversations with students.
When asked to explain why they believe youth start to vape, common reasons proposed included: social connection, peer pressure, curiosity, to be cool / popular, to be a rebel, adults are vaping / they see it everywhere, it’s a new gadget, and, to fit in.
When asked to explain why they believe youth continued to vape, common reasons proposed included: addiction, to be part of a crowd, to be cool, it is easy to hide or conceal, it tastes good, it feels good / head rush, and, to keep busy.
Educators had either heard of or seen their students vaping, but most revealed it wasn’t as big of an issue as other substance use or student-related issues. Most prevalent among the issues is student mental health, including anxiety, fitting in, and depression. Educators are also seeing students struggle with challenging home lives, lack of motivation, managing cell phones, and managing social media.
While vaping is more prevalent at school than before and certainly believed to be more prevalent than other substances in a school setting, some educators explained that it doesn’t affect how students perform or behave in school, unlike marijuana or other substances, and so it is given a far lower priority from a student management perspective.
If educators ever saw a student vaping or about to start, they revealed they might confiscate the device, issue a warning, and/or send them to a designated smoking area outside (if there is one). Educators felt that students are much more casual about getting caught with their vaping devices compared to if they were to get caught with alcohol or drugs.
There was not a consistent approach to handling vaping across schools, and in many cases, the educators were not well informed about school-level rules and policies. The general assumption was that there probably was a policy in place at the board level. Provincial smoking laws were a common reference for where students could and could not vape and what the penalties were.
Notwithstanding student and substance abuse counselors, few educators would say that it is their role to formally intervene and counsel students regarding their vaping. Educators would sooner turn to counselors as the more appropriate resource.
Almost all educators feel they are not well equipped to deal with vaping - most of them only know what they see in the news, but they know that this is not enough. Educators also suspect that many parents are in a similar situation.
Educators were asked to write down any questions they had about vaping. Most of the questions educators had were about the health effects of vaping, how vaping compares to smoking cigarettes, where they could get learning materials for their students, what their involvement as teachers should be to inform their students, and, if there were effective ways to get the message across to students.
Ideally, educators would like to have someone other than themselves educate students on the potential harmful effects of vaping. In a perfect world, there would be student workshops with either an expert in the field, and/or a peer who can come in and give a personal story or a testimonial about how vaping has affected their life.
Educators were shown posters and brochures that were designed by Health Canada and used in the 2019-2020 Youth Vaping Prevention Campaign to inform youth of the risks of vaping. These materials received mixed reviews. Most agreed that students would not sit and read a brochure or stop to look at a poster that is full of text. The materials needed to “speak their language” and leverage mediums like social media, podcasts, “memes” and YouTube influencers.
Very few indicated that their school had hosted an event or activity specifically to talk about vaping. Among those who remembered a Health Canada event (mostly in Vancouver and Regina), feedback was positive.
Educators did admit that some of the resources (e.g. the activity sheet) would be useful for younger students (grades 6 or younger) and that the information sheets and brochures were helpful for them as educators and potentially for parents. They were not all convinced that parents would read the brochure, but it was better than nothing.