Canadian Cannabis Vaping Survey Methodological Report

Prepared for Health Canada
Supplier name: Advanis Inc.
Contract number: HT372-194281 001 CY
Contract value: $46,666.74 (including HST)
Award date: February 13, 2020
Delivery date: May 4, 2020

Registration number: POR 107-19
For more information on this report, please contact Health Canada at:
hc.cpab.por-rop.dgcap.sc@canada.ca

Ce rapport est aussi disponible en Français.

Prepared for Health Canada
Supplier name: Advanis Inc.
May 2020

This public opinion research report presents the results of an online/telephone survey conducted by Advanis Inc. on behalf of Health Canada. The research was conducted with 515 Canadians between March 12th and April 13th, 2020.

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at:
hc.cpab.por-rop.dgcap.sc@canada.ca or at:

Health Canada, CPAB
200 Eglantine Driveway, Tunney’s Pasture
Jeanne Mance Building, AL 1915C
Ottawa, Ontario K1A 0K9

Catalogue number:
H14-350/2020E-PDF

International Standard Book Number (ISBN):
978-0-660-34928-2

Related publications (registration number: POR 107-19):
Catalogue number H14-350/2020F-PDF (Final report, French)
ISBN 978-0-660-34929-9

© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2020

Table of contents

1.0 Background and Objectives

1.1 Background

Use of cannabis is common in Canada. In 2017, Health Canada’s Canadian Tobacco, Alcohol and Drugs Survey (CTADS) found that 15% of Canadians 15 years of age and older reported using cannabis in the past year, with males having a higher prevalence of cannabis use compared to females. Canadians 15-24 years old were significantly more likely to use cannabis in the past 12 months than those 25 years of age and older. Use is also common in students, with 18% of students in grades 7-12 reporting past year use in the 2018-2019 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS). Cannabis and/or cannabinoids extracted from the cannabis plant can be consumed using various methods, using a variety of different cannabis products. Results from CTADS 2017 indicate 91% (4 million) of those who used cannabis in the past year smoked cannabis. Other common methods of consumption include mixing cannabis with tobacco (22% or 942,000), chasing (smoking a tobacco product right after smoking cannabis – 34% or 1.5 million), consuming cannabis in edibles (brownies, etc. – 38% or 1.6 million), and vaporizing (29% or 1.3 million) (note that respondents could select multiple methods of consumption). The results from the Canadian Cannabis Survey (CCS) 2019 were similar with 84% of those who used cannabis in the past 12 months saying they smoked cannabis. Forty-two percent (46%) indicated they had eaten it in food, 15% indicated the vaporized with a non-portable vaporizer and 27% used a portable vaporizer to consume cannabis. Vaporizing is also a common method of cannabis consumption among Canadian students in grade 7 to 12 with 42% (191,000) of students who used cannabis in the past year reporting they vaporized cannabis.

In October 2018, Canada became the first major industrialized country to regulate adult legal access to cannabis for non-medical purposes. When the Cannabis Act came into force, a limited number of cannabis products were authorized for sale. On October 17, 2019, amendments to the Cannabis Regulations came into force. These amendments permit the sale of additional cannabis products, including edibles, extracts and topicals. These amendments also allow the legal cannabis industry to begin producing and selling liquid cannabis extracts suitable for inhalation, such as vaping solutions. The legalization and regulation of additional cannabis products in Canada has also prompted a policy and scientific requirement to collect new comprehensive data on the subject of cannabis use, including indicators in the areas of health, public safety, and markets.  New research on cannabis use is helping the government better evaluate the possible impacts associated with its legalization, regulation, and restriction.

One method of consumption, vaporization, has received considerable attention recently for two reasons: the emergence of vaping-associated lung illness and a rise in youth vaping. First recognized in summer 2019, clusters of severe lung illness began to emerge in the US Midwest, predominantly in otherwise healthy young people. By fall 2019, more than a thousand cases had been identified, and more than a dozen deaths had occurred. Substantial medical interventions are required in some cases with patients tending to be young and male1. At this time there have been 19 cases reported in Canada2. However, results from CSTADS show there has been a rise from nine percent of students in grades 10 to 12 who report the use of an e-cigarette in the past 30 days in 2014/15 to 29% in 2018/19. In addition, the US Center for Disease Control believes injury is caused by chemical exposure, and that THC products are playing a role. Furthermore, the US Food and Drug Administration recently issued a warning to stop using THC vaping products3. As the investigation identifies specific causal or contributing agents, Health Canada has tools to respond for both nicotine and cannabis vaping but needs additional information about what and how Canadians are vaping to help support efforts to minimize negative health outcomes.

At present, there is a lack of detailed information on specific methods of cannabis consumption beyond prevalence estimates. To begin addressing this issue, the Canadian Cannabis Vaping Survey (CCVS) will focus on gathering additional data related to the vaporization of cannabis products. The CCVS will examine patterns of use, such as age of initiation of vaping, type of vaporizing device, products vaporized, frequency of vaping and quantities vaporized. It will also examine where Canadians are accessing both the vaporizing devices and the products they are vaporizing, perceived risk to health from vaping, and whether people have experience any adverse effects or symptoms as a result of vaping.

1.2 Objectives of the survey

The Canadian Cannabis Vaping Survey aimed to gather additional information on cannabis vaping products used by Canadians. More specifically, it examined patterns of use, such as the frequency of use and quantities used, types of products being used and sources. This research will be used to evaluate the impacts associated with the legalization and regulation of cannabis use going forward.

In conducting this research, Health Canada’s objective was to collect information on the following:

Achieving the research objectives will support Health Canada’s ability to assess the health risks or harms of cannabis to people who vape cannabis and/or the community (exposure to unregulated products, harms among at-risk populations).

1.3 Total expenditure

The total cost of this research was $46,666.74 including HST.

2.0 Sampling

2.1 The general approach

The approach recommended a sample size of 500 Canadians age 16 and older who had vaped cannabis in the past 12 months, with a concentrated effort on collecting data from 16 to 24 year olds to ensure that the sample was large enough for age group-specific analyses. Initially, the survey was to be conducted using a two-step approach where respondents were recruited by telephone to participate in the online web survey, however the option to complete the survey by phone was introduced part-way through to increase the response rate.

Approximately 750 respondents from the 2019 Canadian Cannabis Survey who indicated they vaporized cannabis and who agreed they were willing to be contacted again for future research were contacted by telephone and asked to participate in the survey. Considering the time lapse since this survey, we expected approximately 250 respondents from this group would participate in the Canadian Cannabis Vaping Survey. Additional respondents were recruited using a random digit dialing (RDD) recruitment method Advanis employs to gather responents willing to participate in future studies. For CCVS, respondents were recruited from a vaping study conducted in Ontario, as well as a national study in which respondents were prescreened as those who vape. Once respondents agreed to participate, they were sent a link to an online web survey. During data collection, it was determined that rates to complete the online survey were not as high as expected, so call backs were conducted to recruit individuals who had not yet completed the questionnaire. As well, to increase the response rate, respondents were given the option to complete the survey over the phone or online. Overall, 515 completed surveys were collected, including 395 online surveys and 120 phone surveys.

The average survey was estimated to be a length of 5-10 minutes depending on the number of vaping products the respondent had used. Among those completing the survey online, the average survey length was just under 7 minutes, while the telephone survey took an average of 11 minutes to complete.

The Canadian Cannabis Vaping Survey was designed by Health Canada. The Government of Canada’s standards for pre-testing were adhered to, with pretests being conducted in both English and French.

In total, we called 3,710 phone numbers, and 1,811 people agreed to participate in the survey, with a response rate of 54.3%. In total, 1,085 participants went through the screening process of the survey, but only 515 were eligible and completed the full survey. The participants were required to have vaped cannabis in the past 12 months. Of these recruitment calls, 7 percent were conducted in French and 93 percent were conducted in English. The response rate calculation is presented in Appendix A.

During the computer-assisted telephone interviews (CATI) recruit, Advanis requested permission to send the survey link to respondents’ mobile phones via a Short Message Service (SMS). The advantage of SMS survey invitations is that, unlike email invitations, they avoid issues with incorrect email addresses and spam filtering. If the recruited respondent did not have a smartphone or preferred email, survey links were sent via email. Of the respondents who completed the CATI screener, 99 percent were recruited via SMS, and 1 percent were recruited by email. Of those recruited to the online survey by SMS, 47.9% participated in the survey, however, of those, only 21.7% qualified to complete the full online survey by indicating that yes, they had vaped cannabis in the past 12 months. Among those sent an email invitation, the completion rate of the online survey was 27.2% percent, although only 22 email invitations were sent in total.

Invite reminders were sent 3 days and 6 days after the initial invitation. Once SMS/email reminders had been sent, Advanis also called back and offered the option to complete the survey by telephone in order to boost the response rate.

2.2 The pretest and field dates

The pretest was conducted on March 12th, 2020. During this pretest, we recruited 234 people by phone in English only, as the French translation was not yet available. This led to 32 completed online surveys. The validation of the data was completed the morning of March 13th. No changes were made to the survey following the pretest. Once the French translation was ready, a pretest was completed in French and the data was reviewed. Again, no changes to the survey were necessary. The data collection period was from March 12th to April 13th, 2020.

2.3 Quality control

2.3.1 - Quality Control in Survey Programming

Advanis utilizes technology to maximize quality control in survey programming. Having developed a proprietary survey engine tool, Advanis professionals are able to design and program a survey in a browser-based environment, eliminating the need to involve a programmer who is less familiar with the survey subject matter. Below are the steps followed to ensure the quality of the survey.

2.3.2 - CATI Methodology and Quality Control

The CATI recruit script was programmed on Advanis’ proprietary CATI platform with no unforeseen challenges. Advanis was able to leverage its experience for the survey programming and the reminder process to achieve high quality standards.

Advanis implemented the following to ensure the highest quality data collection:

To ensure high interview quality, our interviewers are trained to use various interviewing techniques. As well as maintaining a professional attitude, our interviewers must also be convincing, read word-for-word, take notes, probe deeper on semi-open and open questions, systematically confirm the information given and listen to the respondent.

2.3.3 - Web Methodology and Quality Control

All Advanis Web surveys are hosted internally by Advanis, and we employ a rigorous and stringent set of data collection control mechanisms to ensure the highest quality for the data collected, including:

2.3.4 - Quality Control in Data Handling and Reporting

For all of the data collected, Advanis develops rules to check the validity of the data. These rules include items such as:

Advanis staff have used the SPSS Statistics Software for over 20 years and are very proficient users of the software. All data cleaning performed on projects are outlined in syntax files with intermediate data files saved throughout the process. This ensures that the original raw data file is never overwritten, and that if an error is discovered in our code, we can quickly and easily rerun the syntax to produce a new data file. Individuals developing code incorporate internal checks in their code (e.g., crosstabs) to ensure the syntax had the desired effect. In addition, all syntax is reviewed by another team member or technical specialist for accuracy.

2.4 Sampling plan and data collection

The target audience for this project was Canadians, across all provinces and territories, who are 16 years and older and had vaped cannabis in the past 12 months.

The sample consisted of a core sample of 3,710 Canadians aged 16 and older that declared they had vaped cannabis in a previous study conducted in 2019, the Canadian Cannabis Survey (CCS). We used three sources for this sample: the CCS 2019 (754 cases), an internal study conducted by Advanis in Ontario (252 cases), and a study conducted by Advanis on vaping (2,704 cases). Of the 515 completes obtained, 216 came from the 2019 CCS survey re-contact, with the remaining 299 coming from the Advanis study sample sources.

3.0 Weighting

3.1 The weighting approach

Survey weights are typically used to correct for variation between a survey sample and the target population; they adjust the data to better reflect the population based on parameters such as sex, province and age.  This allows one to generalize the survey results and make inferences on the population. In order to develop and apply survey weights, random sampling (or probability sampling) should be used, where each individual is assumed to have an  equal probability of selection. When non-random samples are used, it is difficult to determine individual weights as the sample size is unlikely to reflect the population, and thus produce unreliable, non-robust results about the target population. In such circumstances, it is better to not weight the data. Based on the sample size and the methodology used to recruit participants (i.e., more of a convenience sampling approach), Health Canada requested that the data remain unweighted.

4.0 Data cleaning and guidelines for analysis and release

4.1 Data cleaning and coding

After the data collection was completed, data cleaning was performed to ensure high quality results. Data cleaning involved converting questions requiring numerical responses into metric questions for ease of analysis. The metric question type simplifies the analysis by easily providing measures of mean, median, etc. For this recoding of scales into a metric value, the recoding used the same values as the original input, given that it was the number of puffs.

A recode was also completed for the CATI data, as well as reviewing the “other, specify” verbatims on the Brand questions, to back code brands into existing brand levels where possible.

Appendices

Appendix A: Response Rate Calculation

  Total %
GENERATED 3,710 100.0%
USED 3,710 100.0%
Not in service 125 3.4%
Not residential 23 0.6%
Line problem 2 0.1%
Fax 2 0.1%
Wrong number 0 0.0%
A. NOT VALIDa 152 4.1%
VALID 3,558 95.9%
Not eligible 78 2.2%
Language barrier 1 0.0%
Age - Illness 1 0.0%
Other 87 2.4%
B. OUT OF SAMPLEb 167 4.5%
SAMPLEc 3,390 91.4%
C. Household refusal 464 13.7%
C. Multiple household refusal 0 0.0%
D. Respondent refusal 559 16.5%
D. Multiple respondent refusal 2 0.1%
D. FINAL refusal 52 1.5%
D. Prolonged absence 1 0.0%
D. Incomplete 0 0.0%
C. No answer 430 12.7%
D. Appointments 71 2.1%
Completed interviews 1,811 53.4%
% REFUSALd 31.8% -
% COMPLETEDe 53.4% -
ELIGIBILITY RATEf 93.7% -
RESPONSE RATEg 54.3% -
  • a No possible contacts at these numbers
  • b Respondents were not eligible or were unable to answer
  • c Usable numbers
  • d Refusal/sample
  • e Completed/sample
  • f D+Completed/B+D+Completed
  • g Completed/C*(E.R.)+D+Completed

Appendix B: Political Neutrality Requirement

Political neutrality certification

I hereby certify as Senior Officer of Advanis 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 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:
Nicolas Toutant, Vice-President, Research and Evaluation

Appendix C: Questionnaire

Health Canada Vaping Study
Government of Canada
Generated on 2020-04-28 at 13:57:54 MT

Languages: English, French

Section Intro1, S1, T2, T1

Page

Intro1

Health Canada is conducting this survey on cannabis vaping, use patterns, and whether people who vape cannabis products are aware of Vaping Associated Lung Illness. Advanis has been hired to administer the survey. Si vous préférez répondre au sondage en français, veuillez cliquer sur le bouton FRANÇAIS ci-dessus.

The survey takes between 5 and 10 minutes to complete and is voluntary and completely confidential. Your answers will remain anonymous.

If you wish to verify the authenticity of this survey please email: hc.odss-bssd.sc@canada.ca (mailto:hc.odss-bssd.sc@canada.ca ).

The survey automatically moves to the next question when possible, however in some cases you need to press the right arrow button at the bottom of the screen to move to the next question. This button will not appear until you have answered the question.

To change previous answers you can press the left arrow button at the bottom of the screen. Some questions provide further information if you press the following symbol:

If you need to stop the survey at any point you can return at a later time and the survey will continue where you left off.


© 2020 Advanis Privacy Policy (http://www.advanis.ca/privacy_policy2.html)

For assistance with the survey please contact Sue Day at 1-888-944-1212 or via email survey+vape@advanis.net (mailto:survey+vape@advanis.net).

S1
What product(s) did you vape in the past 12 months?
Select all that apply

T2 Show if S1 Haven’t Vaped or Refused
We're sorry but for this study we are looking for people who have vaped in the past 12 months.

Thank you very much for your time.
Status Code: 501

T1 Show if Didn’t Select Qualifying products
We're sorry but for this study we are looking for people who have vaped other products.

Thank you very much for your time.
Status Code: 502

Section Demographics D1, D2, D3, D4

Page Demographics

D1

What is your age?
An answer is required

D2

What was your sex at birth?

D3

What is your gender?

Refers to current gender which may be different from sex assigned at birth and may be different from what is indicated on legal documents.

D4

In which province or territory do you currently live?

Section Vaping Section Vape, Q1, Q2, Q3, Q4, Q4b, Q4c, Q5, Q6a, Q6b, Q6c, Q6d, Q7c, Q7aa, Q7ab, Q7ac, Q7ba, Q7bb, Q7bc, Q8a, Q8bEN, Q8bFR, Q8d, Q8c, Q9, Q10a, Q10b, Q11, Q12a, Q12b, Q13a, Q13b, Q13c

Page Vaping Section
Vape


In this survey, when we use the term cannabis, this includes marijuana (e.g., weed, pot), hashish, hash oil or any other products made from the cannabis plant, including CBD products, but not synthetic cannabinoids.

When we ask about vaping, this includes vaping cannabis in its dry form or when mixed or processed into another product such as an extract, a concentrate, including hashish, a liquid, or other product.

Please click the arrow on the right to continue.

Q1
In general, how harmful do you think the following are?

  1. Vaping dried flower/herb
  2. Smoking dried flower/herb
  3. Vaping liquid cannabis oil/extract
  4. Smoking liquid cannabis oil/extract
  5. Vaping solid cannabis extract (e.g., shatter, hash)
  6. Smoking solid cannabis extract (e.g., shatter, hash)

Q2

How long have you been vaping cannabis for?
Minimum: 0.0, Maximum: 100.0

Q3

In the past 12 months, how did you vape cannabis?
Select all that apply

Q4

Have you modified the cannabis vaping device you typically use?

Q4b
Show if Q4 Yes

How did you modify your device?

Please do not enter personally-identifying information

Q4c      
Show if Q4 Yes

Why did you modify your device?

Please do not enter personally-identifying information

Q5
In the past 12 months, how often did you use the following product(s) in a vaping device?

  1. Dried flower/herb (Show if S1 Dried flower herb)
  2. Liquid cannabis oil/extract (Show if S1 Liquid cannabis)
  3. Solid cannabis extract (e.g., shatter, hash) (Show if S1 Solid cannabis)
  4. Other cannabis product: <<S1.specify(6)>> (Show if S1 Other cannabis)

Q6a
Show if S1 Dried flower herb

On a typical use day, how much dried flower/herb did you use?

Q6b
Show if S1 Liquid cannabis

On a typical use day, how much liquid cannabis oil/extract did you use?

Q6c
Show if S1 Solid cannabis

On a typical use day, how much solid cannabis extract (e.g., shatter, hash) did you use?

Q6d
Show if S1 Other cannabis

On a typical use day, how much other cannabis product: <<S1.specify(6)>> did you use?

Q7c
Show if Q3 Vaped liquid cannabis non-disposable

Do you use cartridge/pods or liquid cannabis oil/extract in your non-disposable vaping device?

Q7aa
Show if Q3 Vaped liquid cannabis non-disposable

What brand(s) of cartridge/pod or liquid cannabis oil/extract do you typically use in your non-disposable vaping device?

Begin typing in the search field below and a list of options will appear. Please select the item that corresponds with what you are typing. A selection needs to be made before you can advance to the next page.

Q7ab
Show if Q3 vaped liquid non-disposable AND Q7a gave response
Is there a second brand of cartridge/pod or liquid cannabis oil/extract you typically use in your non-disposable vaping device?

Begin typing in the search field below and a list of options will appear. Please select the item that corresponds with what you are typing. A selection needs to be made before you can advance to the next page.

Q7ac
Show if Q3 vaped liquid non-disposable AND Q7ab gave response

Is there a third brand of cartridge/pod or liquid cannabis oil/extract you typically use in your non-disposable vaping device?

Begin typing in the search field below and a list of options will appear. Please select the item that corresponds with what you are typing. A selection needs to be made before you can advance to the next page.

Q7ba
Show if Q3 Vaped liquid cannabis Disposable

What brand(s) of disposable cannabis vaping device do you typically use?

Begin typing in the search field below and a list of options will appear. Please select the item that corresponds with what you are typing. A selection needs to be made before you can advance to the next page.

Q7bb
Show if Q3 vaped liquid disposable AND Q7ba gave response

Is there a second brand of disposable cannabis vaping device you typically use?

Begin typing in the search field below and a list of options will appear. Please select the item that corresponds with what you are typing. A selection needs to be made before you can advance to the next page.

Q7bc
Show if Q3 vaped liquid disposable AND Q7bb gave response

Is there a third brand of disposable cannabis vaping device you typically use?

Begin typing in the search field below and a list of options will appear. Please select the item that corresponds with what you are typing . A selection needs to be made before you can advance to the next page.

Q8a
Show if Q3 Vaped liquid cannabis non-disposable

In the past 12 months, have you mixed or made your own cannabis vaping liquids?

Q8bEN
Show if Q8 Yes AND English Please indicate what ingredients you used to mix or make your cannabis vaping liquids.

Select all that apply

Q8bFR
Show if Q8 Yes AND French Please indicate what ingredients you used to mix or make your cannabis vaping liquids.

Select all that apply

Q8d
Show if Q8a Made own

What method do you use to make your own cannabis vaping liquids?

Please do not enter personally-identifying information

Q8c
Show if Q8 Yes

Why did you choose to mix or make your cannabis vaping liquids?

Q9
Show if S1 Cannabis product

In the past 12 months, where did you usually obtain or purchase the product(s) you used in the vaping device?

  1. Dried flower/herb (Show if S1 Dried flower herb)
  2. Liquid cannabis oil/extract (Show if S1 Liquid cannabis)
  3. Solid cannabis extract (e.g., shatter, hash) (Show if S1 Solid cannabis)
  4. Other cannabis product: <<S1.specify(6)>> (Show if S1 Other cannabis)

Q10a
Show if Q9 Illegal Source 5 6 9 AND S1 Liquid Solid OR Other

Have you ever purchased cannabis products for vaping from a legal source, on or after December 16th, 2019?

  1. Liquid cannabis oil/extract (Show if Q9 Liquid Illegal source 5 6 9)
  2. Solid cannabis extract (e.g., shatter, hash) (Show if Q9 Solid Illegal source 5 6 9)
  3. Other cannabis product: <<S1.specify(6)>> (Show if Q9 Other Illegal source 5 6 9)

Q10b
Show if Q10a Levels ALL No if answered

Do you intend to purchase cannabis products for vaping from legal sources in the future?

Q11
In the past 12 months, which of the following health care providers, if any, have you had to seek medical attention from due to vaping cannabis?

Select all that apply

Q12a
In the past 12 months, have you looked up health information related to vaping cannabis?

Q12b
Show if Q12a Yes

Where did you look for this information?

Select all that apply

Q13a
Are you aware of vaping-associated lung illness?

Q13b
Show if Q13a Yes

Has your awareness of vaping-associated lung illness changed your cannabis vaping behaviour?

Q13c
Show if Q13b Yes

How has your awareness of vaping-associated lung illness changed your cannabis vaping behaviour?

Select all that apply

Section Finish F1, End1

Page Finish

F1

Finally, would you be willing to participate in this study again in the future?

End1

You have now completed the survey and your answers were submitted. Thank you very much for participating in this survey

If you vape, or have vaped in the past, and have developed symptoms of a cough or shortness of breath, chest pain, or are generally feeling unwell, visit a health care provider. Be sure to mention to your health care provider any history of current or past vaping.

Report any adverse reactions or incidents related to vaping products to Health Canada. For more information, please visit https://www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness.html (https://www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness.html).

Status Code: -1

Footnotes

  1. US Center for Disease Control:  https://www.cdc.gov/media/releases/2019/p1028-first-analysis-lung-injury-deaths.html
  2. Government of Canada: https://www.canada.ca/en/public-health/services/diseases/vaping-pulmonary-illness.html
  3. US Center for Disease Control: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html and US Food and Drug Administration: https://www.fda.gov/consumers/consumer-updates/vaping-illness-update-fda-warns-public-stop-using-tetrahydrocannabinol-thc-containing-vaping