To what extent and through what channels did Canada’s provincial bans on electronic cigarette (e-cigarette) sales to minors reduce their e-cigarette use?
This quasi-experimental difference-in-differences and triple-differences study found that, between 2013 and 2017, e-cigarette use by youths increased in all provinces but less rapidly in provinces with a ban on e-cigarette sales to minors. Youths in provinces with a ban on e-cigarette sales to minors had better perception of harm from e-cigarette use and greater difficulty obtaining e-cigarettes but also higher use of social sources for e-cigarettes.
Banning e-cigarette sales to minors was associated with a lower rate of increase in e-cigarettes use by youths, but a ban alone could not reverse the overall increase in e-cigarette use; to be more effective, this policy needs to be supplemented by other measures that can address youths’ access to e-cigarettes through social sources.
Banning electronic cigarette (e-cigarette) sales to minors has been a key policy to protect children from e-cigarettes in the United States and Canada, but to date little is known about the outcome of such a ban.
To investigate the association of banning e-cigarette sales to minors in Canada with e-cigarette use among youths and the mechanisms through which a ban might be associated with their e-cigarette use.
Design, Setting, and Participants
This quasi-experimental difference-in-differences and triple-differences study used data from the nationally representative Canadian Tobacco, Alcohol and Drugs Survey (2013-2017) and Canadian Student Tobacco, Alcohol and Drugs Survey (2014-2017). Study samples consisted of respondents aged 15 to 18 years (in difference-in-differences analysis; n = 8212) and aged 15 to 25 years (in triple-differences analysis; n = 20 934) in the Canadian Tobacco, Alcohol and Drugs Survey, and students in grades 6 to 12 (in difference-in-differences analysis; n = 78 650) in the Canadian Student Tobacco, Alcohol and Drugs Survey.
Canada’s provincial bans on e-cigarette sales to youths younger than 18 or 19 years (depending on province) implemented between 2015 and 2017.
Main Outcomes and Measures
The primary outcome was past 30-day e-cigarette use among youths. Secondary outcomes were difficulty of access to e-cigarettes, perception of e-cigarette harm, and use of social sources of e-cigarettes.
After the bans, e-cigarette use among youths increased in all provinces, but the increase was 3.1 percentage points (95% CI, 0.2-6.0; P = .04), or 79%, lower in provinces with a ban than in provinces without a ban. Youths in provinces with a ban were 2.6 percentage points (95% CI, 1.5-3.7; P = .001), or 18%, less likely to believe that regular e-cigarette use poses no harm and 6.2 percentage points (95% CI, 1.1-11.4; P = .02), or 16%, more likely to self-report greater difficulty in obtaining e-cigarettes. Among youths who reported using e-cigarettes, the likelihood of obtaining e-cigarettes from social sources was 17.3 percentage points (95% CI, 5.2 -29.4; P = .01), or 29%, higher in provinces with a ban. These findings were robust to several sensitivity analyses.
Conclusions and Relevance
Banning e-cigarette sales to minors was associated with a significant reduction in the rate of increase in e-cigarette use by youths, but this policy alone could not reverse the overall increase in e-cigarette use. The findings from this study suggest that this policy should be supplemented with other measures that can reduce young people’s desire to obtain e-cigarettes through social sources, such as a ban on e-cigarettes with flavors that appeal to youths and children.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Nguyen HV. Association of Canada’s Provincial Bans on Electronic Cigarette Sales to Minors With Electronic Cigarette Use Among Youths. JAMA Pediatr. Published online November 04, 2019. doi:https://doi.org/10.1001/jamapediatrics.2019.3912
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: