E-Cigarette and Waterpipe Use Among Adolescents in Ontario Hayley A. Hamilton 1,2, Roberta Ferrence 2,3, Angela Boak 1, Robert Schwartz 1,2.3, Robert E. Mann 1,2, Shawn O’Connor 1,2,3, Edward M. Adlaf 1,2 1 Centre for Addiction and Mental Health; 2 Dalla Lana School of Public Health, University of Toronto; 3 Ontario Tobacco Research Unit

Background Alternative devices are gaining in popularity Marketing often targets youth Knowledge of these devices and their safety varies

Electronic Cigarette Electronic Nicotine Delivery Systems (ENDS) Contains unknown quantities of nicotine and other chemicals Lack of data that differentiates between nicotine and non-nicotine use among adolescents

Waterpipe Contains nicotine and other toxins that contribute to cancer and other illnesses Little knowledge of adolescent use

Research Objectives To describe the prevalence of waterpipe use and nicotine and non-nicotine e-cigarette use among adolescents in Ontario To describe the association between use of alternative devices and use of tobacco cigarettes and sociodemographic factors.

Data 2013 Ontario Student Drug Use and Health Survey (OSDUHS) Students in grades 7-12 E-cigarette & waterpipe use first asked in 2013

Measure E-cigarette use – lifetime use; half sample of high school students only Waterpipe use – past year & lifetime; half sample of students;

Lifetime use, Grades 9-12

Lifetime use (cont’d)

Gender & Grade Differences

Type of E-Cigarette Among E-Cigarette Users 1 Among e-cigarette users who have or have not used tobacco cigarettes in past year

Adjusted Odds Ratios 1 E-cigaretteWaterpipe Male2.1 (1.5, 2.9) ***1.3 (0.9, 1.9) Grade (0.4, 1.3)1.3 (0.7, 2.3) (0.4, 1.3)2.0 (1.2, 3.5) ** (0.3, 1.1)2.2 (1.4, 3.5) ** Racialized0.7 (0.5, 1.0)1.7 (1.1, 2.7) * Cigarette use, past yr.4.3 (3.0, 6.2) ***5.4 (3.3, 9.0) *** Alcohol use 2, past yr.3.8 (2.4, 5.9) ***3.8 (2.6, 5.5) *** E-cigarette (n=2814); Waterpipe (n=2801) 1 E-cigarette & waterpipe regressed on all characteristics listed 2 Alcohol use – excludes those who drink at special events only

Conclusion Largely used by those who have smoked tobacco cigarettes and drank alcohol in the past year Need to establish safety given relatively high use Greater public health education