Skip to main content
NCBI home page
Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2022 Dec 27;114(3):493–501. doi: 10.17269/s41997-022-00718-5

The availability and distribution of vaping retailers across Ontario neighbourhoods, 2016–2019

Emily Seale 1,2, Shelby L Sturrock 3, Michael J Widener 3,4, Daniel T Myran 5,6,✉
PMCID: PMC10283501  PMID: 36574202

Abstract

Objectives

To characterize the distribution of vaping retailers and examine the association between neighbourhood income and vaping retailer availability in Ontario prior to and after regulatory changes to the vaping market in 2018.

Methods

We quantified vaping access by number of vaping retailers for 19,964 dissemination areas (DAs) in Ontario and percentage of schools near a vaping retailer. We used mixed-effects regression models to examine the associations between vaping access and neighbourhood income in 2018 and 2019.

Results

Between 2016 and 2019, the number of vaping retailers in Ontario increased by 22.6% (5999 to 7355), despite a mild drop from 2016 to 2018. In 2019, 59.7% of urban neighbourhoods had one or more vaping retailers within 1000 m of their geographic centre, and 79.4% of elementary, 82.8% of secondary, and 84.2% of post-secondary schools had at least one within 1000 m. Neighbourhood income was associated with access to vaping retailers, with a greater number in low-income regions. In 2019, neighbourhoods in the lowest income quintile had over twice the number of vaping retailers per capita within 1000 m compared to the highest income quintile (adjusted incidence rate ratio 2.40; 95% CI 2.24–2.58). Increases over time in access to vaping retailers did not differ by geographic region, neighbourhood income quintile, or school type.

Conclusion

We observed a substantial increase in access to vaping retailers in Ontario including proximity to elementary and secondary schools following the 2018 provincial marketing regulations and federal nicotine regulations. Access to vaping was greatest in low-income neighbourhoods and may contribute to established inequities in vaping-related adverse events.

Supplementary Information

The online version contains supplementary material available at 10.17269/s41997-022-00718-5.

Keywords: Vaping, Vaping availability, Vaping policy, Multi-level model, Pre-post design

Introduction

Over the past two decades, the prevalence of e-cigarette use (“vaping”) has rapidly increased globally and within Canada (Gravely et al., 2014). The public health implications of increasing vaping have been subject to considerable debate. Proponents suggest that vaping can aid established tobacco cigarette smokers through harm reduction, and can effectively promote smoking cessation (Erku et al., 2020). In contrast, the use of e-cigarettes may cause adverse health outcomes in youth and young adults who do not smoke and never would have smoked. This includes potential short- and long-term direct organ damage by the inhalation of vapes (Cai & Wang, 2017; Chand et al., 2020; Czoli et al., 2019; Kamboj et al., 2016) and indirect repercussions by increasing the number of smokers through nicotine dependence and renormalizing smoking behaviours (Singh et al., 2020). Experiences from the alcohol and tobacco control field suggest that greater accessibility of e-cigarettes through both brick-and-mortar and online retail outlets, as well as exposure to e-cigarette marketing, may contribute to higher use (Chen-Sankey et al., 2019; Cho et al., 2019; Mantey et al., 2016; Singh et al., 2016).

Studies to date examining the distribution of vaping retailers by sociodemographic characteristics have presented mixed findings. A study conducted across the United States found that vaping retailers were densely distributed near secondary schools, particularly schools with visible minorities (Venugopal et al., 2020). In Quebec, Robitaille et al. (2019) suggested that area deprivation was not associated with proximity to vaping retailers near post-secondary schools. More recently, a study by Venugopal et al. (2022) suggested that neighbourhoods throughout the USA with the lowest socioeconomic status (SES) quintiles had nearly double the incidence of specialty vaping retailers compared to the highest quintile. As such, the relationships among the vaping retail environment, sociodemographic inequities, and availability near schools in North America remain unclear.

Critically, little is known about how the vaping retail market has changed over time in Canada and how government regulations may be contributing to changes in e-cigarette use. E-cigarettes emerged in the early 2000s, and regulations governing their sales, use, and marketing at the provincial and federal levels have changed considerably, particularly within the time period of interest for this study (2016 to 2019). Prior to 2015, the sale of e-cigarettes with and without nicotine was illegal in Ontario under the Smoke-Free Ontario Act, 2006 (SFOA, 2006) and e-cigarettes were federally regulated under the Food and Drugs Act, 1985 (FDA, 1985). In 2015, the Government of Ontario allowed the sale and supply of e-cigarettes without nicotine for individuals aged 19 years and older through the Electronic Cigarettes Act, 2015 (ECA, 2015). The sale of legal e-cigarettes was limited to licensed retailers, and marketing and promotion of e-cigarettes was strictly restricted to inside specialty vape stores. While nicotine-containing e-cigarettes remained illegal during this time, 64.4% of Canadian e-cigarette users in a study conducted in 2017 reported using e-cigarettes with nicotine (Statistics Canada, 2018). In November 2017, the Government of Ontario introduced Bill 174 which repealed the previous smoking-related legislative frameworks and replaced them with a single act, the Smoke-Free Ontario Act, 2017 (SFOA, 2017). The provisions related to e-cigarettes came into effect in October 2018, allowing vaping product advertisements and promotion in all retail outlets, including convenience stores, gas stations, and grocery stores, as long as they complied with federal regulations. Such changes would permit increased visibility of these products to all age groups. Direct product display in non-specialty vaping outlets remained illegal, but was permitted in specialty outlets, where entry was restricted to consumers 19 years or older. The same year, in May 2018, the federal Bill S-5 officially legalized nicotine-containing e-cigarettes and broader Canadian marketing regulations came into effect (Parliament of Canada, 2018). Starting in January 2020, the Government of Ontario amended the SFOA, 2017 to ban advertisements in retail outlets, with the exception of specialty stores (SFOA, 2017). In July 2020, Health Canada introduced Vaping Products Promotion Regulations: SOR/2020-143 to further restrict vaping promotion among youth in public spaces and at points of sale (Health Canada, 2020).

Despite the large regulatory changes for the sale and promotion of e-cigarettes, to our knowledge, no longitudinal studies have evaluated the evolution of the retail availability of e-cigarettes in Canada. In this study, we used a comprehensive dataset containing all licensed vaping retailers in Ontario to examine changes in vaping retailers between 2016 and 2019. This study time frame provides valuable insight into the retail environment in Ontario pre- and post-introduction of provincial Bill 174 and federal Bill S-5. The objectives of this study were to (1) examine the overall access to retailers selling e-cigarettes in Ontario for neighbourhoods and schools, (2) examine the evolution in e-cigarette retail availability over time and associations with the 2018 regulatory changes that allowed retailers to promote vaping products, and (3) investigate the relationship between e-cigarette vaping availability by schools and neighbourhood income across the province.

Methods

Data collection

The number and distribution of active vaping outlets in Ontario were obtained from a list of all retailers with a license to sell e-cigarettes in Ontario that have been longitudinally collected by the Ministry of Health of Ontario. These data reside in the Tobacco Inspection System (TIS) for vapour product retailers in Ontario, based on inspections of vapour product retailers conducted by Public Health Units under the SFOA, 2017, or its predecessor, the ECA, 2015. This dataset was provided under a Freedom of Information Request (FOI) regulated by the Freedom of Information and Protection of Privacy Act, 1990 (FIPPA, 1990). We specifically obtained data at four time points: 31 December 2016, 31 December 2017, 31 December 2018, and 31 December 2019.

Study measures

Our primary outcome was related to the measures of access to and distribution of the physical vaping retail market. Measures included:

  1. Total and per capita numbers of vaping retailers, measured by the number of licensed vaping retailers open at the time of data collection;

  2. Concentration of vaping retailers near schools, measured by the number of licensed vaping retailers located within 1000 m (Euclidian distance) of elementary schools, secondary schools, and post-secondary schools at the time of data collection; and

  3. Concentration of vaping retailers by neighbourhood income, measured as the number of vaping retailers located within 1000 m (Euclidian distance) of the geographic centre of urban neighbourhoods.

Data and covariates

Retail types

We classified the brick-and-mortar retailers into four categories: convenience stores, gas stations, specialty stores, and other. The “other” category included mobile retailers, pharmacies, discount/dollar stores, grocery stores, restaurants, bars, and stores where retailer type was not selected.

Neighbourhoods

Neighbourhoods were defined based on dissemination areas (DA), which contain approximately 400–700 people and are the smallest geographic units for which complete census data are released (N = 19,964 in Ontario) (Statistics Canada, 2018).

Demographics

Ontario is the most populous province in Canada, with a population of approximately 14.7 million people (Statistics Canada, 2021). For each DA, we used the most recent Canadian census (2016) to determine the population aged 15 years or older, the percentage aged 20–29 years, the proportion of males, and the population density.

Geography

In 2016, 74% of Canadians lived in an urban region. When examining proximity to schools and concentration by neighbourhood income, we only included census subdivisions with Statistical Area Classification (SAC) codes from 1 to 3, meaning they were either within a census metropolitan area (SAC 1), within a census agglomeration with at least one census tract (SAC 2), or no census tract (SAC 3). Census subdivisions outside of census metropolitan areas/census agglomeration areas were excluded given the limited accuracy of the Euclidian distance measurements at capturing retail access in more rural regions of Canada.

Primary exposures

Neighbourhood income

We used Statistics Canada’s Postal Code Conversion File Plus to classify each DA in Ontario according to income using the neighbourhood income quintile (census metropolitan area/census agglomeration) after tax (QAATIPPE) variable. This measure of household income represents the after-tax income of individuals adjusted for household size, relative to the income of other neighbourhoods within Ontario. Variables used to calculate QAATIPPE were obtained from the 2016 census.

Schools

We used the education layer from Desktop Mapping Technologies’ CanMap content suite to map the location of all schools in Ontario. We divided schools into elementary, secondary, and post-secondary schools. The CanMap content suite is updated quarterly with the use of data from provincial and territorial governments and cross-validated through additional public and private data listings.

Data analysis

We conducted all data analysis in Stata SE version 16.1 (StataCorp LP, College Station, TX) and ArcGIS Pro 2.2 (Environmental Systems Research Institute, Redlands, CA). We used QGIS 3.16 (Geographic Information System API Documentation, QGIS Association) to geocode the addresses of vaping outlets to a corresponding latitude and longitude. We also used QGIS to calculate the Euclidean distance from the geographic centre of each DA to the nearest vaping outlet and the number of vaping outlets within buffers of 1000 m from the geographic centre of each DA.

We reported the total and per capita number of vaping retailers for all of Ontario for each year and by retail outlet type. We calculated the relative change in the number of vaping retailers from pre-regulatory changes in 2018 to post-regulatory changes in 2019. We then assessed the number of retailers by neighbourhood income using mixed-effects Poisson regression in 2018 and 2019. The unit of analysis was the DA and the dependent variable was the number of vaping retailers within 1000 m of the neighbourhood’s centroid, offset by the population of each DA aged 15 years and older (with model results representing number of retailers per capita). The main independent variable was neighbourhood income quintile. We adjusted for the population density of each DA to account for urban/suburban differences, the proportion of males, and percent aged 20–29 years to adjust for confounders that may increase vaping retailers access in low-income neighbourhoods. A random effect was used to control for correlation from repeat measures on the same DAs. We conducted a sensitivity analysis using negative binomial regressions to account for overdispersion with no difference in results (see Supplementary material, Appendix A).

Results

Types of retail outlets across Ontario over time

Overall, between 2016 and 2019, the number of retailers increased from 5999 to 7355, a 22.6% increase (Fig. 1). Under the SFOA (2006) and Electronic Cigarettes Act, 2015, there was a trend of decreasing retailers from 2016 to 2018 (5999 to 5243), representing a 12.6% decrease. Between 2018 and 2019, the period coinciding with the passage of the federal Bill S-5 and enactment of SFOA, 2017, the number of retailers increased by 2112 (40.3% increase). This increase from 2018 to 2019 represented 1097 more vaping retailers in convenience stores (36.3% increase), 686 more in gas stations (51.6% increase), and 370 more in other retail types (93.4% increase), while there were 41 fewer specialty stores selling e-cigarettes (8.2% decrease).

Fig. 1.

Fig. 1

Open in a new tab

Change in number of vaping retail outlet types in Ontario over time from 2016 to 2019. Note: The dashed line represents the transition before and after the enactment of provincial SFOA, 2017 and the passage of federal Bill S-5, which both took place in 2018

Access to vaping retail outlets across Ontario

Figure 2 suggests that there was a fairly uniform increase in retailers across Ontario between 2018 and 2019. The relative percent change appeared greatest in Northwestern Ontario, with a 1.6- to 2.0-fold increase in the number of vaping retailers per 1000 in 2019, compared to 2018. However, increases appeared to occur relatively consistently across the whole province.

Fig. 2.

Fig. 2

Open in a new tab

Relative percent change in the number of vaping retailers in Ontario between 2018 and 2019 per 10,000 individuals aged 15+

Distribution of vaping retailers over time

In 2019, there was a 15.2% increase across the province in DAs with vaping retailers within 1000 m of their centre compared to 2018, and there was an average of 4.3 retailers within 1000 m per DA, representing a 4.9% increase in the average from the previous year (Table 1). The mean number of retailers within 1000 m of DA was greater in DAs in the lowest income quintile (4.7 in 2019) compared to DAs in the highest income quintile (3.9 in 2019) across the 4 years. All neighbourhood income quintiles experienced similar relative and absolute increases in retailers between 2018 and 2019. From 2018 to 2019, 7.5% more elementary schools, 4.8% more secondary schools, and 4.7% more post-secondary schools had access to a vaping retailer within a 1000 m radius.

Table 1.

Distribution of retailers within 1000 m of DA and within 1000 m of schools between 2018 and 2019

2018 2019 Absolute and relative change (2018–2019)
Neighbourhoods
No. and percent of urban DAs with vaping retailers within 1000 m 9041 (51.8%) 10,419 (59.7%) 1378 (+ 15.2%)

Mean number of retailers within 1000 m of DA with at least 1 retailer

Mean [sd]

 4.1 [1.3] 4.3 [1.2] 0.2 (+4.9%)
Mean number of retailers within 1000 m of DA with at least 1 retailer: by income quintile
 Q1 (highest income quintile) 3.6 [1.4] 3.9 [1.4] 0.3 (+ 8.3%)
 Q2 3.8 [1.4] 4.0 [1.3] 0.2 (+ 5.2%)
 Q3 3.9 [1.3] 4.2 [1.2] 0.3 (+ 7.7%)
 Q4 4.2 [1.2] 4.5 [1.0] 0.3 (+ 7.1%)
 Q5 (lowest income quintile) 4.5 [1.0] 4.7 [0.8] 0.2 (+ 4.4%)
Schools
No. and percent of elementary schools with vaping retailers within 1000 m 3754 (73.9%) 4035 (79.4%) 281 (+ 7.5%)
No. and percent of high schools with vaping retailers within 1000 m 1529 (78.9%) 1603 (82.8%) 74 (+ 4.8%)
No. and percent of post-secondary schools with vaping retailers within 1000 m 148 (80.4%) 155 (84.2%) 7 (+ 4.7%)
Open in a new tab

Relationship between e-cigarette vaping availability and income across the province

Table 2 presents differences in vaping retailer counts by neighbourhood income across Ontario in December 2018 and December 2019. In both time periods, there was a gradient in the association between neighbourhood income and retailer counts, as lower-income neighbourhoods had a higher number of retailers within 1000 m compared to higher-income neighbourhoods. In 2019, there were 2.4 times more retailers per capita located within 1000 m of neighbourhoods in the lowest income quintile compared to neighbourhoods in the highest income quintile (aIRR 2.40; 95% CI 2.24–2.58). An interaction term for income quintile and year was not significant, suggesting no change in concentration by neighbourhood income over time. The proportion of males, percent of young adults (20–29 years old), and population density were all significantly associated with concentration by neighbourhoods in retailer access.

Table 2.

Mixed-effects Poisson regression fitting the number of vaping retail outlets within 1000 m from the geographic centre of urban neighbourhoods based on income quintile and year: Ontario, Canada, 2016–2019

2018: prior to regulatory changes 2019: following regulatory changes
Variable Mean number of retailers within 1000 m of DA
Mean [sd]		 Incidence rate ratio (95% CI) Mean number of retailers within 1000 m of DA
Mean [sd]		 Incidence rate ratio (95% CI)
Unadjusted Adjusted Unadjusted Adjusted
Income
 Q1 (highest income) 3.6 [1.4] Ref Ref 3.9 [1.4] Ref Ref
 Q2 3.8 [1.4] 1.14 (1.06–1.23)* 1.09 (1.01–1.17)* 4.0 [1.3] 1.13 (1.06–1.21)* 1.08 (1.01–1.15)*
 Q3 3.9 [1.3] 1.92 (1.79–2.06)* 1.70 (1.58–1.82)* 4.2 [1.2] 1.83 (1.71–1.95)* 1.64 (1.54–1.75)*
 Q4 4.2 [1.2] 3.06 (2.85–3.28)* 2.40 (2.24–2.58)* 4.5 [1.0] 2.85 (2.68–3.04)* 2.31 (2.16–2.46)*
 Q5 4.5 [1.0] 3.92 (3.65–4.21)* 2.58 (2.40–2.79)* 4.7 [0.8] 3.46 (3.24–3.69)* 2.40 (2.24–2.58)*
% male – – 0.95 (0.94–0.96)* – – 0.95 (0.94–0.96)*
% 20–29 – – 1.05 (1.04–1.05)* – – 1.04 (1.04–1.05)*
Population density – – 1.00 (1.00–1.00)* – – 1.00 (1.00–1.00)*
Open in a new tab

Adjusted models control for % of population male, % of population aged 20–29, and population density. All models are offset by the total population 15+ of a dissemination area

CI confidence interval, DA dissemination area, Q quintile, Ref reference level

*p < 0.05

Discussion

To our knowledge, this is the first study to characterize the evolution of access to Ontario’s e-cigarette brick-and-mortar retail environment over time. Results from this study suggested that Ontario’s vaping retail market changed substantially between 2016 and 2019. Prior to the introduction of the SFOA, 2017 and the passage of Bill S-5 in 2018, the number of vaping retailers in Ontario was declining, decreasing by 12.6% (from 5999 to 5243) over 3 years. Between 2018 and 2019, following the passage of Bill 174 and Bill S-5 that enabled broader promotion of vaping products, the number of retailers in Ontario increased by 40.3% (from 5243 to 7355). The most notable increase in retailers has been among gas stations and convenience stores, which are points of sale that do not control the age of entry, and may have allowed for greater exposure among youth. Additionally, this study highlighted that as of 2019, almost two thirds of urban neighbourhoods in Ontario (59.7%) had access to retailers within at least 1000 m and that the majority of schools in Ontario have a vaping retailer within 1000 m.

Experiences from the controlled regulation of alcohol and tobacco, in addition to preliminary vaping studies, suggest that greater accessibility of e-cigarette retailers and increased visibility of e-cigarette marketing contribute to normalization and higher use (Chen-Sankey et al., 2019; Cho et al., 2019; Mantey et al., 2016; Singh et al., 2016; Abdel Magid et al., 2020; Schleicher et al., 2016). The published tobacco evidence suggests that retailers are unequally distributed throughout North America, and retailer proximity and density may contribute to environments that encourage smoking behaviours, which in turn can further influence health disparities (Marsh et al., 2021; Young-Wolff et al., 2014; Lee et al., 2017; Wheeler et al., 2020). Our study suggests that retailers appeared to concentrate in low-income neighbourhoods in both 2018 and 2019 (prior to and after regulatory changes). In 2019, neighbourhoods in the lowest income quintile had over twice the number of vaping retailers per capita within 1000 m compared to the highest income quintile (aIRR 2.40; 95% CI 2.24–2.58). This reflects similar findings reported in the study by Dai et al. (2017) that suggested that higher vape retailer density in urban areas in the USA was associated with higher poverty, and the recent study by Venugopal et al. (2022) that suggested double the incidence of specialty vape stores in lower SES quintiles compared to the highest quintile. Interestingly, when stratifying by SES to examine the distribution of vaping retailers around schools, a Canadian study by Robitaille et al. (2019) suggests there is no association between area deprivation and proximity to vaping retailers near post-secondary schools, and the study by Venugopal et al. (2020) suggests that retailers were farther from schools in districts with more poverty. More research is recommended to better characterize the relationships among access to vaping retailers, access near schools, and socioeconomic factors.

Despite the growth in the number of retailers in 2019, the distribution across neighbourhood income quintiles remained similar across time. This finding suggests that while the regulatory changes introduced in 2018 increased the number of retailers overall, they did not significantly influence the distribution of retailers across neighbourhoods with different income levels. Among long-term smokers, the increased proximity and density of vaping products, especially in lower-income neighbourhoods, may reduce tobacco use and offer a harm reduction alternative. However, there remains a paucity of research exploring the association between vaping retail access and e-cigarette use in Canada.

In contrast, retail access may promote e-cigarette use in youth. In 2019, the majority of elementary schools (79.4%) and secondary schools (82.8%) in Ontario had vaping retailers within 1000 m, representing 355 more schools located near vaping retailers following the 2018 regulatory changes. Interestingly, there was only a small absolute change in vaping retailers near post-secondary schools compared to elementary and high schools, which may have been as a result of there being no ban on the use of vaping products in post-secondary schools despite the regulatory changes during our study time frame. The findings regarding elementary and secondary schools are concerning as an increase in access for students who are generally less than 18 years old offers earlier opportunities to be exposed to point-of-sale promotion and in turn use vaping products (Bostean et al., 2016; Giovenco et al., 2016). A recent publication reported that in 2019, 23% of Ontario students in grades 7–12 had in fact used a vaping device in the past year, and 13% used it on a weekly or daily basis, despite typically being under the legal age to purchase these products (Boak et al., 2020). Increases in the number of vaping retailers near schools combined with increasing normalization of the behaviour may further impact harmful adverse health outcomes among youth.

Since the conclusion of our study, provincial and federal regulatory changes have been introduced to limit youth’s exposure to vaping advertisements in retail settings, particularly the Government of Ontario’s amendment of SFOA, 2017 in January 2020 to ban advertisements in retail outlets, except specialty stores (SFOA, 2017), and Health Canada’s Vaping Products Promotion Regulations: SOR/2020-143 in July 2020 to further restrict vaping promotion among youth in public spaces and at points of sale (Health Canada, 2020). Martin et al. (2021) examined 18 secondary schools in London, Ontario, and suggested that there has been a 78.2% decrease in advertisements near schools following the 2020 vaping advertisement restrictions. However, further research will be needed to examine the extent to which these regulatory changes have contributed to decreased vaping exposure and e-cigarette use among youth on a larger scale.

Limitations

There are several limitations to this study. First, our study does not include online or illicit vaping retailers, since the government only systematically monitors brick-and-mortar retailers in Ontario. Approximately 27.5% of consumers are estimated to purchase their vaping products online (Braak et al., 2019), and the characterization of sales occurring through illicit means is limited. However, irrespective of this, physical marketing, promotion, and overall visibility of vaping were permitted to increase following SFOA, 2017 and our study characterizes the changes before and after 2018 accompanying these new regulations. Second, regulatory changes are one of the many factors that contribute to the dynamic availability of vaping retailers described in this article. Other factors such as municipal by-laws, opening hours, and the selection of products were not studied in this project but may further influence the complex vaping environment and vaping behaviours. Third, significant regulatory changes occurred after our study period and further research should evaluate the association of these new changes on vaping availability and use. Additionally, although we chose to limit our geospatial analyses to large, urban population centres, these areas still include some more sparsely distributed suburbs. Finally, vaping availability was measured using Euclidean distances. In small geographic regions, these estimates are accurate but accuracy may have decreased in areas with less uniform road networks (Apparicio et al., 2008). More sophisticated measures of vaping availability that go beyond geographic distance and capture travel opportunity, cost, and time would allow generalization to all regions of the province.

Conclusion

The findings of this study suggest that access to vaping retailers increased following the 2018 provincial and federal regulatory changes permitting point-of-sale marketing and legalizing nicotine-containing e-cigarettes. Vaping retailers remain concentrated within low-income areas, and the majority of elementary and secondary schools in Ontario are within close proximity of vaping retailers. Further research is required to better understand the influence of the increasing number of vaping retailers on the prevalence of vaping and vaping-related health outcomes. In the interim, regulations to reduce vaping-related harms and inequities among youth could consider limiting the availability and location of vaping retailers.

Contributions to knowledge

What does this study add to existing knowledge?

  • Evaluates the evolution of the retail availability of vaping products in Ontario, Canada, over time.

  • Examines the influence of provincial and federal regulatory changes in 2018 on vaping product availability.

  • Investigates the relationship between e-cigarette vaping availability and both schools and neighbourhood income across the province.

What are the key implications for public health interventions, practice, or policy?

  • Findings suggest that access to vaping retailers increased following the 2018 provincial and federal regulatory changes that permitted point-of-sale marketing and legalized nicotine-containing e-cigarettes.

  • This study provides a first step in better understanding the influence of the increasing number of vaping retailers on the prevalence of vaping and vaping-related health outcomes throughout Ontario, Canada.

  • Regulations to reduce vaping-related harms and inequities among youth could consider limiting the availability and location of vaping retailers.

Supplementary Information

ESM 1 (62.4KB, docx)

(DOCX 62 kb)

Author contributions

Seale and Myran conceived the original idea. Seale performed a background literature review. Seale and Myran designed the study and interpreted the results. Seale and Sturrock performed the statistical analyses. Seale and Myran drafted the manuscript, and all authors provided critical feedback to prepare the final manuscript. All of the authors gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

Funding

This research did not use grants from any funding agency in the public, commercial, or not-for-profit sectors.

Availability of data and material

Dataset available upon communication with the authors.

Code availability

Custom code available upon communication with the authors.

Declarations

Ethics approval

This article does not contain any studies with human participants performed by any of the authors.

Consent to participate

Not applicable

Consent for publication

Not applicable

Conflict of interest

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  1. Abdel Magid, H. S., Halpern-Felsher, B., Ling, P. M., Bradshaw, P. T., Mujahid, M. S., & Henriksen, L. (2020). Tobacco retail density and initiation of alternative tobacco product use among teens. Journal of Adolescent Health, 66(4), 423–430. [DOI] [PMC free article] [PubMed]
  2. Apparicio P, Abdelmajid M, Riva M, Shearmur R. Comparing alternative approaches to measuring the geographical accessibility of urban health services: Distance types and aggregation-error issues. International Journal of Health Geographics. 2008;7(1):1–14. doi: 10.1186/1476-072X-7-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Boak, A., Elton-Marshall, T., Mann, R. E., & Hamilton, H. A. (2020). Drug use among Ontario students, 1977–2019: Detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS). Toronto, ON.
  4. Bostean G, Crespi C, Vorapharuek P, McCarthy W. E-cigarette use among students and e-cigarette specialty retailer presence near schools. Health & Place. 2016;42:129–136. doi: 10.1016/j.healthplace.2016.09.012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Braak, D. C., Cummings, K. M., Nahhas, G. J., Heckman, B. W., Borland, R., Fong, G. T., Hammond, D., Boudreau, C., McNeill, A., Levy, D. T., & Shang, C. (2019). Where do vapers buy their vaping supplies? Findings from the International Tobacco Control (ITC) 4 Country Smoking and Vaping Survey. International Journal of Environmental Research and Public Health, 16(3), 338. [DOI] [PMC free article] [PubMed]
  6. Cai, H., & Wang, C. (2017). Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns. Redox Biology. Elsevier B.V. 10.1016/j.redox.2017.05.013. [DOI] [PMC free article] [PubMed]
  7. Chand, H. S., Muthumalage, T., Maziak, W., & Rahman, I. (2020). Pulmonary toxicity and the pathophysiology of electronic cigarette, or vaping product, use associated lung injury. Frontiers in Pharmacology, 0, 1619. [DOI] [PMC free article] [PubMed]
  8. Chen-Sankey, J. C., Unger, J. B., Bansal-Travers, M., Niederdeppe, J., Bernat, E., & Choi, K. (2019). E-cigarette marketing exposure and subsequent experimentation among youth and young adults. Pediatrics, 144(5). [DOI] [PMC free article] [PubMed]
  9. Cho, Y. J., Thrasher, J. F., Reid, J. L., Hitchman, S., & Hammond, D. (2019). Youth self-reported exposure to and perceptions of vaping advertisements: Findings from the 2017 International Tobacco Control Youth Tobacco and Vaping Survey. Preventive Medicine, 126. 10.1016/j.ypmed.2019.105775. [DOI] [PMC free article] [PubMed]
  10. Czoli, C. D., Fong, G. T., Goniewicz, M. L., & Hammond, D. (2019). Biomarkers of exposure among “dual users” of tobacco cigarettes and electronic cigarettes in Canada. Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco, 21(9), 1259–1266. [DOI] [PMC free article] [PubMed]
  11. Dai H, Hao J, Catley D. Vape shop density and socio-demographic disparities: A US census tract analysis. Nicotine & Tobacco Research. 2017;19(11):1338–1344. doi: 10.1093/ntr/ntx063. [DOI] [PubMed] [Google Scholar]
  12. ECA. Electronic Cigarette Act. Making Healthier Choices Act, 2015. (2015). Canada. https://www.ontario.ca/laws/statute/s15007. Accessed 7 Feb 2022.
  13. Erku D, Gartner CE, Morphett K, Snoswell CL, Steadman KJ. Nicotine vaping products as a harm reduction tool among smokers: Review of evidence and implications for pharmacy practice. Research in Social and Administrative Pharmacy. 2020;16(9):1272–1278. doi: 10.1016/j.sapharm.2020.02.002. [DOI] [PubMed] [Google Scholar]
  14. FDA. Food and Drugs Act. 1985. (1985). Canada. https://laws-lois.justice.gc.ca/eng/acts/F-27/. Accessed 20 Jul 2022.
  15. FIPPA. Freedom of Information and Protection of Privacy Act, 1990. (1990). Canada. https://www.ontario.ca/laws/statute/90f31. Accessed 29 June 2022.
  16. Giovenco DP, Casseus M, Duncan DT, Coups EJ, Lewis MJ, Delnevo CD. Association between electronic cigarette marketing near schools and e-cigarette use among youth. Journal of Adolescent Health. 2016;59(6):627–634. doi: 10.1016/j.jadohealth.2016.08.007. [DOI] [PubMed] [Google Scholar]
  17. Gravely, S., Fong, G., Cummings, K., Yan, M., Quah, A., Borland, R., … Hummel, K. (2014). Awareness, trial, and current use of electronic cigarettes in 10 countries: Findings from the ITC Project. International Journal of Environmental Research and Public Health, 11(11), 11691–11704. [DOI] [PMC free article] [PubMed]
  18. Health Canada. Vaping Products Promotion Regulations SOR/2020-143. (2020). Canada. https://laws-lois.justice.gc.ca/eng/regulations/SOR-2020-143/page-1.html. Accessed 14 July 2022.
  19. Kamboj, A., Spiller, H. A., Casavant, M. J., Chounthirath, T., & Smith, G. A. (2016). Pediatric exposure to e-cigarettes, nicotine, and tobacco products in the United States. Pediatrics, 137(6). [DOI] [PubMed]
  20. Lee JGL, Sun DL, Schleicher NM, Ribisl KM, Luke DA, Henriksen L. Inequalities in tobacco outlet density by race, ethnicity and socioeconomic status, 2012, USA: Results from the ASPiRE Study. Journal of Epidemiology and Community Health. 2017;71(5):487–492. doi: 10.1136/jech-2016-208475. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Mantey DS, Cooper MR, Clendennen SL, Pasch KE, Perry CL. E-cigarette marketing exposure is associated with e-cigarette use among US youth. Journal of Adolescent Health. 2016;58(6):686–690. doi: 10.1016/j.jadohealth.2016.03.003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Marsh, L., Vaneckova, P., Robertson, L., Johnson, T. O., Doscher, C., Raskind, I. G., ... & Henriksen, L. (2021). Association between density and proximity of tobacco retail outlets with smoking: a systematic review of youth studies. Health & Place, 67, 102275. [DOI] [PMC free article] [PubMed]
  23. Martin G, Bowman DD, Graat M, Clark AF, Wray AJ, Askwith Z, Seabrook JA, Gilliland JA. Examining how changes in provincial policy on vape marketing impacted the distribution of vaping advertisements near secondary schools in London, Ontario. Canadian Journal of Public Health. 2021;112(3):440–448. doi: 10.17269/s41997-020-00453-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Parliament of Canada. (2018). Bill S-5: An Act to amend the Tobacco Act and the Non-smokers’ Health Act and to make consequential amendments to other Acts. Canada. https://www.parl.ca/DocumentViewer/en/42-1/bill/S-5/royal-assent. Accessed 7 Feb 2022.
  25. Robitaille É, Bergeron P, Houde M. Analysis of the geographical accessibility of vape shops in the vicinity of Quebecʼs secondary and college educational institutions. Health Promotion & Chronic Disease Prevention in Canada: Research, Policy & Practice. 2019;39(8-9):235–243. doi: 10.24095/hpcdp.39.8/9.01. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Schleicher NC, Johnson TO, Fortmann SP, Henriksen L. Tobacco outlet density near home and school: Associations with smoking and norms among US teens. Preventive Medicine. 2016;91:287–293. doi: 10.1016/j.ypmed.2016.08.027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. SFOA. (2006). Smoke-Free Ontario Act, Ontario Regulation 48/06. Canada. https://www.ontario.ca/laws/statute/94t10/v2. Accessed 29 Jun 2022.
  28. SFOA. (2017). Cannabis, Smoke-Free Ontario and Road Safety Statute Law Amendment Act, 2017. Canada. https://www.ola.org/en/legislative-business/bills/parliament-41/session-2/bill-174. Accessed 29 Jun 2022.
  29. Singh, T., Agaku, I. T., Arrazola, R. A., Marynak, K. L., Neff, L. J., Rolle, I. T., & King, B. A. (2016). Exposure to advertisements and electronic cigarette use among US middle and high school students. Pediatrics, 137(5), e20154155. [DOI] [PMC free article] [PubMed]
  30. Singh S, Windle SB, Filion KB, Thombs BD, O’Loughlin JL, Grad R, Eisenberg MJ. E-cigarettes and youth: Patterns of use, potential harms, and recommendations. Preventive Medicine. 2020;133:106009. doi: 10.1016/j.ypmed.2020.106009. [DOI] [PubMed] [Google Scholar]
  31. Statistics Canada. (2018). Dissemination area (DA). https://www150.statcan.gc.ca/n1/en/catalogue/92-169-X. Accessed 7 Feb 2022.
  32. Statistics Canada. (2021). Population estimates on July 1st, by age and sex. Ottawa. Retrieved from https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000501&pickMembers%5B0%5D=1.7&pickMembers%5B1%5D=2.1&cubeTimeFrame.startYear=2016&cubeTimeFrame.endYear=2020&referencePeriods=20160101%2C20200101. Accessed 7 Feb 2022.
  33. Venugopal P. D., Morse A. L., Tworek C., & Chang H. W. (2020). Socioeconomic disparities in vape shop density and proximity to public schools in the conterminous United States, 2018. Health Promotion Practice, 21(1_suppl), 9S–17S. [DOI] [PMC free article] [PubMed]
  34. Venugopal PD, Morse AL, Alrefai-Kirkpatrick R, Tworek C, Chang HW. The co-occurrence of specialty vape shops, social disadvantage, and poor air quality in the United States: An assessment of cumulative risks to youth. Health Equity. 2022;6(1):132–141. doi: 10.1089/heq.2021.0151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Wheeler DC, Do EK, Hayes RB, Fugate-Laus K, Fallavollita WL, Hughes C, Fuemmeler BF. Neighborhood disadvantage and tobacco retail outlet and vape shop outlet rates. International Journal of Environmental Research and Public Health. 2020;17(8):2864. doi: 10.3390/ijerph17082864. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Young-Wolff KC, Henriksen L, Delucchi K, Prochaska JJ. Tobacco retailer proximity and density and nicotine dependence among smokers with serious mental illness. American Journal of Public Health. 2014;104(8):1454–1463. doi: 10.2105/AJPH.2014.301917. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

ESM 1 (62.4KB, docx)

(DOCX 62 kb)

Data Availability Statement

Dataset available upon communication with the authors.

Custom code available upon communication with the authors.

Articles from Canadian Journal of Public Health = Revue Canadienne de Santé Publique are provided here courtesy of Springer

RESOURCES