Behavioral and Attitudinal Correlates of Trusted Sources of COVID-19 Vaccine Information in the US

There is a critical need for the public to have trusted sources of vaccine information. A longitudinal online study assessed trust in COVID-19 vaccine information from 10 sources. A factor analysis for data reduction revealed two factors. The first factor contained politically conservative sources (PCS) of information. The second factor included eight news sources representing mainstream sources (MS). Multivariable logistic regression models were used. Trust in Dr. Fauci was also examined. High trust in MS was associated with intention to encourage family members to get COVID-19 vaccines, altruistic beliefs that more vulnerable people should have vaccine priority, and belief that racial minorities with higher rates of COVID-19 deaths should have priority. High trust in PCS was associated with intention to discourage friends from getting vaccinated. Higher trust in PCS was also associated with participants more likely to disagree that minorities with higher rates of COVID-19 deaths should have priority for a vaccine. High trust in Dr. Fauci as a source of COVID-19 vaccine information was associated with factors similar to high trust in MS. Fair, equitable, and transparent access and distribution are essential to ensure trust in public health systems’ abilities to serve the population.

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Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999–2015

International Journal of Epidemiology ◽

10.1093/ije/dyaa263 ◽

2020 ◽

Author(s):

Kosuke Inoue ◽

Roch Nianogo ◽

Donatello Telesca ◽

Atsushi Goto ◽

Vahe Khachadourian ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Regression Models ◽

Machine Learning Algorithms ◽

Logistic Regression Models ◽

Health And Nutrition ◽

Increased Risk ◽

The Us ◽

All Cause Mortality ◽

Hba1c Levels

Abstract Objective It is unclear whether relatively low glycated haemoglobin (HbA1c) levels are beneficial or harmful for the long-term health outcomes among people without diabetes. We aimed to investigate the association between low HbA1c levels and mortality among the US general population. Methods This study includes a nationally representative sample of 39 453 US adults from the National Health and Nutrition Examination Surveys 1999–2014, linked to mortality data through 2015. We employed the parametric g-formula with pooled logistic regression models and the ensemble machine learning algorithms to estimate the time-varying risk of all-cause and cardiovascular mortality by HbA1c categories (low, 4.0 to <5.0%; mid-level, 5.0 to <5.7%; prediabetes, 5.7 to <6.5%; and diabetes, ≥6.5% or taking antidiabetic medication), adjusting for 72 potential confounders including demographic characteristics, lifestyle, biomarkers, comorbidities and medications. Results Over a median follow-up of 7.5 years, 5118 (13%) all-cause deaths, and 1116 (3%) cardiovascular deaths were observed. Logistic regression models and machine learning algorithms showed nearly identical predictive performance of death and risk estimates. Compared with mid-level HbA1c, low HbA1c was associated with a 30% (95% CI, 16 to 48) and a 12% (95% CI, 3 to 22) increased risk of all-cause mortality at 5 years and 10 years of follow-up, respectively. We found no evidence that low HbA1c levels were associated with cardiovascular mortality risk. The diabetes group, but not the prediabetes group, also showed an increased risk of all-cause mortality. Conclusions Using the US national database and adjusting for an extensive set of potential confounders with flexible modelling, we found that adults with low HbA1c were at increased risk of all-cause mortality. Further evaluation and careful monitoring of low HbA1c levels need to be considered.

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POS0023 RACIAL/ETHNIC AND REGIONAL DIFFERENCES IN MULTIMORBIDITY BETWEEN PATIENTS WITH RHEUMATOID ARTHRITIS AND COMPARATORS IN A LARGE NATIONWIDE US STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1610 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 213.1-214

Author(s):

H. J. Dykhoff ◽

E. Myasoedova ◽

M. Peterson ◽

J. M. Davis ◽

V. Kronzer ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Logistic Regression ◽

Regression Models ◽

Index Date ◽

Ethnic Disparities ◽

Logistic Regression Models ◽

The Us ◽

Race Ethnicity ◽

Geographic Regions ◽

Racial Ethnic

Background:Patients with rheumatoid arthritis (RA) have an increased burden of multimorbidity. Racial/ethnic disparities have also been associated with an increased burden of multimorbidity.Objectives:We aimed to compare multimorbidity among different racial/ethnic groups and geographic regions of the US in patients with RA and comparators without RA.Methods:We used a large longitudinal, real-world data warehouse with de-identified administrative claims for commercial and Medicare Advantage enrollees, to identify cases of RA and matched controls. Cases were defined as patients aged ≥18 years with ≥2 diagnoses of RA in January 1, 2010 - June 30, 2019 and ≥1 prescription fill for methotrexate in the year after the first RA diagnosis. Controls were persons without RA matched 1:1 to RA cases on age, sex, census region, calendar year of index date (corresponding to the date of second diagnosis code for RA), and length of prior medical/pharmacy coverage. Race was classified as non-Hispanic White (White), non-Hispanic Black (Black), Asian, Hispanic, or other/unknown, based on self-report or derived rule sets. Multimorbidity (2 or more comorbidities) was defined using 25 chronic comorbidities from a combination of the Charlson and Elixhauser Comorbidity Indices assessed during the year prior to index date. Rheumatic comorbidities were not included. Logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI).Results:The study included 16,363 cases with RA and 16,363 matched non-RA comparators (mean age 58.2 years, 70.7% female for both cohorts). Geographic regions were the same in both cohorts: 50% South, 26% Midwest, 13% West, and 11% Northeast. Race/ethnicity was not part of the matching criteria and varied slightly between the cohorts: among RA (non-RA) patients, 74% (74%) were White, 11% (9%) Hispanic, 10% (9%) Black, 3% (4%) Asian, and 3% (4%) other/unknown. Patients with RA had more multimorbidity than non-RA subjects (51.3% vs 44.8%). Multimorbidity comparisons across US geographic regions were similar in both cohorts, with comparable multimorbidity levels for patients in the West and Midwest and higher levels for those in the Northeast and South (Figure 1). Among the non-RA patients, 43.5% of Whites experienced multimorbidity, compared to 33.9% of Asians, 46.1% of Hispanics, and 58.4% of Blacks. These associations remained after adjustment for age, sex, and geographic region, with significantly lower multimorbidity among Asians (OR: 0.81; 95%CI: 0.67-0.99) and significantly higher multimorbidity among Hispanics (OR: 1.21; 95%CI: 1.07-1.37) and Blacks (OR: 1.74; 95%CI: 1.54-1.97), compared to Whites in the non-RA cohort. Among the RA patients, racial/ethnic differences were less pronounced; 50.6% of Whites, 42.8% of Asians, 48.8% of Hispanics, and 58.4% of Blacks experienced multimorbidity. Adjusted analyses revealed no significant differences in multimorbidity for Asians (OR: 0.88; 95%CI: 0.70-1.08) and Hispanics (OR: 1.06; 95%CI: 0.95-1.19) and a less pronounced increase in multimorbidity among Blacks (OR: 1.32; 95%CI: 1.17-1.49) compared to Whites in the RA cohort.Conclusion:This large nationwide study showed increased occurrence of multimorbidity in RA versus non-RA patients and in both cohorts for residents of the Northeast and South regions of the US. Racial/ethnic disparities in multimorbidity were more pronounced among patients without RA compared to RA patients. This indicates the effects of RA and race/ethnicity on multimorbidity do not aggregate. The underlying mechanisms for these associations require further investigation.Figure 1.Logistic regression models comparing multimorbidity levels in RA and non-RA cohorts.Disclosure of Interests:Hayley J. Dykhoff: None declared, Elena Myasoedova: None declared, Madeline Peterson: None declared, John M Davis III Grant/research support from: Research grant from Pfizer, Vanessa Kronzer: None declared, Caitrin Coffey: None declared, Tina Gunderson: None declared, Cynthia S. Crowson: None declared.

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Arsenic exposure and the seroprevalence of total hepatitis A antibodies in the US population: NHANES, 2003–2012

Epidemiology and Infection ◽

10.1017/s0950268815003088 ◽

2016 ◽

Vol 144 (8) ◽

pp. 1641-1651 ◽

Cited By ~ 8

Author(s):

A. CARDENAS ◽

E. SMIT ◽

J. W. BETHEL ◽

E. A. HOUSEMAN ◽

M. L. KILE

Keyword(s):

Regression Models ◽

Hepatitis A ◽

Arsenic Exposure ◽

Effect Modification ◽

Multivariate Logistic Regression ◽

Logistic Regression Models ◽

Immunization Status ◽

Urinary Arsenic ◽

Health And Nutrition ◽

The Us

SUMMARYWe evaluated the association between urinary arsenic and the seroprevalence of total hepatitis A antibodies (total anti-HAV: IgG and IgM) in 11 092 participants aged ⩾6 years using information collected in the US National Health and Nutrition Examination Survey (2003–2012). Multivariate logistic regression models evaluated associations between total anti-HAV and total urinary arsenic defined as the sum of arsenite, arsenate, monomethylarsonate and dimethylarsinate (TUA1). Effect modification by self-reported HAV immunization status was evaluated. Total anti-HAV seroprevalence was 35·1% [95% confidence interval (CI) 33·3–36·9]. Seropositive status was associated with higher arsenic levels and this association was modified by immunization status (P= 0·03). For participants that received ⩾2 vaccine doses or did not know if they had received any doses, a positive dose-response association was observed between increasing TUA1 and odds of total anti-HAV [odds ratio (OR) 1·42, 95% CI 1·11–1·81; and OR 1·75, 95% CI 1·22–2·52], respectively. A positive but not statistically significant association was observed in those who received <2 doses (OR 1·46, 95% CI 0·83–2·59) or no dose (OR 1·12, 95% CI 0·98–1·30). Our analysis indicates that prevalent arsenic exposure was associated with positive total anti-HAV seroprevalence. Further studies are needed to determine if arsenic increases the risk for incident hepatitis A infection or HAV seroconversion.

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The Presence of Gut Microbial Genes Encoding Bacterial Genotoxins or Pro-Inflammatory Factors in Stool Samples from Individuals with Colorectal Neoplasia

Diseases ◽

10.3390/diseases7010016 ◽

2019 ◽

Vol 7 (1) ◽

pp. 16 ◽

Cited By ~ 2

Author(s):

Ramón Gómez-Moreno ◽

María González-Pons ◽

Marievelisse Soto-Salgado ◽

Marcia Cruz-Correa ◽

Abel Baerga-Ortiz

Keyword(s):

Logistic Regression ◽

Regression Models ◽

Colorectal Neoplasia ◽

Bacterial Toxin ◽

Inflammatory Factors ◽

Logistic Regression Models ◽

The Us ◽

Genes Encoding ◽

Stool Samples ◽

Bacterial Genes

Gut bacterial toxins are thought to contribute to the development of colorectal cancer (CRC). This study examines the presence of specific gut bacterial toxin genes in stool samples from individuals with colorectal neoplasia (adenomas and/or CRC). The presence of bacterial genes encoding genotoxic or pro-inflammatory factors (pks, tcpC, gelE, cnf-1, AMmurB, and usp) was established by PCR of stool samples from individuals from mainland US (n = 30; controls = 10, adenoma = 10, CRC = 10) and from Puerto Rico (PR) (n = 33; controls = 13; adenomas = 8; CRC = 12). Logistic regression models and multinomial logistic regression models were used to estimate the magnitude of association. Distinct bacterial gene profiles were observed in each sample cohort. In individuals with CRC, AMmurB was detected more frequently in samples from the US and gelE in samples from PR. In samples from PR, individuals with ≥2 gut bacterial toxin genes in stool had higher odds of having colorectal neoplasia (OR = 11.0, 95%: CI 1.0–637.1): however, no significant association between bacterial genes and colorectal neoplasia was observed in the US cohort. Further analyses are warranted in a larger cohort to validate these preliminary findings, but these encouraging results highlight the importance of developing bacterial markers as tools for CRC diagnosis or risk stratification.

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Associations of Meeting 24-hour Movement Guidelines with Stress and Self-rated Health among Adults: Is Meeting more Guidelines Associated with Greater Benefits?

10.21203/rs.3.rs-226399/v1 ◽

2021 ◽

Author(s):

Kaja KASTELIC ◽

Željko PEDIŠIĆ ◽

Dean LIPOVAC ◽

Nika KASTELIC ◽

Si-Tong CHEN ◽

...

Keyword(s):

Public Health ◽

Odds Ratio ◽

Regression Models ◽

Linear Trend ◽

Movement Behaviour ◽

Public Health Importance ◽

Public Health Perspective ◽

Logistic Regression Models ◽

The Public ◽

Self Rated Health

Abstract Background: Several countries have recently issued 24-hour movement guidelines for adults. From a public health perspective, it is important to explore the health benefits of meeting the 24-hour movement guidelines. This study, therefore, aimed to explore the associations of meeting the 24-hour movement guidelines with stress and self-rated health among adults, and whether the likelihood of favourable outcomes increases with the number of movement guidelines met.Methods: A total of 2476 adults participated in our survey. The participants were categorised depending on whether they met the combined 24-hour movement guidelines, any combination of two individual guidelines, or any individual guideline. The associations of meeting the movement guidelines with stress and self-rated health were analysed using ordinal logistic regression models.Results: Significantly lower odds of reporting higher frequency of stress were found for those who met the combined 24-hour movement guidelines (adjusted odds ratio [OR] = 0.45; 95% confidence interval [CI]: 0.32, 0.63; p < 0.001), any combination of two guidelines (OR range: 0.48 – 0.63; p < 0.05 for all), and sleep guideline only (OR = 0.51; 95% CI: 0.35, 0.75; p = 0.001). Significantly higher odds of reporting better self-rated health were found for those who met the combined 24-hour movement guidelines (OR = 2.94; 95% CI: 2.07, 4.19; p < 0.001), combination of MVPA and SB guidelines (OR = 2.33; 95% CI: 1.57, 3.44; p < 0.001), combination of MVPA and sleep guidelines (OR = 1.78; 95% CI: 1.23, 2.59; p = 0.002), and MVPA guideline only (OR = 2.24; 95% CI: 1.50, 3.36; p < 0.001). Meeting more guidelines was associated with greater odds of favourable outcomes (p for linear trend < 0.001). Conclusion: Adults who meet the sleep guideline, any combination of two guidelines, or all three guidelines experience stress less frequently. Meeting the MVPA guideline alone or in combination with any other movement behaviour guideline was associated with better self-rated health. The likelihood of less frequent stress and better self-rated health increases with the number of guidelines met. These findings highlight the public health importance of encouraging adults to meet as many movement behaviour guidelines as possible.

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Party Control as a Context for Homophily in Collaborations among US House Representatives, 1981 -- 2015

10.31219/osf.io/qwdxs ◽

2020 ◽

Author(s):

Zachary Neal ◽

Rachel Domagalski ◽

Xiaoqin Yan

Keyword(s):

House Of Representatives ◽

Regression Models ◽

Collaboration Networks ◽

Cross Sectional ◽

Logistic Regression Models ◽

Representation Of Women ◽

New Methods ◽

Party Control ◽

The Us ◽

And Gender

Effective lawmaking requires collaboration among legislators, who form coalitions to advance their legislative agendas. In the US House of Representatives, these collaborations develop in a context of shifting political party control. In this paper we explore how legislators' party and gender identities simultaneously influence whom they choose as collaborators by examining differential party and gender homophily during a period of shifting party control and increasing representation of women. We introduce new methods for inferring legislative collaboration networks from bill co-sponsorship data, then estimate cross-sectional logistic regression models on these networks from 1981 -- 2015. We find evidence of differential homophily by both party and gender: Republicans and women tend to prefer same-party and same-gender political collaborators more than Democrats and men. However, party homophily (i.e. partisanship) is stronger than gender homophily, suggesting that party is a more salient identity for legislators than gender.

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Abstract P502: Significance of Asymptomatic Hemorrhage After Mechanical Thrombectomy: A Post-Hoc Analysis of the Best Study

Stroke ◽

10.1161/str.52.suppl_1.p502 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Michael Feldman ◽

Steven Roth ◽

Matthew Fusco ◽

Shadi Yaghi ◽

Tapan V Mehta ◽

...

Keyword(s):

Endovascular Therapy ◽

Regression Models ◽

Primary Outcome ◽

Mechanical Thrombectomy ◽

Logistic Regression Models ◽

Post Hoc Analysis ◽

Conflicting Evidence ◽

The Us ◽

Post Hoc

Introduction: Intracerebral hemorrhage (ICH) occurs in 20-30% of the stroke patients undergoing endovascular therapy (EVT). However, there is conflicting evidence regarding the effect of asymptomatic ICH (aICH) on post-EVT outcomes. Methods: In this post-hoc analysis of our multi-center, prospective, “Blood Pressure after Endovascular Therapy (BEST)” study, we determined the rates of patients with aICH and symptomatic ICH (sICH; any ICH associated with ≥4 points deterioration in the baseline NIH Stroke scale). Their associations with a primary outcome of 90-day modified Rankin Scores (mRS) 0-2 vs 3-6 and early neurological recovery (ENR; NIHSS of 0-1 or ≥8-point improvement at 24 hours from baseline) was determined using univariable and multivariable logistic regression models (adjusted for age, NIH stroke scale, ASPECT score, age, thrombolytic administration, and successful recanalization defined as mTICI ≥2b). Results: Of 485 patients included in BEST at 12 comprehensive stroke centers across the US, 446 patients had a 90-day follow-up available. Of these, 92 (20.6%) developed aICH and 18 (4%) developed sICH. The aICH was not associated with worse 90-day outcome or lower ENR (OR 1.19 [0.74-1.88], p=0.45, aOR 1.19 [0.69-2.06], p= 0.53 for 90-day mRS 3-6; OR 0.77 [0.48-1.23], p=0.30, aOR 0.72 [0.43-1.22] for ENR).A higher proportion of patients with aICH had mTICI ≥2b compared to those without any ICH (97%vs 87%, p=0.01, Table). The aICH was not associated with 90-day outcome or ENR in patients with mTICI ≥2b (OR 1.28 [0.79-2.08], p=0.32 for 90-day mRS 3-6; OR 0.89 [0.69-1.12], p=0.14 for ENR). Conclusion: We found insufficient evidence that aICH associated with worse outcomes in EVT-treated patients, including those with successful recanalization. Interestingly, aICH was more frequent in patients with successful recanalization. Further validation of our findings in other large cohort studies of EVT-treated patients is warranted.

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Distance and Trust: An Examination of the Two Opposing Factors Impacting Adoption of Postal Voting Among Citizens Living Abroad

Political Behavior ◽

10.1007/s11109-021-09709-7 ◽

2021 ◽

Author(s):

Miroslav Nemčok ◽

Johanna Peltoniemi

Keyword(s):

Regression Models ◽

Political Representation ◽

Postal Service ◽

Parliamentary Elections ◽

Logistic Regression Models ◽

State Office ◽

Two Factors ◽

The One ◽

The Impact ◽

Do So

AbstractPostal voting intends to provide citizens residing abroad with a convenient voting technique to influence political representation in their country of origin. However, its adoption among individuals is dependent on two opposing factors. On the one hand, voting via post helps to overcome the increasing distance between a voter’s residency abroad and the nearest polling station organized by a diplomatic mission (mostly at an embassy or a consulate). On the other hand, this way of voting also requires enough trust that the postal service and designated state office will successfully deliver one’s vote to the ballot box because the result cannot be effectively verified without violation of the ballot secrecy. We examine the interaction of these two factors in an originally conducted survey among Finnish citizens residing abroad fielded shortly after the 2019 Parliamentary elections—the first occasion after Finland put postal voting into effect. Altogether, 664 respondents responded to all questions required for our specification of binomial logistic regression models controlling for various potential confounders. The results demonstrate that trust in postal voting moderates the impact of distance on one’s probability to adopt postal voting. While low-trusting emigrant voters remain largely indifferent regardless of the distance to the nearest polling station, medium-trusting non-resident citizens increasingly mail their ballots when the nearest polling station is more than 100 km away. High-trusting individuals begin to increasingly do so when they are ten to 30 km away.

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Epidemiology of Invasive Meningococcal Disease with Decreased Susceptibility to Penicillin in Ontario, Canada, 2000 to 2006

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01077-09 ◽

2010 ◽

Vol 54 (3) ◽

pp. 1016-1021 ◽

Cited By ~ 17

Author(s):

Elizabeth M. Brown ◽

David N. Fisman ◽

Steven J. Drews ◽

Sharon Dolman ◽

Prasad Rawte ◽

...

Keyword(s):

Meningococcal Disease ◽

Regression Models ◽

Temporal Trends ◽

Fatal Outcome ◽

Invasive Meningococcal Disease ◽

Logistic Regression Models ◽

The Public ◽

Risk Of Mortality ◽

Resistance To Penicillin ◽

The Relationship

ABSTRACT Neisseria meningitidis has been relatively slow to acquire resistance to penicillin. We previously reported an increase in the incidence of invasive meningococcal disease (IMD) strains with decreased susceptibility to penicillin (DSP) in Ontario. Our objectives were to evaluate trends in IMD with DSP, to identify case-level predictors of IMD with DSP, and to evaluate the relationship among DSP, bacterial phenotype, and the likelihood of a fatal outcome. All IMD isolates received in Ontario between 2000 and 2006 were submitted to the Public Health Laboratories, Toronto, for confirmation of the species, serogroup determination, and susceptibility testing. Isolates were considered to be IMD strains with DSP if the penicillin MIC was ≥0.125 μg/ml. Temporal trends were evaluated using multivariable Poisson regression models. Correlates of diminished susceptibility and fatal outcome were evaluated with multivariable logistic regression models. The overall rate of IMD caused by strains with DSP in Ontario was approximately 1.20 cases per million population annually (95% confidence interval [95% CI], 0.99 to 1.46). Seventy-nine strains (21.7%) were IMD strains with DSP. There was no year-to-year trend in the incidence of IMD with DSP. IMD with DSP was strongly associated with strains of serogroups Y (odds ratio [OR], 6.3; 95% CI, 3.6 to 11.1) and W-135 (OR, 8.2; 95% CI, 4.0 to 16.7). Infection with serogroup B or C strains was associated with a marked increase in the risk of mortality (OR, 3.07; 95% CI, 1.39 to 6.75); however, no association between IMD with DSP and mortality was observed. In contrast to trends of the 1990s, the incidence of IMD with DSP was stable in Ontario between 2000 and 2006. In Ontario, the serogroup rather than the penicillin MIC is the microbiological parameter most predictive of mortality.

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Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys

BMJ ◽

10.1136/bmj.l2219 ◽

2019 ◽

pp. l2219 ◽

Cited By ~ 72

Author(s):

David Hammond ◽

Jessica L Reid ◽

Vicki L Rynard ◽

Geoffrey T Fong ◽

K Michael Cummings ◽

...

Keyword(s):

United States ◽

Regression Models ◽

Smoking Prevalence ◽

The United States ◽

Close Monitoring ◽

Cross Sectional ◽

Logistic Regression Models ◽

Nicotine Concentration ◽

The Past ◽

The Us

Abstract Objective To examine differences in vaping and smoking prevalence among adolescents in Canada, England, and the United States. Design Repeat cross sectional surveys. Setting Online surveys in Canada, England, and the US. Participants National samples of 16 to 19 year olds in 2017 and 2018, recruited from commercial panels in Canada (n=7891), England (n=7897), and the US (n=8140). Main outcome measures Prevalence of vaping and smoking was assessed for use ever, in the past 30 days, in the past week, and on 15 days or more in the past month. Use of JUUL (a nicotine salt based electronic cigarette with high nicotine concentration) and usual vaping brands were also assessed. Logistic regression models examined differences in vaping and smoking between countries and over time. Results The prevalence of vaping in the past 30 days, in the past week, and on 15 days or more in the past month increased in Canada and the US between 2017 and 2018 (P<0.001 for all), including among non-smokers and experimental smokers, with no changes in England. Smoking prevalence increased in Canada (P<0.001 for all measures), with modest increases in England, and no changes in the US. The percentage of ever vapers who reported more frequent vaping increased in Canada and the US (P<0.01 for all), but not in England. The use of JUUL increased in all countries, particularly the US and Canada—for example, the proportion of current vapers in the US citing JUUL as their usual brand increased threefold between 2017 and 2018. Conclusions Between 2017 and 2018, among 16 to 19 year olds the prevalence of vaping increased in Canada and the US, as did smoking in Canada, with little change in England. The rapidly evolving vaping market and emergence of nicotine salt based products warrant close monitoring.

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