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Addiction. 2018 Dec 11. doi: 10.1111/add.14527. [Epub ahead of print]

Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey.

Author information

Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.
Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Tobacco Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico.
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
King's College London, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA.
Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.
School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
The Cancer Council Victoria, Melbourne, Victoria, Australia.
School of Psychology, Deakin University, Geelong, Victoria, Australia.
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
School of Public Health, Faculty of Medicine and Queensland Alliance for Environmental Health Sciences, The University of Queensland, The Public Health Building, Herston, QLD, Australia.
Ontario Institute for Cancer Research, Toronto, Ontario, Canada.



Debate exists about whether health professionals (HPs) should advise smokers to use nicotine vaping products (NVPs) to quit smoking. The objectives were to examine in four countries: (1) the prevalence of HP discussions and recommendations to use an NVP; (2) who initiated NVP discussions; (3) the type of HP advice received about NVPs; and (4) smoker's characteristics related to receiving advice about NVPs.


Cross-sectional study using multivariable logistic regression analyses on weighted data from the 2016 ITC Four Country Smoking and Vaping Survey (ITC 4CV1).


Four countries with varying regulations governing the sale and marketing of NVPs: 'most restrictive' (Australia), 'restrictive' (Canada) or 'less restrictive' (England and United States).


A total of 6615 adult smokers who reported having visited an HP in the last year (drawn from the total sample of 12 294 4CV1 respondents, of whom 9398 reported smoking cigarettes daily or weekly). Respondents were from the United States (n = 1518), England (n = 2116), Australia (n = 1046), and Canada (n = 1935).


Participants' survey responses indicated if they were current daily or weekly smokers and had visited an HP in the past year. Among those participants, further questions asked participants to report (1) whether NVPs were discussed, (2) who raised the topic, (3) advice received on use of NVPs and (4) advice received on quitting smoking.


Among the 6615 smokers who visited an HP in the last year, 6.8% reported discussing NVPs with an HP and 2.1% of smokers were encouraged to use an NVP (36.1% of those who had a discussion). Compared with Australia (4.3%), discussing NVPs with an HP was more likely in the United States [8.8%, odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.41-3.29] and Canada (7.8%, OR = 1.87, 95% CI = 1.26-2.78). Smokers in Australia were less likely to discuss NVPs than smokers in England (6.2%), although this was not statistically significant (OR = 1.47, 95% CI = 0.98-2.20). Overall, the prevalence of HPs recommending NVPs was three times more likely in the United States than in Australia (OR = 3.07, 95% CI = 1.45-6.47), and twice as likely in Canada (OR = 2.28, 95% CI = 1.06-4.87) than in Australia. Australia and England did not differ (OR = 1.76, 95% CI = 0.83-3.74). Just over half (54%) of respondents brought up NVPs themselves; there were no significant differences among countries.


Discussions in Australia, Canada, England, and the United States between smokers and health professionals about nicotine vaping products appear to be infrequent, regardless of the regulatory environment. A low percentage of health professionals recommended vaping products. This was particularly evident in Australia, which has the most restrictive regulatory environment of the four countries studied.


E-cigarettes; health professional; nicotine vaping products; policy; regulation; smokers


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