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Addiction. 2019 Jan 25. doi: 10.1111/add.14558. [Epub ahead of print]

Prevalence of awareness, ever-use and current use of nicotine vaping products (NVPs) among adult current smokers and ex-smokers in 14 countries with differing regulations on sales and marketing of NVPs: cross-sectional findings from the ITC Project.

Author information

1
University of Waterloo, Waterloo, Ontario, Canada.
2
Medical University of South Carolina, Charleston, SC, USA.
3
Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
4
UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK.
5
Cancer Council Victoria, Melbourne, Australia.
6
National Institute of Public Health, Cuernavaca, Morelos, Mexico.
7
Arnold School of Public Health, Columbia, SC, USA.
8
University of Otago, Wellington, New Zealand.
9
University Sains Malaysia, Penang, Malaysia.
10
Deakin University, Geelong, Victoria, Australia.
11
Maastricht University, Maastricht, the Netherlands.
12
Centro de Investigación para la Epidemia del Tabaquismo, Montevideo, Uruguay.
13
Universidad de la República, Montevideo, Uruguay.
14
University of Zambia, Lusaka, Zambia.
15
National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
16
American Cancer Society, Washington, DC, USA.
17
Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
18
Brazil Cancer Foundation, Rio de Janeiro, Brazil.
19
Ontario Institute for Cancer Research, Toronto, Canada.

Abstract

AIMS:

This paper presents updated prevalence estimates of awareness, ever-use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS:

A cross-sectional analysis of adult (≥ 18 years) current smokers and ex-smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013-17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country-specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non-daily).

FINDINGS:

NVP awareness and use were lowest in NRP countries. Generally, ever- and current use of NVPs were lower in MRP countries (ever-use = 7.1-48.9%; current use = 0.3-3.5%) relative to LRP countries (ever-use = 38.9-66.6%; current use = 5.5-17.2%) and RP countries (ever-use = 10.0-62.4%; current use = 1.4-15.5%). NVP use was highest among high-income countries, followed by upper-middle-income countries, and then by lower-middle-income countries.

CONCLUSIONS:

With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products.

KEYWORDS:

E-cigarettes; global; income classification; nicotine vaping products (NVPs); smoking; international; regulations; policies; survey

PMID:
30681215
DOI:
10.1111/add.14558

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