Cross-Sectional E-Cigarette Findings From the ITC Project

Summary of Study

Bottom Line: The strength and implementation of regulatory policies may shape the behavior of Nicotine Vapor Products (NVPs) use by current and former smokers. This paper presents updated prevalence estimates of awareness, ever-use, and current use of NVPs from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. Findings continue to suggest that awareness and use patterns vary according to the level and strength of the regulatory environment.

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): 

  • Most restrictive policies (MRPs): not legal to be sold or marketed with strict enforcement.
  • Restrictive policies (RPs): not approved for sale or marketing with weak enforcement.
  • Less restrictive policies (LRPs): legal to be sold and marketed with regulations. 
  • No regulatory policies (NRPs). 

Key Findings include: 

  • NVP awareness and use were lowest in NRP countries. 
  • Generally, ever- and current use of NVPs were lower in MRP countries relative to LRP countries.
  • NVP use was highest among high-income countries, followed by upper-middle-income countries, and then by lower-middle income countries.
  • Daily use was highest for 2 LRP countries: England (9.4%) and the US (6.6%) and 2 RP countries: NZ (7.8%) and Canada (4.4%).

In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in NVPs in these countries where smoking populations are predominantly poorer. The higher awareness and use of NVPs in high-income countries with moderately (e.g., Canada, NZ) and less (e.g., England, US) restrictive policies, is likely due to the greater availability and affordability of NVPs

The concept of using NVPs to replace cigarette smoking as a harm reduction strategy has been a hotly debated topic. Less than a decade ago, many countries implemented policies to restrict access to vaping products. However, this was not the case for England, a country where NVPs have been embraced by PHE and the Royal College of Physicians as a harm reduction strategy, whereas most public health agencies in the other countries have not done anything similar, including the Netherlands, which has similar NVP regulations. This may explain why all prevalence estimates were highest in England

As many governments around the world have implemented a broad range of regulatory policies on the sale and marketing of NVPs, and in other domains that would affect NVP use (e.g., taxation and vape-free laws), further international studies with longitudinal data—that can both inform governments about policy approaches and/or policy changes— are urgently needed.

Read the full report here.