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

Shannon Gravely, Pete Driezen, Janine Ouimet, Anne C K Quah, K Michael Cummings, Mary E Thompson, Christian Boudreau, David Hammond, Ann McNeill, Ron Borland, James F Thrasher, Richard Edwards, Maizurah Omar, Sara C Hitchman, Hua-Hie Yong, Tonatiuh Barrientos-Gutierrez, Marc C Willemsen, Eduardo Bianco, Marcelo Boado, Fastone Mathew Goma, Hong Gwan Seo, Nigar Nargis, Yuan Jiang, Cristina De Abreu Perez, Geoffrey T Fong, Shannon Gravely, Pete Driezen, Janine Ouimet, Anne C K Quah, K Michael Cummings, Mary E Thompson, Christian Boudreau, David Hammond, Ann McNeill, Ron Borland, James F Thrasher, Richard Edwards, Maizurah Omar, Sara C Hitchman, Hua-Hie Yong, Tonatiuh Barrientos-Gutierrez, Marc C Willemsen, Eduardo Bianco, Marcelo Boado, Fastone Mathew Goma, Hong Gwan Seo, Nigar Nargis, Yuan Jiang, Cristina De Abreu Perez, Geoffrey T Fong

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.

© 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Figures

Figure 1
Figure 1
Country classification based on the strength of regulatory policies for the sale and marketing of nicotine vaping products (NVPs) during country survey data collection. 1Uruguay and Brazil also prohibit the sale and marketing of non‐nicotine vaping products. 2Malaysia: There is no existing law related directly to the legality of NVP products (the government applied an existing law to the sale of e‐liquids particularly those with nicotine). Nicotine is classified as a class C poison under the Poisons Act 1952 and Control of Drugs and Cosmetics Regulations 1984. Therefore, the sale, distribution or importation of unlicensed nicotine‐containing e‐cigarettes is prohibited
Figure 2
Figure 2
Awareness (ever heard) of nicotine vaping products (NVPs) among smokers and recent ex‐smokers (weighted %)
Figure 3
Figure 3
Ever‐used nicotine vaping products (NVPs) among smokers and recent ex‐smokers (weighted %)
Figure 4
Figure 4
Current use (daily, weekly or monthly) of nicotine vaping products (NVPs) among smokers and recent ex‐smokers (weighted %)
Figure 5
Figure 5
Daily use of nicotine vaping products (NVPs) among smokers and recent ex‐smokers (weighted %)
Figure 6
Figure 6
Prevalence of current nicotine vaping products (NVPs) use by smoking status (weighted %). [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 7
Figure 7
Daily and weekly users using vaping products with nicotine (% yes, weighted). [Colour figure can be viewed at wileyonlinelibrary.com]

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