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Characteristics and changes over time of nicotine vaping products used by vapers in the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys
  1. Nicholas J Felicione1,
  2. Brian Vincent Fix1,
  3. Ann McNeill2,3,
  4. K. Michael Cummings4,
  5. Maciej Lukasz Goniewicz1,
  6. David Hammond5,
  7. Ron Borland6,7,
  8. Bryan W Heckman4,
  9. Maansi Bansal-Travers1,
  10. Shannon Gravely8,
  11. Sara C Hitchman2,
  12. David T Levy9,
  13. Geoffrey T Fong8,10,
  14. Richard O'Connor1
  1. 1 Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
  2. 2 Department of Addictions, King's College London, London, UK
  3. 3 Shaping Public Health Policies to Reduce Inequalities and Harm (SPECTRUM), Nottingham, UK
  4. 4 Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  5. 5 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  6. 6 School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
  7. 7 Cancer Council Victoria, Melbourne, Victoria, Australia
  8. 8 Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  9. 9 Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
  10. 10 Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  1. Correspondence to Dr Nicholas J Felicione, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA; nicholas.felicione{at}


Objectives Regulation of nicotine vaping products (NVPs) varies between countries, impacting the availability and use of these products. This study updated the analyses of O’Connor et al on types of NVPs used and examined changes in NVP features used over 18 months in four countries with differing regulatory environments.

Design Data are from 4734 adult current vapers in Australia, Canada, England and the USA from Waves 1 (2016) and 2 (2018) of the International Tobacco Control Four Country Smoking and Vaping Survey. NVP characteristics included device description, adjustable voltage, nicotine content and tank size. Longitudinal analyses (n=1058) assessed movement towards or away from more complex/modifiable NVPs. A logistic regression was used to examine factors associated with changes in device description from 2016 to 2018.

Results Like 2016, box-tanks were the most popular NVP (37.3%) in all four countries in 2018. Over 80% of vapers continued using the same NVP and nicotine content between waves, though movement tended towards more complex/modifiable devices (14.4% of vapers). Box-tank users, exclusive daily vapers and older vapers were most likely to continue using the same device description. Certain NVPs and features differed by country, such as higher nicotine contents in the USA (11.5% use 21+ mg/mL) and greater device stability over time in Australia (90.8% stability).

Conclusions Most vapers continued using the same vaping device and features over 18 months. Differences in NVP types and features were observed between countries, suggesting that differing NVP regulations affect consumer choices regarding the type of vaping device to use.

  • Electronic nicotine delivery devices
  • Public policy
  • Surveillance and monitoring

Data availability statement

Data are available on reasonable request. Data were obtained through the ITC Project (

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Data availability statement

Data are available on reasonable request. Data were obtained through the ITC Project (

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  • Contributors NJF, BVF and RO were responsible for data analyses and writing initial drafts. GTF is the Chief PI of the ITC Project. AM, MC, DH and RB are PIs, and MLG, BWH (former), MB-T, SCH, DTL and RO are Co-Is of the project. All authors provided review of drafts and approved the final manuscript.

  • Funding The ITC Four Country Smoking and Vaping Survey was supported by grants from the US National Cancer Institute (P01 CA200512), the Canadian Institutes of Health Research (FDN-148477) and the National Health and Medical Research Council of Australia (APP1106451).

  • Disclaimer The views expressed in this article are hers and not necessarily those of the NIHR, or the UK Department of Health and Social Care.

  • Competing interests AM is a UK National Institute for Health Research (NIHR) Senior Investigator. MC has received payment as a consultant to Pfizer, Inc. for service on an external advisory panel to assess ways to improve smoking cessation delivery in health care settings. MC and DH also have served as a paid expert witness in litigation filed against cigarette manufacturers. MLG has received a research grant from Pfizer and served as a member of scientific advisory board to Johnson & Johnson. DH and GTF have served as expert witnesses on behalf of governments in litigation involving the tobacco industry and vaping industry (DH).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.