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
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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).
Patient consent for publication Not required.
Ethics approval The survey protocols and all materials of W1 and/or W2 ITC Four Country Smoking and Vaping Survey, including the survey questionnaires, were cleared for ethics by Office of Research Ethics, University of Waterloo, Canada (ORE#20803/30570, ORE#21609/30878); Research Ethics Office, King’s College London, UK (RESCM-17/18–2240); Human Research Ethics, Cancer Council Victoria, Australia (HREC1603) and Human Ethics, Research Management Office, University of Queensland, Australia (2016000330/HREC1603) and Institutional Review Board Medical University of South Carolina (waived due to minimal risk). All participants provided consent to participate.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. Data were obtained through the ITC Project (https://itcproject.org/request-data-form/).
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