Electronic cigarettes (i.e., e-cigarettes) are devices in which solution containing nicotine is atomized by a heating coil and then inhaled. These e-cigarettes, mentioned in ASHES, Vol. 9(4), are a relatively new addition to the nicotine product landscape. Since entering the market less than ten years ago, they have faced increased scrutiny from policymakers (e.g., DeLancey, 2010), including outright bans in Canada (Health Canada, 2009) and Australia (Australian Government Therapeutic Goods Administration, 2013) due to questionable health and safety evidence. This week’s ASHES reviews a study that measured the awareness, attitudes and usage of e-cigarettes in four industrialized nations (Adkison et al., 2013).
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- Researchers analyzed data from Wave 8 of the
International Tobacco Control Four-Country Survey, occurring between July 2010
and June 2011 (Thompson et al.,
- Respondents were from the U.S. (n = 1520), the U.K. (n = 1325), Canada (n=1581), and Australia (n = 1513).
- At enrollment, respondents included in the current study (1) were 18 years old or older, (2) had smoked at least 100 cigarettes over their lifetime and (3) smoked at least one cigarette in the 30 days before enrollment.
- This survey asked respondents if they had heard
of e-cigarettes, whether they had tried an e-cigarette themselves in the past, and
whether they were current users.
- The survey also asked those who were aware of e-cigarettes whether they thought that e-cigarettes were more harmful than traditional cigarettes, equally as harmful as traditional cigarettes, or less harmful than traditional cigarettes.
- As shown in Figure 1, larger percentages of respondents had heard of e-cigarettes in the countries where sales were legal (the U.S and the U.K.) than in the countries where e-cigarettes were banned (Canada and Australia).
- Roughly one out of every six respondents who were
aware of e-cigarettes had tried one.
- Despite the bans, 10% of Canadians and 11% of Australians who were aware of e-cigarettes reported having tried one.
- Across countries, roughly 70% of those who were aware of e-cigarettes believed that they were less harmful than traditional cigarettes. This varied somewhat by country; respondents in the UK were most likely to view e-cigarettes as less harmful than traditional cigarettes (82%), while those in the US were least likely to hold this view (66%).
Figure 1: Percentages of respondents who were aware of e-cigarettes and had used e-cigarettes by country.
- The study only surveyed current and former smokers, so the results are not necessarily indicative of the awareness and beliefs of overall populations.
- Data on awareness may be out of date, since there have been changes in the advertisement and distribution of e-cigarettes since the time of the study. For example, last December the first ads appeared on television in the U.S. (Sanburn, 2013).
Larger percentages of smokers know about e-cigarettes in the countries where e-cigarettes are legal, presumably due to differences in marketing efforts. For example, in the U.S., smokers are exposed to ads via magazines and on television. Despite a lack of solid evidence, a substantial number of people believe that e-cigarettes are less harmful than traditional cigarettes. Even in the two countries where they were banned, nontrivial percentages of people reported trying or using e-cigarettes. Through internet sales and other means, consumers are finding ways around the restrictions. Researchers should conduct more studies and clinical trials to determine if e-cigarettes are truly less harmful, if they can actually help people quit, and if so, how they can be used as part of smoking cessation programs.
– Matthew Tom
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Adkison, S. E., O’Connor, R. J., Bansal-Travers, M., Hyland, A., Borland, R., Yong, H.-H., … Fong, G. T. (2013). Electronic Nicotine Delivery Systems. American Journal of Preventive Medicine, 44(3), 207–215. doi:10.1016/j.amepre.2012.10.018
Australian Government Therapeutic Goods Administration. (2013, March 12). Electronic cigarettes. Australian Government Department of Health and Ageing. Retrieved from http://www.tga.gov.au/consumers/ecigarettes.htm
DeLancey, S. (2010, September 9). FDA acts against 5 electronic cigarette distributors. WebContent. Retrieved June 3, 2013, from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2010/ucm225224.htm
Health Canada. (2009, March 4). To All Persons Interested in Importing, Advertising or Selling Electronic Smoking Products in Canada - Health Canada Notice 2009-03-27. notice. Retrieved June 11, 2013, from http://www.hc-sc.gc.ca/dhp-mps/prodpharma/applic-demande/pol/notice_avis_e-cig-eng.php
Sanburn, J. (2013, January 8). Can Electronic Cigarettes Challenge Big Tobacco? Time.com. Retrieved from http://business.time.com/2013/01/08/can-electronic-cigarettes-challenge-big-tobacco/#ixzz2VBdCiXPg
Thompson, M. E., Fong, G. T., Hammond, D., Boudreau, C., Driezen, P., Hyland, A., … Laux, F. L. (2006). Methods of the International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 15(suppl_3), iii12–iii18. doi:10.1136/tc.2005.013870
 Some respondents had quit smoking between enrollment and Wave 8, but still remained in the sample for follow-up interviews.