Background The combustion of tobacco is the main cause of tobacco-related morbidity and mortality. E-cigarettes are potentially disruptive innovations with considerable potential for population health. A key question is whether e-cigarettes are replacing tobacco cigarettes, which requires mapping their prevalence. Collecting information on nicotine use is difficult for many countries due to cost. The objective of this study was to derive a global estimate of e-cigarette use (vaping). Methods Since 2018 we have collected information on the prevalence of e-cigarette use. To estimate the prevalence of vaping in countries lacking information, we used the method of assumed similarity between countries in the same region and economic condition. Based on surveys, we calculated the average prevalence of vaping for each WHO region, World Bank income classification group, and the legal status of e-cigarettes in each country. For each of these groups the average prevalence of vaping was calculated. These values were used as substitutes for the prevalence figures in the countries with absent data. The number of vapers was calculated by taking as the denominator the adult population. Results Survey data on e-cigarette users were available for 49 countries covering 2.8 b of the adult population in 2018 and unavailable for 2.9 b. Information on vaping was lacking for half of the world's population. We estimated a total of 58.1 m vapers worldwide in 2018. By reference to market growth the data were adjusted to arrive at estimates for 2020. Results were fitted to revenue data at the 2018. For the year 2020, the projection is for 68 m vapers globally. Conclusions Many global epidemiological studies use the method of assumed similarity between countries with shared characteristics in order to estimate missing data. The methodological limitations are likely to overestimate the global number of vapers. Our estimate of 68 m vapers indicates considerable uptake given that: e-cigarettes have been available on most markets for only a decade; there is either no support, or there is opposition to vaping in many countries; and countries which regulate e-cigarettes have controls over advertising and promotion. However, given the global scale of tobacco smoking (at 1.1 billion people), progress in adoption of alternative products is slow. Those using e-cigarettes are still a small fraction of those who smoke.
Purpose Nicotine is consumed by one in five of the global adult population, mostly by smoking tobacco cigarettes. Modern electronic cigarettes came onto the market from around 2007 and have considerable potential to improve population health by displacing tobacco smoking. The purpose of this study is to map the use of e-cigarettes, but this is difficult due to absence of data sources for many countries. Design/methodology/approach The global number of vapers was estimated to be 68 million in 2020. New data in 2021 offered an opportunity to update that estimate. The method of assumed similarity was used for countries with missing data. The average prevalence of vaping was calculated for each World Health Organization region, World Bank income classification group and the legal status of e-cigarettes in each country. The number of vapers was calculated for the adult population. The estimate was refined by adjusting for changes in market value size and the actual year of surveys. Findings Population prevalence data on e-cigarette used were available for 48 countries. We estimate that there were 82 million vapers worldwide in 2021: 9.2 million in the Eastern Mediterranean region; 5.6 million in the African region; 20.1 million in the European region; 16.8 million in the Americas; 16.0 million in the Western Pacific region; and 14.3 million in South-East Asia. Originality/value Global, regional and national estimates of the numbers of vapers are important indicators of trends in nicotine use, and monitoring the uptake of vaping is important to inform international and national policy.
Introduction The study investigated the role and activities of organizations that advocate for the adoption of and access to safer nicotine products (SNPs), such as nicotine vaping products (e‐cigarettes), Swedish‐style snus, nontobacco nicotine pouches, and heated tobacco products, as safer alternatives to combustible cigarettes and other high‐risk tobacco products, following a harm reduction approach. The aim was to map the number and locations of nicotine consumer organizations globally and describe their history, legal status, membership, structure, objectives, working methods and activities, and funding. Methods We identified active organizations through the use of existing networks and referrals. All identified organizations were contacted and asked to fill in an online self‐completion survey through the representatives of the organizations. The data collected were cleaned and anonymized. Categorization and analysis of variable distributions were carried out. Responses to open–ended questions were analyzed qualitatively. Results A total of 52 active organizations were identified: 13 in Latin America, 8 in Africa, 24 in Europe, 5 in the Asia‐Pacific region, and 2 in North America. Most were established from 2016 onward, and 39 were legally incorporated. Their reported objectives were to raise awareness about SNP, promote rights to access SNP, and advocate for a legal and regulatory environment in which SNPs are available. They are small organizations: Most are operated with volunteers, with only 7 having any contracted or paid staff, and only 13 persons globally with a paid position. A total of 31 organizations had not received any funding support. The total global funding for all organizations was US$ 309,810. None reported receiving funding from tobacco or pharmaceutical companies. All pointed to important achievements in the public debate about SNP and tobacco harm reduction. Conclusion The organizations are run by enthusiastic individuals, most of whom have successfully quit smoking with the help of SNP. Organizations depend on the input of a small number of core workers, all organizations are under‐resourced and potentially fragile, and yet, they report significant activity and success. The challenge for these groups is to gain recognition at national and international level as legitimate stakeholders in the development of tobacco control policy with respect to safer alternatives to smoking.
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