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INTRODUCTION: The rapid rise in electronic cigarettes (ECs) globally has stimulated much debate about the relative risk and public health impact of this new emerging product category as compared to conventional cigarettes. The sale and marketing of ECs containing nicotine are banned in many countries (eg, Australia) but are allowed in others (eg, United Kingdom). This study examined prevalence and correlates of the belief that ECs are a lot less harmful than conventional cigarettes under the different regulatory environments in Australia (ie, more restrictive) and the United Kingdom (ie, less restrictive). METHODS: Australian and UK data from the 2013 survey of the International Tobacco Control Four-Country project were analyzed. RESULTS: More UK than Australian respondents (58.5% vs. 35.2%) believed that ECs are a lot less harmful than conventional cigarettes but more respondents in Australia than in the United Kingdom selected "Don't Know" (36.5% vs. 17.1%). The proportion that responded "A little less, equally or more harmful" did not differ between countries. Correlates of the belief that ECs are "A lot less harmful" differed between countries, while correlates of "Don't Know" response did not differ. CONCLUSIONS: Consistent with the less restrictive regulatory environment affecting the sale and marketing of ECs, smokers and recent ex-smokers in the United Kingdom were more likely to believe ECs were less harmful relative to conventional cigarettes compared to those in Australia. IMPLICATIONS: What this study adds: Among smokers and ex-smokers, this study found that the belief that ECs are (a lot) less harmful than conventional cigarettes was considerably higher in the United Kingdom than in Australia in 2013. The finding is consistent with the less restrictive regulatory environment for ECs in the United Kingdom, suggesting that the regulatory framework for ECs adopted by a country can affect smokers' perceptions about the relative harmfulness of ECs, the group that stands to gain the most from having an accurate belief about the relative harms of ECs.

Exposure to tobacco product marketing promotes the initiation, continuation, and reuptake of cigarette smoking and as a result the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) has called upon member Parties to enact comprehensive bans on tobacco advertising and promotion. This study examines the immediate and long term effectiveness of advertising restrictions enacted in different countries on exposure to different forms of product marketing, and examines differences in exposure across different socioeconomic status (SES) groups. Nationally representative data from the United Kingdom, Canada, Australia, and the United States, collected from adult smokers between 2002 and 2008 using the International Tobacco Control Four Country Survey (ITC-4), were used in this study (N = 21,615). In light of the specific marketing regulation changes that occurred during the course of this study period, changes in awareness of tobacco marketing via various channels were assessed for each country, and for different SES groups within countries. Tobacco marketing regulations, once implemented, were associated with significant reductions in smokers' reported awareness of pro-smoking cues, and the observed reductions were greatest immediately following the enactment of regulations. Changes in reported awareness were generally the same across different SES groups, although some exceptions were noted. While tobacco marketing regulations have been effective in reducing exposure to certain types of product marketing there still remain gaps, especially with regard to in-store marketing and price promotions. © 2011 by the authors; licensee MDPI, Basel, Switzerland.

This study examined reported use of, and beliefs about, so-called light cigarettes among adult smokers in four countries: Australia (Aus), Canada (Can), the United Kingdom (U.K.) and the United States (U.S.). The method used was parallel telephone surveys among 9,046 smokers across the four countries. The results indicated that more than half of all smokers in each country except the U.K. reported smoking light cigarette brands. A majority of smokers surveyed in each country except Canada continue to believe that light cigarettes offer some health benefit compared to regular cigarettes (Canada 43%, U.S. 51%, Australia 55%, U.K. 70%). A majority of smokers in all four countries believed that light cigarettes are smoother on the throat and chest than regular cigarettes. Predictors of use of light cigarettes and beliefs about possible benefits were very similar in the four countries. These results demonstrate an ongoing need for public education about why light cigarettes do not reduce harm and do not make quitting easier. The results provide further evidence for the need for regulatory measures in all four countries to prohibit the use of misleading light and mild descriptors including package imagery in product marketing (as prescribed in Article 11 of the Framework Convention on Tobacco Control), abandon the use of standard FTC/ISO tar and nicotine yields as consumer information, and adopt policies to regulate deceptive design features of cigarettes, such as ventilated filters.

INTRODUCTION: E-cigarettes (ECs) have gained significant attention in recent years. They have been introduced in jurisdictions with divergent existing laws that affect their legality. This provides the opportunity for natural experiments to assess effects of such laws in some cases independent of any formulated government policy. We compare patterns of EC awareness and use over a 3 year period in Australia where laws severely restrict EC availability, with awareness and use in the United Kingdom where ECs are readily available. METHODS: Data analyzed come from Waves 8 and 9 (collected in 2010 and 2013, respectively) of the International Tobacco Control surveys in Australia and the United Kingdom (approximately 1,500 respondents per wave per country). RESULTS: Across both waves, EC awareness, trial, and use among current and former smokers were significantly greater in the United Kingdom than in Australia, but all 3 of these measures increased significantly between 2010 and 2013 in both countries, and the rate of increase was equivalent between countries. Seventy-three percent of U.K. respondents reported that their current brands contained nicotine as did 43% in Australia even though sale, possession and/or use of nicotine-containing ECs without a permit are illegal in Australia. EC use was greater among smokers in both countries, at least in part due to less uptake by ex-smokers. CONCLUSIONS: EC awareness and use have risen rapidly between 2010 and 2013 among current and former smokers in both Australia and the United Kingdom despite different EC regulatory environments. Substantial numbers in both countries are using ECs that contain nicotine.

AIMS: To examine whether norms towards nicotine vaping product (NVP) use varied between Australia, Canada, England and the United States and by sociodemographics, smoking and NVP status. DESIGN: Cross-sectional data from the 2016 ITC Four Country Smoking and Vaping Survey. SETTING: Four countries with distinct regulatory policies relating to the sale and advertising of NVPs: Australia (most restrictive), Canada (restrictive), England and United States (least restrictive). PARTICIPANTS: 10,900 adult (age 18+) current smokers, former smokers, or at least weekly NVP users. Respondents were from Australia (n=1,366), Canada (n=3,309), England (n=3,835) and the United States (n=2,390). MEASUREMENTS: Questions permitted the categorization of respondents as current smokers, former smokers, NVP users and sociodemographic categories (sex, age, country, ethnicity, income and education). Further questions were asked regarding the frequency of exposure to NVPs in public, whether they had a partner or close friends who vaped and whether they believed society or those considered important to them approved of NVPs. FINDINGS: Adjusting for relevant covariates, compared to Australian respondents, those in England, Canada and United States were more likely to report frequent exposure to NVPs in public (83.1%, 57.3% and 48.3% respectively, compared to 19.8% in Australia; p<0.0001), having a partner who vaped (13.8%, 7.1% and 7.7% respectively, compared to 2.1% in Australia; p<0.0001) and having close friend(s) who vaped (31.7%, 25.3%, 20.9% respectively, compared to 10.0% in Australia; p<0.0001). Compared to Australian respondents, respondents from England were more likely to report that society (27.6% , compared to 12.3% in Australia; p<0.0001) and people important to them approved of NVP use (28.9% compared to 14.3% in Australia; p<0.0001). CONCLUSIONS: Our findings suggest that norms towards NVP use vary within distinct regulatory contexts. Country differences in norms towards NVP use may also reflect differences ...

BACKGROUND AND AIMS: Government regulations of nicotine vaping products (NVP) have evolved rapidly over the past decade. The impact of NVP regulatory environment and vaping on cigarette demand in unknown. The current study aims to investigate whether or not respondents' reported cigarette demand, as measured by a hypothetical cigarette purchase task, varies with 1) smoking status, 2) vaping status, or 3) NVP regulatory environment (country used as proxy). PARTICIPANTS: 10,316 adult smokers. SETTING: Australia (AU), Canada (CA), England (EN), and the Untied States (US). DESIGN: Cross-sectional survey data from Wave 1 of the International Tobacco Control (ITC) Four Country Smoking and Vaping (4CV) Survey (2016). METHODS: Data for this cross-sectional study were from 10,316 adult smokers who participated in Wave 1 of the International Tobacco Control (ITC) Four Country Smoking and Vaping (4CV) Survey, which was conducted in 2016 in Australia (AU), Canada (CA), England (EN), and the United States (US). The purchase task asked smokers to estimate how many cigarettes they would purchase for consumption in a single day across multiple cigarette prices. Overall sensitivity of cigarette consumption to price increases was quantified to index cigarette demand elasticity whereas estimated consumption when cigarettes are free was used to index cigarette demand intensity. MEASUREMENTS: A hypothetical purchase task asked smokers to estimate how many cigarettes they would purchase for consumption in a single day across multiple cigarette prices. Responses were used to derive measures of cigarette demand. Overall sensitivity of cigarette consumption to price increases was quantified to index cigarette demand elasticity whereas estimated consumption when cigarettes are free was used to index cigarette demand intensity. RESULTS: A majority of the non-daily smokers had previously smoked daily (72.3%); daily vapers were more likely to be former daily smokers (89.9%) compared to non-daily vapers (70.1%) and non-vapers (69.2%) ...