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Introduction: Little is known about the international impact of E-cigarette or Vaping-Associated Lung Injury ('EVALI') on youth perceptions of vaping harms.Methods: Repeat cross-sectional online surveys of youth aged 16-19 years in England, Canada, and the United States before (2017, 2018), during (2019 August/September), and after (2020 February/March, 2020 August) the 'EVALI' outbreak (N = 63380). Logistic regressions assessed trends, country differences, and associations between exposure to negative news stories about vaping and vaping harm perceptions.Results: Exposure to negative news stories increased between 2017 and February-March 2020 in England (12.6% to 34.2%), Canada (16.7% to 56.9%), and the United States (18.0% to 64.6%), accelerating during (2019) and immediately after (February-March 2020) the outbreak (p < .001) before returning to 2019 levels by August 2020. Similarly, the accurate perception that vaping is less harmful than smoking declined between 2017 and February-March 2020 in England (77.3% to 62.2%), Canada (66.3% to 43.3%), and the United States (61.3% to 34.0%), again accelerating during and immediately after the outbreak (p < .001). The perception that vaping takes less than a year to harm users' health and worry that vaping will damage health also doubled over this period (p ≤ .001). Time trends were most pronounced in the United States. Exposure to negative news stories predicted the perception that vaping takes less than a year to harm health (Adjusted Odds Ratio = 1.55, 1.48-1.61) and worry that vaping will damage health (Adjusted Odds Ratio = 1.32, 1.18-1.48).Conclusions: Between 2017 and February-March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after 'EVALI'. Effects were seen in all countries but were most pronounced in the United States.Implications: This is the first study examining changes in exposure to news stories about vaping, and perceptions of vaping harms, among youth in England, Canada, and the United States before, during, and after 'EVALI'. Between 2017 and February-March 2020, youth exposure to negative news stories, and perceptions of vaping harms, increased, and increases were exacerbated during and immediately after 'EVALI'. By August 2020, exposure to negative news stories returned to 2019 levels, while perceptions of harm were sustained. Exposure to negative news stories also predicted two of the three harm perception measures. Overall, findings suggest that 'EVALI' may have exacerbated youth's perceptions of vaping harms internationally. [ABSTRACT FROM AUTHOR]

Objectives. To examine the impact of US restrictions implemented in February 2020 prohibiting flavors other than menthol and tobacco in cartridge-based e-cigarettes. Methods. We analyzed 5 cross-sectional waves of the International Tobacco Control Policy Evaluation Project Youth Tobacco and Vaping Surveys, conducted online with youths aged 16 to 19 years in the United States, Canada, and England, for differences in usual e-cigarette flavor, device, and brand reported by past-30-day vapers (n = 9512) before (2017, 2018, 2019), during (February 2020), and after (August 2020) implementation of US flavor restrictions. Results. In August 2020, 78.7% of vapers in the United States reported using a flavor prohibited in cartridges or pods, versus 86.3% in Canada (adjusted odds ratio [AOR] = 1.73; 95% CI = 1.25, 1.40) and 79.8% in England (AOR = 1.10; 95% CI = 0.78, 1.55). Disposable e-cigarettes (exempt from flavor restrictions) increased to a greater extent among vapers in the United States (13.2% to 36.8%) versus Canada (7.7% to 14.2%; AOR = 2.01; 95% CI = 1.33, 3.04) and England (10.8% to 16.4%; AOR = 2.33; 95% CI = 1.52, 3.57). Puff Bar (disposable) emerged as the most popular brand in the United States. Conclusions. Usual flavors used by youth vapers in the United States were unchanged after 2020 restrictions on cartridge-based e-cigarettes. Youths used brands and devices exempt from the restrictions. (Am J Public Health. 2022;112(7):1014–1024. https://doi.org/10.2105/AJPH.2022.306780) [ABSTRACT FROM AUTHOR]

Background and Aims: Debate exists about whether health professionals (HPs) should advise smokers to use nicotine vaping products (NVPs) to quit smoking. The objectives were to examine in four countries: (1) the prevalence of HP discussions and recommendations to use an NVP; (2) who initiated NVP discussions; (3) the type of HP advice received about NVPs; and (4) smoker's characteristics related to receiving advice about NVPs. Design Cross‐sectional study using multivariable logistic regression analyses on weighted data from the 2016 ITC Four Country Smoking and Vaping Survey (ITC 4CV1). Setting: Four countries with varying regulations governing the sale and marketing of NVPs: 'most restrictive' (Australia), 'restrictive' (Canada) or 'less restrictive' (England and United States). Participants: A total of 6615 adult smokers who reported having visited an HP in the last year (drawn from the total sample of 12 294 4CV1 respondents, of whom 9398 reported smoking cigarettes daily or weekly). Respondents were from the United States (n = 1518), England (n = 2116), Australia (n = 1046), and Canada (n = 1935). Measurements Participants' survey responses indicated if they were current daily or weekly smokers and had visited an HP in the past year. Among those participants, further questions asked participants to report (1) whether NVPs were discussed, (2) who raised the topic, (3) advice received on use of NVPs and (4) advice received on quitting smoking. Findings Among the 6615 smokers who visited an HP in the last year, 6.8% reported discussing NVPs with an HP and 2.1% of smokers were encouraged to use an NVP (36.1% of those who had a discussion). Compared with Australia (4.3%), discussing NVPs with an HP was more likely in the United States [8.8%, odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.41–3.29] and Canada (7.8%, OR = 1.87, 95% CI = 1.26–2.78). Smokers in Australia were less likely to discuss NVPs than smokers in England (6.2%), although this was not statistically significant (OR = 1.47, 95% CI = 0.98–2.20). Overall, the prevalence of HPs recommending NVPs was three times more likely in the United States than in Australia (OR = 3.07, 95% CI = 1.45–6.47), and twice as likely in Canada (OR = 2.28, 95% CI = 1.06–4.87) than in Australia. Australia and England did not differ (OR = 1.76, 95% CI = 0.83–3.74). Just over half (54%) of respondents brought up NVPs themselves; there were no significant differences among countries. Conclusions: Discussions in Australia, Canada, England, and the United States between smokers and health professionals about nicotine vaping products appear to be infrequent, regardless of the regulatory environment. A low percentage of health professionals recommended vaping products. This was particularly evident in Australia, which has the most restrictive regulatory environment of the four countries studied. [ABSTRACT FROM AUTHOR]

Background and Aims: The regulatory environment for nicotine vaping products (NVPs) varies widely across countries and this will probably affect the devices used, nicotine content and usage, and hence the ability of NVPs to substitute for cigarettes. We aimed to describe the types of NVPs used by current vapers in four countries with varying regulatory and enforcement approaches toward the marketing and sale of NVPs., Methods: Data are from wave 1 (July-November 2016) of the ITC Four Country Smoking and Vaping Survey (4CV1), conducted among a cohort of current and former smokers, and current NVP users (n = 5147 adults; ≥ 18 years) in Australia (AU), Canada (CA), England (EN) and the United States (US) reporting either current daily, weekly or occasional NVP use. Devices were described by type, brand, voltage variability and refill capacity. Refill solutions were described by flavour and nicotine content. Descriptive statistics and bivariate analyses were conducted on the overall sample and stratified by country. A multinomial logistic regression examined factors associated with device preference across the whole sample., Results: The types of NVPs used differed by pattern of use and country. Exclusive, daily vapers were more likely to use refillable pen-shaped devices [odds ratio (OR) = 10.0] or refillable box-shaped devices (OR = 5.4) than disposable cigalike devices, when compared with other (non-daily/dual) users. Nearly all respondents reported using flavoured NVPs, fruit (28.3%) being the most common flavour. Refillable devices were the most popular: refillable box-shaped devices were more commonly reported by vapers in AU (36.8%) and US (31.4%), whereas in EN (47.4%) and CA (29.7%), vapers more often reported using refillable pen-style devices. Most users also reported that their products contained nicotine, even in CA (87.8%) and AU (91.2%), where vaping products containing nicotine were technically illegal., Conclusions: In Australia, Canada, England and the United States in 2016, refillable nicotine vaping products were the most common type of nicotine vaping products used by daily vapers. Most daily vapers reported using flavoured e-liquids/refills (with variance across countries) and most reported using products that contain nicotine, even where vaping products with nicotine were banned., (© 2019 Society for the Study of Addiction.)