• Sarah E Adkison, Richard J O'Connor, Maansi Bansal-Travers, Andrew Hyland, Ron Borland, Hua-Hie Yong, K Michael Cummings, Ann McNeill, James F Thrasher, David Hammond, and Geoffrey T Fong.
• Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
• Am J Prev Med. 2013 Mar 1; 44 (3): 207-15.

BackgroundElectronic nicotine delivery systems (ENDS) initially emerged in 2003 and have since become widely available globally, particularly over the Internet.PurposeData on ENDS usage patterns are limited. The current paper examines patterns of ENDS awareness, use, and product-associated beliefs among current and former smokers in four countries.MethodsData come from Wave 8 of the International Tobacco Control Four-Country Survey, collected July 2010 to June 2011 and analyzed through June 2012. Respondents included 5939 current and former smokers in Canada (n=1581); the U.S. (n=1520); the United Kingdom (UK; n=1325); and Australia (n=1513).ResultsOverall, 46.6% were aware of ENDS (U.S.: 73%, UK: 54%, Canada: 40%, Australia: 20%); 7.6% had tried ENDS (16% of those aware of ENDS); and 2.9% were current users (39% of triers). Awareness of ENDS was higher among younger, non-minority smokers with higher incomes who were heavier smokers. Prevalence of trying ENDS was higher among younger, nondaily smokers with a high income and among those who perceived ENDS as less harmful than traditional cigarettes. Current use was higher among both nondaily and heavy (≥20 cigarettes per day) smokers. In all, 79.8% reported using ENDS because they were considered less harmful than traditional cigarettes; 75.4% stated that they used ENDS to help them reduce their smoking; and 85.1% reported using ENDS to help them quit smoking.ConclusionsAwareness of ENDS is high, especially in countries where they are legal (i.e., the U.S. and UK). Because trial was associated with nondaily smoking and a desire to quit smoking, ENDS may have the potential to serve as a cessation aid.Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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