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Vaping and smoking: Findings from the ITC project

Ron Borland PhDNigel Gray Distinguished Fellow in Cancer Prevention,

Cancer Council Victoria

On behalf of all ITC-4 Country team

Global Forum on Nicotine Warsaw, Poland, June 2017

Funding: See logosCOI: None

Australian funding, primarily NHMRC #11006451

• Aim to evaluate policies and mass disseminated

interventions

– US, UK, Canada and Australia

• Follows cohorts of smokers and recent quitters in

different countries

– Common methodology

– Assesses mediational pathways

– Embedded natural experiments

– Demonstrate differential effects when policy introduced

• Now major focus on vaping

ITC Project

• First asked specifically in 2010

• Extended each wave

• 2016 wave major focus

• People who used nicotine in last 2 years

– Focus on those who have been daily

smokers n=11,146

• Preliminary data, cleaned and partly

weighted

– Rapidly changing environment, need to get

information out quickly

ITC and vaping

• Not simply a therapy to quit

– Partly or mainly a substitute

– Conventional approaches are limited

• Choice may involve

– Relative experienced benefits (including enjoyment)

– Perceived costs

• Monetary and worry

Conceptual frame

• Patterns of use

– Prevalence of use

– Use to try to quit smoking

– Intensity/patterns of use

– Where used

• Relevant beliefs and attitudes

– Acceptability

– Harmfulness

– Enjoyment/Satisfaction (users only)

• Future intentions: to use or not use

Vaping and its effects on smoking

Results – Trends in EC use (ITC data)

0

10

20

30

40

50

60

Canada USA England Australia

Daily

All curent

Patterns of vaping: ITC 2016 (%s among recent nicotine users)

Preliminary data, do not cite as precise figure

Current Daily

Smoker

Current Weekly

Smoker

Current

Occasional

Smoker

Current Daily

Vaper

19.7% 3.5% 2.7%

Current

Weekly Vaper

17.4% 3.4% 1.1%

Current

Occasional

Vaper

39.7% 5.0% 7.5%

Prevalence of 9/5 types of dual users among ever-daily smokers (ITC 4 country 2016)

Unweighted prevalence from sample of 4,743

6.2%

17.0%

Preliminary data, do not cite as precise figure

Age

Daily

smoke

&

non-

vape

< daily

smoke

&

non-

vaper

< daily

smoke

&

daily

vaper

18-24 20.4% 5.4% 4.2%

25-39 24.7% 8.0% 3.0%

40-54 42.7% 7.2% 2.0%

55 and

up

51.0% 5.2% 2.1%

Vapers , Smokers and type of dual use by age, SES and sex

Dual use declines with ageOlder more quittingHigh SES a bit like younger respondents. Women a little less likely to be dual daily users

Preliminary data, do not cite as precise figures

Less

addictive

Vaping much

less harmful

than smoking

Passive vaping

much less

harmful

Daily smoker only 23.8% 12.5% 19.7%

Daily smoker. < weekly

vape

47.1% 25.8% 36.5%

Daily smoke, weekly vape 57.7% 28.5% 35.8%

Daily smoke, daily vape 57.7% 36.2% 41.9%

<daily smoke, daily vape 52,8% 21.4% 26.8%

Vapers (any and no

smoking)

60.5% 59.4% 69.0%

Quit nicotine 24.0% 14.8% 22.5%

Overall 37.4% 21.9% 29.5%

Perceptions of harmfulness and addictiveness

Massive difference by use patternsNon daily users more negative (not shown)Passive vaping more benign than active??


Trends in Levels of Perceived Harm of

vaping: Australia and England

0

10

20

30

40

50

60

2013 2014 2016

Australian

England

Percentages saying much less harmful than smoking


Quit attempts by smoker type

Any vaping associated with more quit attempts


Any vaping associated with more interest in quitting

Daily

smoker

&

daily

vaper

Daily

smoker

&

weekly

vaper

Daily

smoker

& <

weekly

vaper

Daily

smoker

&

< daily

smoker

&

daily

vaper

Plan to

quit

Within 6

months51.7% 46.2% 40.3% 49.6%

Want to

quit

A lot38.5% 44.9% 37.9% 54.4%

Any vaping associated with more interest in quitting


Daily

smoke

r

&

daily

vaper

Daily

smoker

&

weekly

vaper

Daily

smoker

&

less

than

weekly

vaper

Daily

smoker

&

non-

vaper

Less

than

daily

smoker

&

daily

vaper

Sure of

quit

success?

Very/

Extremely20.6% 13.2% 13.7% 10.9% 28.1%

How hard

to quit?Very hard 35.4% 44.1% 47.0% 54.2% 29.2%

Daily smokers (only) less confident of success and report quitting harder

Any vaping associated with greater self-efficacyThe more they vape the more confident


Time to first nicotine (vaporiser or cigarette).

No clear association with TTFCIf anything vapers may be more dependent by this indicator


% using vaping on

last quit attempt

% using tank

system

Canada 51% 60%

United Stated 59% 42%

England 59% 54%

Australia 36% 50%

Raw unweighted data. These figures will change, only presented to show

the big pattern

NB: Some significant differences in the sample characteristics between

countries. Oversampling of <25s in all, except Australia. Also recruitment

sources somewhat different.

Preliminary ITC 2016 data


Vaping and Quitting by Age

<25 25 – 39 40 - 54 55 +

% Recent nicotine users who have

quit (ie, of entire sample) 7.7 11.0 14.1 19.3

% Daily vapers who have quit 7.4 10.5 29.5 46.7


Yong et al (NTR 2017): impact of regulatory environment on

the effectiveness of e-cigarettes for cessation

• ≥ 30 day abstinence: E-cigarettes only vs. No meds/no ecigs

• More restrictive countries (Canada, Australia) vs.

Less restrictive countries (USA, United Kingdom)

20%

30%

40%

50%

60%

70%

80%

No Meds/ No E-Cigs

E-Cigarettes

Less Restrictive (USA, UK)

More Restrictive (Canada, Australia)

• Less restrictive countries:

E-cigs significantly higher

than No Aids

• More restrictive countries:

E-cigs significantly lower

than No Aids

Preliminary 2016 data on quitting and use of vapingNB> No by country interaction this time


• Use continuing to increase

• Most vaping is not daily use

• Large amount of experimental use

• Any vaping associated with

– Increased interest in quitting

– Greater confidence in ability

– Although perhaps more dependent

• Gradation in beliefs by extent of

vaping and extent of smoking

Patterns of use

• Around half used vaping on last quit attempt (less

in Australia)

– Associated with better outcomes overall

• Around half used tanks (less in US)

– Tanks associated with better outcomes

• Among daily vapers few younger smokers have

quit smoking, but among older smokers around half

have.

Quitting

• Data presented largely preliminary

• Earlier established data is mainly of historical

interest

– Given rapid changes

• Use these data to focus on patterns not as precise

estimates

Reminder of limitations

• Vaping appears to be here to stay

• Public policy is having a smaller effect than

we might expect

– But some may have huge consequences

– Lack of enforcement = approval

• Concept of dual use is useless

• Current vaping not good enough to kill off

smoking, especially in those where quitting

is less urgent (young)

• Can we push more to quit with improved

policies?

– Or do we need to rely on new products?

Conclusions

Thank you

Contact: [email protected]

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