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Additionally, since vape shops are typically not in the business of selling cigarettes or other tobacco products, there would be an incentive for the vape shop owners to encourage consumers to completely switch away from cigarettes . Briefly, the ITC four country survey is an online panel-based survey which included respondents 18 years or older who had smoked at least 100 cigarettes in their lifetime, who was currently smoking, or who had quit smoking within the last two years. Strong decisive action is needed to prevent the uptake of e-cigarettes based on the growing body of evidence of use by children and adolescents and health harm


While it appears that the regulatory environment in different countries can influence vaping prevalence, even in restricted environments, such as AU, vaping is still happening with consumers relying on online sources to purchase their nicotine vaping devices and supplies . In AU, the ban of sale of NVPs appears to have led to current vapers relying mainly on online purchasing sources, unless they are buying non-nicotine containing e-liquid, in which case, other retail outlets were the primary purchase location. In the US and EN the purchase locations were fairly evenly distributed among vape shops, online, and other. Table 1a–d display the bi-variate descriptive characteristics of NVP users by purchase location separately within each of the four countries. With the exception of NVP users in EN (42.5%), the majority of survey participants reported using NVP that allowed for adjustable power (61.7% in CA, 59.1% in the US, and 57.9% in AU), though this question did not assess the 259 participants who reported using disposable systems. Current vapers in all four countries reported having a high household income the most often, and a moderate education level (except in the US where the largest category of education level was "low"


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WHO is concerned that the tobacco industry funds and promotes false evidence to argue that these products reduce harm, while at the same time heavily promoting these products to children and non-smokers and continuing to sell billions of cigarettes. There is an alarming increase in use of e-cigarettes among children and young people, Live Resin + THC vape pens with rates exceeding adult use in many countries. Currently, 88 countries have no minimum age at which e-cigarettes can be bought and 74 countries have no regulations in place for these harmful product


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In all four countries, most current vapers were categorized as daily vapers; in EN and AU greater than 50% of current vapers did not smoke at all, whereas in Canada the largest category of smoking frequency was daily smoking (45.2% of current vapers). Overall, in all four countries the majority of current vapers were white, and male. Frequencies and percentages were reported as well as odds ratios with 95% confidence intervals for pair-wise comparisons between countries (i.e. country vs country by location vs location


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In CA and the US, the majority of vapers bought their vaping products from vape shops, 65.3% and 43.3%, respectively. In England and in Canada the ages of the participants skewed a little older with the largest category in England being 55+ (38.3%) and the largest category in Canada being 40–45 (38.6%). Those who refused or did not report ethnicity, household income, and educational level were excluded along with those who reported buying nicotine-free e-liquid. The model was adjusted for smoking and vaping frequency, age, gender, ethnicity, household income, educational level, e-liquid flavor, and type of vaping device. Data were available from a sub-sample of the 2016 (Wave 1) International Tobacco Control Four Country Smoking and Vaping (ITC 4CV1) participants who reported currently vaping daily or weekly.
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While countries regulated the source of purchase differently, information on where individuals buy their NVPs is limited. NVPs could be legally sold to adults at retail locations in England (EN) and the United States (US). However, at the time of this study in 2016, health authorities in Canada did not enforce the NVP sales ban in retail establishments . In CA, the law restricting the sale of NVPs in retail locations changed in May 2018. A 2014 survey of online sites selling Live Resin + THC vape pens NVPs identified at least 466 brands available in 7764 assorted flavors, with two types of propellants, offering an average of four to five nicotine strengths . Some types of products (ex. tank systems) require more accessory parts than others (ex. disposable), it is possible that some retail locations will be more or less likely to sell certain products.
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We also examined how demographic characteristics, and vaping product features varied by purchase location in each of the four countries. Participants were asked "Now thinking about the LAST TIME you purchased disposable e-cigarettes, cartridges, or e-liquid, where did you make this last purchase? In this study, we reported on where current (daily and/or weekly) vapers purchase their vaping products and refills, behavioral characteristics of users, and product features by purchase location. One cross sectional study on California high Live Resin + THC vape pens school students, found that the most likely purchase location for NVPs was "smoke shops" for those older and younger than 18.
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In addition, participants in each country were asked, "which of the following categories best describes your annual household income, that is the total income before taxes, or gross income, of all persons in your household combined, for one year? This study did not include "vape shop" in its answer choices, was mainly concerned with tobacco products in general, and the majority of students surveyed obtained their products from a friend . Because of their novelty and the lack of conclusive evidence on their health effects, safety, and cessation efficacy, it has been unclear whether NVPs should be regulated as tobacco products, therapeutic goods, medical devices, or consumer lifestyle products [12,13]. Sales of nicotine vaping products (NVPs), also referred to as electronic cigarettes, have increased over the past decade, and in some countries they have become the most popular quitting aid used by smokers [1,2,3,4