Awareness and use of e-cigarettes and heated tobacco products, reasons for their use, and associated factors in five countries: a report from Global Adult Tobacco Surveys (2021-2023)

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ID: 320838
2026
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Abstract
INTRODUCTION: Adoption patterns of electronic cigarettes and heated tobacco products (HTPs) across diverse low- and middle-income countries (LMICs) remain poorly understood. This study aimed to evaluate country-level prevalence of e-cigarettes and HTPs across five geographically diverse nations. METHODS: We analysed Global Adult Tobacco Survey microdata from Costa Rica (2022), Malaysia (2023), Mauritania (2021), Mexico (2023), and South Africa (2021). For each country, we estimated weighted prevalence and 95% CIs of awareness, ever and current use, and their distribution by cigarette smoking status. Factors associated with e-cigarette and/or HTP use in each country were explored using binary logistic regression analyses (except Mauritania). RESULTS: For e-cigarettes, weighted prevalence of awareness ranged from 22.2% (Mauritania) to 70.7% (Mexico), 'current use' from 0.4% (Mauritania) to 5.8% (Malaysia), and 'ever use' from 2.8% (Malaysia) to 10.6% (Mexico). For HTPs, weighted prevalence of 'awareness' ranged from 5.6% (Costa Rica) to 15.8% (South Africa), 'current use' from <0.1% (South Africa) to 0.2% (Mexico), and 'ever use' from 0.4% (Malaysia) to 0.9% (Mexico). Awareness and use were significantly higher among respondents with current and past smoking behaviours (p < 0.01). Reasons given for current e-cigarette use were "attractive flavors" (50-70%), "enjoyment" (53-68%), and "to quit smoking" (38-58%). Reasons for HTP use were "enjoyment" (50-80%) and "to quit smoking" (20-60%). CONCLUSIONS: E-cigarette and HTP awareness and use vary substantially across diverse low- and middle-income country contexts. This demands localised, agile surveillance and regulatory frameworks rather than a uniform, global policy approach.
Reference Key
openalex_W7168141145 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Chandrashekhar T Sreeramareddy, Aqil Mohammed Daher, Divya Reshmi
Journal nicotine & tobacco research : official journal of the society for research on nicotine and tobacco
Year 2026
DOI
10.1093/ntr/ntag159
URL
https://doi.org/10.1093/ntr/ntag159
Keywords Keywords not found

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