Vaping surveys - data availability
Information on the prevalence of nicotine vaping from nationally representative surveys was available for 49 countries (see Fig. 2 and supplementary table). There are two publicly available international research programmes and eight national programmes on tobacco use and vaping. The international research from which we obtained data comprises: The Global Adult Tobacco Survey (GATS) [25], last conducted in 2017, providing data on six countries (there are 25 of them in the study, but only six were used due to outdated surveys or not covering the subject of e-cigarettes); and the Special Eurobarometer on Attitudes of Europeans towards tobacco and electronic cigarettes [8], last conducted in 2017, gathering data from 28 countries1. The International Tobacco Control surveys [26] include 29 countries with data on e-cigarette use in six countries but we did not use it due to methodological issues including the use of non-probabilistic samples.
National surveys on tobacco use and vaping (or at least having some information on this topic) include for example: National Drug Strategy Household Survey 2019 (Australia), Healthy Ireland survey 2017, Malaysia 2016 National E-Cigarette Survey, Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco (ENCODAT 2016–2017, Mexico), Action on Smoking and Health survey (Great Britain 2018), Office for National Statistics (UK 2019), and the National Adult Tobacco Survey (USA). In addition, we obtained information from general surveys for seven other countries.
Survey population coverage
To be more relevant, it is useful to look at the availability of data from a world population perspective. According to the United Nations, the adult (15 years old or above) population of the countries for which vaping survey data were available was nearly 2.8 billion in 2018. The population of the remaining countries was over 2.9 billion. Thus, information on vaping was lacking for just over half of the world's population (see Table 1).
Table 1
Adult population (15 years old or above) in surveyed and not surveyed countries in 2018
|
Surveyed population
|
Not surveyed population
|
|
Count
|
Percent
|
Count
|
Percent
|
World
|
2,749,362,376
|
48.59
|
2,909,456,112
|
51.41
|
WHO Region
|
African region
|
22,676,140
|
3.68
|
593,557,990
|
96.32
|
Eastern Mediterranean region
|
8,221,320
|
1.76
|
458,884,199
|
98.24
|
European region
|
572,964,392
|
75.48
|
186,119,293
|
24.52
|
Region of the Americas
|
596,683,633
|
76.73
|
180,998,282
|
23.27
|
South-East Asia region
|
116,665,629
|
8.02
|
1,338,217,118
|
91.98
|
Western Pacific region
|
1,432,151,262
|
90.60
|
148,518,994
|
9.40
|
World Bank income classification
|
High income
|
877,755,162
|
87.43
|
126,156,254
|
12.57
|
Upper middle income
|
1,658,636,497
|
77.72
|
475,526,821
|
22.28
|
Lower middle income
|
190,294,577
|
9.02
|
1,920,295,084
|
90.98
|
Low income
|
22,676,140
|
5.53
|
387,286,693
|
94.47
|
It is even more interesting to look at what proportion of the population was surveyed by region and income group. The most complete vaping survey coverage – over 90% – was in the Western Pacific region, driven by Australia, China, Japan, Malaysia, New Zealand, the Philippines and Taiwan. In Europe and the Americas, more than three-quarters of citizens were surveyed. The rest of the world remains almost unknown. Only 8% of people in Asia were surveyed, 3.6% in Africa, and less than 2% in the Eastern Mediterranean.
As might be expected, this is closely related to the economic status of countries. In high-income countries, more than 87% of citizens were surveyed. In upper middle-income countries, not much less – 77%. There is a huge gap between them and lower income countries with only 9% of citizens surveyed. In the lowest income countries, it was less than 6%.
Estimation for countries without nicotine vaping survey data
Based on the available information from the surveys, we calculated the average prevalence of vaping for each WHO region, World Bank income classification group and the legal status of the sale of e-cigarettes. Unfortunately, as we expected, some groups are very poorly represented (see Table 2). Low-income countries are represented by survey data only from Uganda. Uganda is also the only data point for the African region. Similarly, we have only one data point from the South East Asia region with Bangladesh and the East Mediterranean region with the United Arab Emirates.
Table 2
Average prevalence of nicotine vaping by factors used in the estimation
|
Number
of surveys
|
Prevalence
of nicotine vaping use (%)
|
World Bank income classification
|
|
|
High income
|
35
|
1.90
|
Upper middle income
|
11
|
1.21
|
Lower middle income
|
2
|
0.50
|
Low income
|
1
|
0.50
|
WHO region
|
|
|
South-East Asia region
|
1
|
0.20
|
African region
|
1
|
0.50
|
Western Pacific region
|
8
|
1.34
|
European region
|
32
|
1.70
|
Region of the Americas
|
6
|
1.72
|
Eastern Mediterranean region
|
1
|
5.00
|
Legal status of e-cigarettes
|
|
|
Banned
|
6
|
0.93
|
Allowed
|
40
|
1.75
|
No specific law
|
3
|
1.80
|
These three factors gave us four income groups, six regions and three sales statuses, which allowed us to separate 72 subgroups. For each of the groups the average prevalence of vaping was calculated. These 72 values were used as substitutes for the prevalence figures in the countries belonging to the group. Of course, not all subgroups were represented. For the first (1 – in Fig. 3) - the most detailed, three-factor - subdivision we had information for only 13 subgroups, which allowed us to calculate estimates for 83 countries.
For the other countries, we used a two-factor breakdown covering all pairs of these three factors. A second (2) split was made on the basis of income groups and sales status, which gave us eight information cells covering 161 countries, a third (3) was made on the basis of income groups and regions with 10 information cells covering 142 countries and a fourth (4) was made on the basis of regions and sales status with nine information cells covering 102 countries. The last (5) subdivision was based only based on one income groups factor.
The results of the calculations have been placed successively in the blanks remaining after the previous step. This means that the countries remaining without an estimated value after the first step have been assigned the values generated in the second step. In the third step we filled in the missing values remaining after the second step and in the fourth step remaining after the third step. All remaining gaps were filled with the fifth step.
We started with 49 known countries. The first step increased this number to 83, the next to 161, next to 190, the fourth one gave only three more countries, increasing the number of countries to 193, and the fifth to 198. There were still three countries left. We attributed the average value obtained from all known countries to these countries. Figure 3 shows detailed information of this process.
The number of vapers was calculated by taking as the denominator the total adult population (over 15 years old) obtained from the UN database for 2018 [2].
Adjustment of the estimate for market value changes between 2018 and 2020
Given the time lapse between when most of the surveys were undertaken and 2020, it is necessary to estimate subsequent growth. The only indicator available is estimates of market growth i.e. the value of sales. The question is, what is the relationship between e-cigarette market growth and changes in nicotine vaping prevalence? We have information on both variables for the UK for the period 2011 to 2019. We have used market average e-cigarette market revenues per capita to avoid distortions related to population changes. As can be seen in Fig. 4, both trends were characterised by steady growth. The correlation between both time series was very strong with a Pearson correlation coefficient of 0.933. Based on this analysis, changes in e-cigarette market revenue are consistent with changes in vaping prevalence by 93%. We assumed that this relationship is similar globally.
Global estimation of nicotine vaping – 2018
The number of vapers in the 49 countries from which the survey data are derived is 40.3 million. Using our estimation procedures we estimate that 17.8 million vapers live in the remaining 152 countries. This gives a total of 58.1 million vapers worldwide in 2018.
More than half of them live in high income countries. We estimate that 2.1 million vapers live in low income countries, 7.8 million in lower middle income countries, 19 million in upper middle income countries and 29.3 million in high income countries.
4.1 million vapers live in the African region, 4.2 million in the Eastern Mediterranean region, 4.6 million in the South-East Asia region, 11.2 million in the Western Pacific region, 15.3 million in the European region and 18.7 million in the region of the Americas.
38.6 million vapers live in countries where sale of nicotine vaping products is allowed, 9.5 million in countries where sale of nicotine vaping products is banned and 10 million in countries where there is no specific law.
Table 3
Estimated number of nicotine vapers by income groups for 2018
|
Number of
countries
|
Number of
nicotine vapers
|
World
|
201
|
58,107,606
|
Countries with data from surveys
|
49
|
40,334,650
|
Countries with estimated data
|
152
|
17,772,956
|
World Bank income classification
|
|
|
Low income
|
31
|
2,115,585
|
Lower middle income
|
47
|
7,760,169
|
Upper middle income
|
54
|
18,959,299
|
High income
|
54
|
29,269,384
|
Unknown
|
1
|
3,169
|
WHO regions
|
|
|
African region
|
47
|
4,107,918
|
Eastern Mediterranean region
|
21
|
4,199,293
|
South-East Asia region
|
11
|
4,554,551
|
Western Pacific region
|
23
|
11,150,297
|
European region
|
50
|
15,345,345
|
Region of the Americas
|
33
|
18,741,095
|
Unknown
|
2
|
9,107
|
Legal status of e-cigarettes
|
|
|
Allowed
|
72
|
38,648,243
|
Banned
|
36
|
9,458,630
|
No specific law
|
79
|
10,000,733
|
Projection of the estimated global number of vapers – 2020
The projection for year 2020 was made on the basis of information from the E-Cigarettes Worldwide Statista Market Forecast [24]. The global number of vapers estimate was fitted to revenue data at the 2018 time point (meaning revenue data from 2018 was directly paired with estimated number of vapers). The market trend was zeroed (calibrated) at 2018. The proportions series was adjusted with the above-mentioned coefficient of the correlation between average e-cigarette market revenue and number of vapers.
Table 4
Average e-cigarette market revenue trend in percent centred at 2018
|
|
|
|
|
|
Point zero
|
|
Target point
|
|
|
|
2012
|
2013
|
2014
|
2015
|
2016
|
2017
|
2018
|
2019
|
2020
|
2021
|
2022
|
2023
|
37%
|
44%
|
52%
|
62%
|
74%
|
87%
|
100%
|
110%
|
117%
|
129%
|
139%
|
148%
|
Multiplying subsequent proportions by the estimated global number of vapers, we have given projections of this number for other years. For the year 2020, the projection is 68 million vapers globally (see Fig. 5).
1A new special Eurobarometer 506 was published in February 2021 [9]. Comparing our projection to 2020 (GNV) and the Eurobarometer data from 2020 (EB), we have 16 countries where the prevalence of vaping are greater in EB than GNV; 12 countries where prevalence are less in EB than GNV. The differences are small. On average, GNV is underestimated relative to EB by about 0.29 percentage points.