4 Country Smoking and Vaping Survey

The 4 Country Smoking and Vaping (4CV) Survey is a longitudinal survey of representative cohorts in the United States (US), Canada (CA), England (EN) and Australia (AU). The 4CV Survey was initiated after the conclusion of the ITC Four Country (4C) Survey in 2015. The 4CV Survey is designed to investigate the relationship between the use of vaping devices (such as e-cigarettes) and tobacco use, and to evaluate and inform emerging policies on nicotine vaping products (NVPs) in the four countries. The ITC 4CV Survey expanded upon the existing ITC 4C Survey infrastructure, conceptual model, and methodologies to examine the use and evolution of the NVP market and policy environments by surveying adult smokers, recent former smokers, and vaping device users (i.e., vapers) in AU, CA, EN, and the US—four countries with similar cigarette-smoking rates, but divergent policies related to NVPs.

Over the past few years, demand for NVPs has grown rapidly, and data are required to inform public health policies. While NVPs may be less harmful compared to combustible tobacco products—the known leading preventable cause of premature death in high-income countries—the effect of NVP use on tobacco cessation, uptake, and/or sustained use is currently not well understood.

The four specific objectives of the ITC 4CV Survey are to:

  1. Describe how NVP and cigarette use differ among smokers and recent former smokers, both over time and between important subgroups (e.g., age, gender, income, intention to quit cigarettes, nicotine dependence level), in particular whether the interactions between NVP and cigarette use vary across countries,
  2. Examine how differences in tobacco control and NVP policies between countries are related to different patterns of NVP and cigarette use; and
  3. Contribute to the methods for monitoring health behaviours (e.g., NVP use) by comparing characteristics of the online samples recruited in this study with samples collected by conventional methods, and explore the extent to which behaviours of the self-identified early adopters of NVPs provide useful indications of the behaviour of the broader adult smoker population.