E-cigarette use in low-income and middle-income countries: opportunity or challenge for global tobacco control

Abstract

Tobacco smoking kills more than 8 million people worldwide annually, with a disproportionately high burden of these deaths occurring in low-income and middle-income countries (LMICs). About 80% of the world's 1·3 billion tobacco users live in LMICs. The emergence of electronic nicotine delivery systems (ENDS) could contribute to either reducing or exacerbating this burden, depending on how their accessibility and use is regulated. Although ENDS have gained some popularity in LMICs, their prevalence still lags behind the current usage rates in high-income countries (HICs). The adoption of ENDS varies across countries and regions, and this variation is influenced by diverse cultural and policy environments, often swayed by tobacco industry interests. Several key factors affect the prevalence of ENDS use, including economic conditions, cultural norms, laws and regulations around tobacco products, and marketing tactics used by tobacco industry. These factors shape how socially or culturally acceptable and accessible ENDS use is within both LMICs and HICs.