Electronic nicotine delivery systems (ENDS), or e-cigarettes, are less harmful than traditional cigarettes and its use can help reduce the number of cigarette smokers, suggest experts. After it debuted in China in 2003, E-cigarettes have since become available globally, particularly through the Internet. While they resemble traditional tobacco cigarettes, they produce fewer toxins in the vapor for the smoker. Still, these novel products have unknown long-term health and addiction consequences, are of varying nicotine content and delivery, and may appeal to nonusers and youth.

ENDS have been banned by health authorities in Canada and Australia. Researchers from the United States, Australia, the United Kingdom, and Canada investigated ENDS awareness, use, and perceptions among current and former cigarette smokers. "We were not aware of any studies to date that examined cross-national patterns of ENDS use. No studies have examined use in markets where ENDS are nominally banned," said lead investigator Richard J. O''Connor, PhD, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York.

Data from the International Tobacco Control ( ITC) Four-Country Survey, collected from nearly 6,000 respondents through telephone and web surveys from July 2010 to June 2011, formed the basis of the study. Across countries, ENDS awareness reached nearly 47 per cent, ranging from 73 per cent in the United States where ENDS are legal, to 20 per cent in Australia where they are banned. Awareness was higher among younger (aged 18-24), non-minority populations with higher incomes. Of those aware, 16 per cent had tried ENDS.