Trends and correlates of consumer beliefs about the efficacy of vaping for smoking cessation: Findings from the 2016–2024 International Tobacco Control Four Country Smoking and Vaping Survey

BACKGROUND AND AIMS: Nicotine Vaping Products are widely used, effective tools for smoking cessation, despite not being approved medicines. Public beliefs that vaping is more harmful than smoking have increased contrary to accumulating evidence. This study explored trends in beliefs about the efficacy of vaping for smoking cessation. DESIGN: Analysis of five biennial waves (2016-2024) of the longitudinal panel data from the International Tobacco Control Four Country (ITC-4C) Survey, which uses broadly based sampling via different commercial survey firms. SETTING: Population-based online surveys conducted in Canada, United States, England and Australia. PARTICIPANTS: Adult current daily smokers (n = 22 536 participants; 33 624 observations) and recent ex-smokers (n = 7132 participants; 11 130 observations) aged 18 years and above. Most were aged 55 + (n = 12 888) and had never vaped (n = 12 163), with roughly equal males and females. MEASUREMENTS: The primary outcome was self-reported belief in the effectiveness of vaping for quitting smoking. We examined trends over time, demographic and behavioural correlates, and associations with vaping experience, vaping harm beliefs, quit-related motivation and self-efficacy. Analyses were stratified by current smoking status using data weighted for relevant covariates. RESULTS: Between 2016 and 2024, the belief that vaping makes quitting smoking easier declined from 43.6% (±1.1%) to 27.1%, (±1.2%) among smokers, but not among ex-smokers (47.9% to 45.3%; P = 0.12). Current daily vapers were more likely than never-vapers to believe that vaping makes quitting easier for both ex-smokers [adjusted odds ratio (aOR) = 24.98; 95% confidence interval (CI) = 18.78-33.23] and smokers (aOR = 7.49; 95% CI = 6.62-8.47). Among smokers, the vaping efficacy belief declined similarly in all groups. It was notable that vaping efficacy and vaping harm beliefs were strongly correlated (P < 0.001) and controlling for vaping harm greatly reduced the trend of declining vaping efficacy beliefs. Associations with sociodemographic variables and vaping efficacy were generally stronger among smokers than ex-smokers. Among both ex-smokers and smokers, compared with Canadians, those from England were most likely, and those from the United States least likely, to endorse vaping's effectiveness. Among current smokers, belief in vaping efficacy was positively associated with quit motivation and quit plans. SUMMARY: Internationally, there appears to be a growing disconnect between public beliefs and scientific evidence regarding the demonstrated effectiveness of vaping for smoking cessation. The decline in public beliefs about vaping efficacy is associated with misbeliefs regarding its harmfulness relative to smoking. Those with experience of vaping, particularly current daily vapers, are generally more likely to believe in vaping efficacy.