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Which Countries Use E-Cigarettes the Most?

May 26, 2023

Tobacco use has been common around the world for decades. But only recently has e-cigarette use become a leading method of consuming tobacco.

As e-cigarette use ramps up worldwide, it becomes a more important subject of study. Read on to find out why e-cigarette is such a vital subject for research, where recent studies have shown e-cigarettes are most used, and what that means.

The Importance of Studying E-Cigarette Use

Any activity which impacts individual health is a worthy activity of study. Since smoking cigarettes became popular around the turn of the 19th century, it attracted the attention of scientists and researchers. Now that technology has expanded the definition of what smoking looks like and how to consume tobacco and nicotine, research is even more important. 

Recent studies from venerable institutions like the National Institutes of Health, the University of Missouri-Kansas, and The Lancet have explored subjects relating to e-cigarette use, including the effects of vaping on blood vessels, e-cigarette use among adolescents, and global trends among adolescent e-cigarette users, respectively.

Studies like these are vital because e-cigarette use has begun to have an impact on global health outcomes. If we don't understand that variable, we will be in the dark as to a number of other questions, including why cancer and heart disease incidences are fluctuating, and why maternal mortality rates are changing around the world.

There's also the question of prevention. To prevent adolescents from picking up hard-to-kick smoking habits, we must understand where e-cigarette use is most common and why.

Prevalence of E-Cigarette Awareness and Use

Awareness of E-Cigarettes

Just about everybody knows what cigarettes and tobacco are. But e-cigarettes aren't quite as well known around the world. 

In this context, “awareness” refers to two questions. Had respondents to the Lancet survey ever once used an electronic cigarette? Whether yes or not, had they ever heard of electronic cigarettes? It's important to distinguish between use and awareness, as measuring the two responses can reveal important contextual information.

The countries with the highest awareness of e-cigarettes include:

  • Russia (79.9% of respondents)
  • Ukraine (50.9%)
  • China (48.5%)
  • Costa Rica (47.5%)
  • Uruguay (45.2%)
  • Mexico (35.3%)
  • Philippines (31.7%)

E-Cigarette Use

E-cigarette use differs starkly from e-cigarette awareness. The study found that e-cigarette use corresponded to e-cigarette awareness. In other words, countries with greater awareness of e-cigarettes reported higher usage statistics. 

The percentage of individuals who reported using e-cigarettes was highest in the following countries:

  • Russia (14.2%)
  • Romania (11.3%)
  • Ukraine (6.4%)

Countries in which e-cigarette awareness was low reported correspondingly low usage statistics:

  • India (.1% use)
  • Ethiopia (.2%)
  • Bangladesh (.4%)

Other factors also play a role in respondents' answers. The study found notable differences in e-cigarette use when broken down along gender lines, for instance. Men consistently reported higher e-cigarette use than women in virtually every country surveyed.

How Was This Data Collected?

The data in the Lancet survey was collected using the Global Adult Tobacco Survey (GATS), administered by the World Health Organization.

The GATS survey monitors tobacco use among those over the age of 15 in a variety of countries. It is a cross-sectional survey that includes questions about smoking, tobacco use, cessation, secondhand smoke, e-cigarette use, and the effects of economics and media.

The survey is designed to produce national and regional estimates and is conducted electronically. The samples are randomly selected through multistage cluster sampling methods to survey an adequate cross-section of the population.

What Can We Conclude From This Data?

The main findings from the Lancet study on e-cigarette use present a troubling picture on the global scene. E-cigarette use is increasing among young people. Over 30% of adults in 8 of the 14 surveyed countries were aware of e-cigarettes, and across those countries, an estimated 18.3 million adults reported use.

Those numbers are up from a study conducted in 2013. The reason numbers have increased has to do with several variables, including global economics, tobacco marketing prevalence, e-cigarette technology development, and other cultural factors. If we strive for a tobacco-informed world, we're going to have to work harder to understand the causes of e-cigarette use.

Frequently Asked Questions

Who Is the Largest Consumer of E-Cigarettes?

The largest consumer of e-cigarettes in the world, according to the Lancet study, was Russia. Russians reported e-cigarette awareness of almost 80% and e-cigarette use of just over 14%. 

Thankfully, there's still a meaningful disparity between awareness and use, but we have to act fast if we want that gap to remain wide.


There's still a lot to learn about e-cigarette use. Companies like RELX manufacture tobacco-free pods and vape devices, which have made an impact on the global consumption of tobacco and nicotine. The more we understand global smoking trends, the better we can protect young people from exposure.

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