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In 2019, Altria purchased a stake in JUUL.9 10 ENDS are now the second most common tobacco product in the USA, with 4.5% of adults reporting current use.11 Similar prevalence has been observed in Europe, though regional differences exist, such as higher prevalence in Eastern than Western Europe.12 ENDS use is less common in Asia than in these other regions, with current use around 1.8% in China.13 ENDS also have emerged in South African market.1416 ENDS use prevalence is even lower in some low and middle-income countries (LMICs) such as Bangladesh and Zambia.17 WHO recommends that ENDS be regulated to bar unproven health claims, minimise health risks, protect non-users from secondhand exposure and prevent initiation among youth (eg, by limiting advertising/sponsorship, restricting flavours), though the legal and regulatory status of these products differs widely by country

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