| Summary: | Country-level differences in nicotine vaping products used and biomarkers of exposure among long-term e-cigarette users and dual users remain understudied. This cross-sectional study was conducted in 2014 in the United States (<i>n</i> = 166), United Kingdom (<i>n</i> = 129), and Poland (<i>n</i> = 161). We compared patterns of tobacco product use and nicotine and toxicant exposure among cigarette-only smokers (<i>n</i> = 127); e-cigarette-only users (<i>n</i> = 124); dual users of tobacco cigarettes and e-cigarettes (<i>n</i> = 95); and non-users (control group, <i>n</i> = 110) across three countries using mixed-effects linear regression. Compared with cigarette smokers, e-cigarette-only users had lower levels of toxicant biomarkers, but higher levels of nicotine biomarkers. Dual users had higher levels of toxicant biomarkers than e-cigarette-only users but similar levels to cigarette-only smokers. E-cigarette users in Poland, who overwhelmingly used refillable tank devices, exhibited greater levels of nicotine, and toxicant biomarkers relative to e-cigarette users in US/UK. Despite smoking fewer cigarettes, dual users from Poland exhibited similar levels of nicotine biomarkers compared with UK dual users, but higher than US dual users. Country-level differences in e-cigarette devices used and smoking behaviors (e.g., intensity) may contribute to differences in biomarker levels among users of the same products residing in different countries.
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