Impacts of EU Tobacco Products Directive Regulations on young people’s use of e-cigarettes in Great Britain: a natural experimental evaluation

Moore, Graham ORCID: https://orcid.org/0000-0002-6136-3978, Hallingberg, Britt ORCID: https://orcid.org/0000-0001-8016-5793, Brown, Rachel, McKell, Jennifer, Van Godwin, Jordan ORCID: https://orcid.org/0000-0001-5288-6614, Bauld, Linda, Gray, Linsay, Maynard, Olivia, Mackintosh, Anne-Marie, Munafò, Marcus, Blackwell, Anna, Lowthian, Emily and Page, Nicholas ORCID: https://orcid.org/0000-0002-4671-2797 2023. Impacts of EU Tobacco Products Directive Regulations on young people’s use of e-cigarettes in Great Britain: a natural experimental evaluation. [Project Report]. Public Health Research, vol. 11(5). NIHR Journals Library. Available at: https://doi.org/10.3310/WTMH3198

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Abstract

Participants: Survey participants were aged 13–15 years, living in England, Scotland or Wales and participated in routinely conducted surveys from 1998 to 2019. Process evaluation participants included 14- to 15-year-olds in England, Scotland and Wales, policy stakeholders, trading standards offices and retailers. Intervention: Regulation of e-cigarettes, including bans on cross-border advertising, health warnings and restrictions on product strength. Comparison group: Interrupted time series design, with baseline trends as the comparator. Main outcome measures: The primary outcome was ever e-cigarette use. Secondary outcomes included regular use, ever and regular smoking, smoking attitudes, alcohol and cannabis use. Data capture and analysis: Our primary statistical analysis used data from Wales, including 91,687 young people from the 2013–19 Health Behaviour in School-aged Children and School Health Research Network surveys. In Scotland, we used the Scottish Schools Adolescent Lifestyle and Substance Use Survey and in England we used the Smoking Drinking and Drug Use surveys. The process evaluation included interviews with 73 young people in 2017 and 148 young people in 2018, 12 policy stakeholders, 13 trading standards officers and 27 retailers. We observed 30 retail premises before and after implementation. Data were integrated using the Medical Research Council’s process evaluation framework. Results: Ever smoking continued to decline alongside the emergence of e-cigarettes, with a slight slowing in decline for regular use. Tobacco Products Directive regulations were described by stakeholders as well implemented, and observations indicated good compliance. Young people described e-cigarettes as a fad and indicated limited interaction with the components of the Tobacco Products Directive regulations. In primary statistical analyses in Wales [i.e. short (to 2017) and long term (to 2019)], growth in ever use of e-cigarettes prior to Tobacco Products Directive regulations did not continue after implementation. Change in trend was significant in long-term analysis, although of similar magnitude at both time points (odds ratio 0.96). Data from England and Scotland exhibited a similar pattern. Smoking followed the opposite pattern, declining prior to the Tobacco Products Directive regulations, but plateauing as growth in e-cigarette use stalled. Limitations: Alternative causal explanations for changes cannot be ruled out because of the observational design. Conclusions: Young people’s ever and regular use of e-cigarettes appears to have peaked around the time of the Tobacco Products Directive regulations and may be declining. Although caution is needed in causal attributions, findings are consistent with an effect of regulations. Our analysis provides little evidence that e-cigarettes renormalise smoking. More recent data indicate that declines in smoking are plateauing. Future work: International comparative work to understand differences in use of e-cigarettes, and tobacco, within varying regulatory frameworks is a priority.

Item Type:	Report (Project Report)
Date Type:	Publication
Status:	Published
Schools:	Schools > Social Sciences (Includes Criminology and Education) Research Institutes & Centres > Centre For Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Publisher:	NIHR Journals Library
ISSN:	2050-4381
Funders:	PHR programme
Projects:	16/57/01
Date of First Compliant Deposit:	5 October 2022
Date of Acceptance:	27 June 2022
Last Modified:	11 Aug 2026 10:33
URI:	https://orca.cardiff.ac.uk/id/eprint/153079

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