Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation

Moore, Graham; Brown, Rachel; Page, Nicholas; Hallingberg, Britt; Maynard, Olivia; McKell, Jennifer; Gray, Linsay; Blackwell, Anna; Lowthian, Emily; Munafò, Marcus R; MacKintosh, Anne Marie; Bauld, Linda

doi:10.1016/j.drugpo.2020.102795

Cited by 16 publications

(13 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The fact that we did not find evidence to suggest an effect of e-cigarette retail display exposure on susceptibility to using e-cigarettes is encouraging, given concerns about e-cigarette use in children. However, the evidence we find for cross-cueing effects provides grounds for remaining cautious about the impact of the introduction of new products to market, and associated marketing strategies 38. If e-cigarette displays have an impact on smoking attitudes—and potentially behaviour—in children, this is obviously a matter of public health concern.…”

Section: Discussionmentioning

confidence: 85%

Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

et al. 2022

View full text Add to dashboard Cite

ObjectivesTo estimate the impact of electronic cigarette (e-cigarette) retail display exposure on attitudes to smoking and vaping (susceptibility to tobacco smoking and using e-cigarettes, and perceptions of the harms of smoking and e-cigarette use).DesignBetween-subjects randomised experiment using a 2 (e-cigarette retail display visibility: high vs low)×2 (proportion of e-cigarette images: 75% vs 25%) factorial design.SettingOnline via the Qualtrics survey platform.ParticipantsUK children aged 13–17 years (n=1034), recruited through a research agency.InterventionParticipants viewed 12 images of retail displays that contained e-cigarette display images or unrelated product images. E-cigarette display images were either high or low visibility, based on a conspicuousness score. Participants were randomised to one of four groups, with e-cigarette display visibility and proportion of e-cigarette images, compared with images of unrelated products, manipulated: (1) 75% e-cigarettes, high visibility; (2) 25% e-cigarettes, high visibility; (3) 75% e-cigarettes, low visibility; (4) 25% e-cigarettes, low visibility.Main outcome measuresThe primary outcome was susceptibility to smoking (among never smokers only). Secondary outcomes were susceptibility to using e-cigarettes (among never vapers only), and perceptions of smoking and e-cigarette harm (all participants).ResultsNeither e-cigarette retail display visibility, nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to smoking (visibility: OR=0.84, 95% CI 0.62 to 1.13, p=0.24; proportion: OR=1.34, 95% CI 1.00 to 1.82, p=0.054 (reference: low visibility, not susceptible)).Planned subgroup analyses indicated that exposure to a higher proportion of e-cigarette images increased susceptibility to smoking among children who visited retail stores more regularly (n=524, OR=1.59, 95% CI 1.04 to 2.43, p=0.034), and those who passed the attention check (n=880, OR=1.43, 95% CI 1.03 to 1.98, p=0.031).In addition, neither e-cigarette retail display visibility nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to using e-cigarettes (visibility: OR=1.07, 95% CI 0.80 to 1.43, p=0.65; proportion: OR=1.22, 95% CI 0.91 to 1.64, p=0.18).Greater visibility of e-cigarette retail displays reduced perceived harm of smoking (mean difference (MD)=−0.19, 95% CI −0.34 to −0.04, p=0.016). There was no evidence that the proportion of e-cigarette images displayed had an effect (MD=−0.07, 95% CI −0.22 to 0.09, p=0.40).Perceived harm of e-cigarette use did not appear to be affected by e-cigarette retail display visibility (MD=−0.12, 95% CI −0.28 to 0.05, p=0.16) or by the proportion of e-cigarette images displayed (MD=−0.10, 95% CI −0.26 to 0.07, p=0.24).ConclusionsThere is no evidence in the full sample to suggest that children’s susceptibility to smoking is increased by exposure to higher visibility e-cigarette retail displays, or to a higher proportion of e-cigarette images. However, for regular store visitors or those paying more attention, viewing a higher proportion of e-cigarette images increased susceptibility to smoking. In addition, viewing higher visibility e-cigarette images reduced perceived harm of smoking. A review of the current regulatory discrepancy between tobacco and e-cigarette point-of-sale marketing is warranted.Trial registration numberISRCTN18215632.

show abstract

Section: Discussionmentioning

confidence: 85%

Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Understanding the implementation of the TPD is helpful in providing context for interpreting effects and planning for future tobacco control activities. In terms of the policy aim of minimizing youth use of e-cigarettes, evidence suggests that the growth in youth use observed in the UK since 2013 has not continued post-TPD 19 . However, it is as yet unclear if this is associated with the policy or with changing social trends in youth behavior that may have happened anyway 20 and this absence of clarity is important in considering potential revisions to the TPD in the future.…”

Section: Discussionmentioning

confidence: 99%

Implementation of e-cigarette regulation through the EU Tobacco Products Directive ( 2016 ) in Wales, Scotland and England from the perspectives of stakeholders involved in policy introduction and enforcement

Brown¹,

Godwin²,

Page³

et al. 2021

Tob. Prev. Cessation

Self Cite

View full text Add to dashboard Cite

INTRODUCTION From May 2016, the European Union introduced the Tobacco Products Directive (TPD) regulations, which included restrictions to advertising and new safety and labeling standards for e-cigarette products. This represented the first supranational policy regulating e-cigarette sales and marketing. This study explores perceptions of TPD and its implementation in Wales, Scotland and England, from perspectives of stakeholders involved in tobacco and e-cigarette policy and implementation in each nation. METHODS Semi-structured qualitative interviews were completed with 12 stakeholders from government and third sector organizations in the UK involved in tobacco control policy-making processes, and Trading Standards Officers from 13 UK local authorities. Data were analyzed thematically and a sub-sample double-coded. RESULTS Stakeholders held varying views of e-cigarettes, recognizing potential benefits and harms of both the products and the new policy actions. Nevertheless, most perceived TPD to be a positive step in introducing regulation for e-cigarettes. Compliance was perceived as high across nations, although stakeholders highlighted product adaptations to circumvent restrictions, and absence of controls on non-nicotine products. Budgetary and staffing limitations also meant that capacity to communicate new measures, and enforce change, was limited. This led to a gap occupied by industry representatives, who played a substantial role in preparing retailers for adoption of new measures. CONCLUSIONS TPD policy roll-out was largely perceived positively and as having been effectively implemented. However, contribution of industry to communication of new measures and absence of resourcing for effective communication perhaps introduced widespread innovations within regulations. While largely viewed positively, some refinements to device regulations were proposed.

show abstract

“…We used individual-level data from November 2006 to December 2019 to carry out a segmented regression analysis to study level and post-slope changes [20,21] in current smoking status after the implementation of the standardised packaging policy in England, using a before and after approach [21,22]. Our analysis first explored effects before and after May 2017, the end of the one-year implementation period, as the main implementation point, and then before and after May 2016 and explored effects after the start of that implementation period.…”

Section: Data Sources and Research Designmentioning

confidence: 99%

Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019

et al. 2021

View full text Add to dashboard Cite

Background and aimIn 2016, England initiated the implementation of standardised tobacco packaging, introduced in conjunction with minimum pack sizes and other measures included in the 2014 European Tobacco Products Directive, over the course of a 1-year sell-off period ending in May 2017. These measures have been shown to have been associated with increases in tobacco prices and product diversity. We now investigate the association between implementation of the new legislation and smoking status in England.DesignSegmented regression analysis of repeated cross-sectional surveys using a generalised linear model with individual-level data to test for a change in trend and immediate step change.SettingEngland.ParticipantsParticipants in the Smoking Toolkit Study, which involves repeated, cross‐sectional household surveys of individuals aged 16 years and older in England. The sample included 278 219 individual observations collected between November 2006 and December 2019.InterventionImplementation of standardised packaging legislation (May 2016 and May 2017).MeasurementsIndividual-level current smoking status adjusted for implementation of tobacco control policies, cigarette price, seasonality and autocorrelation.FindingsThe implementation of standardised packaging was associated with a significant step reduction in the odds of being a smoker after May 2017 (OR: 0.93; 95% CI 0.87 to 0.99). The magnitude of the association was similar when modelling the step change in May 2016 at the start of the 1-year policy implementation period (OR: 0.90; 95% CI: 0.83 to 0.97).ConclusionsThis is the first independent study demonstrating that implementation of standardised packaging was associated with a reduction in smoking in England which occurred in anticipation of, rather than after, full policy implementation. It appears that the odds of being a smoker were affected by the prospect of the move to standardised packs and accompanying legislation.

show abstract

Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation

Cited by 16 publications

References 48 publications

Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

Impact of e-cigarette retail displays on attitudes to smoking and vaping in children: an online experimental study

Implementation of e-cigarette regulation through the EU Tobacco Products Directive ( 2016 ) in Wales, Scotland and England from the perspectives of stakeholders involved in policy introduction and enforcement

Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019

Contact Info

Product

Resources

About