Developing a novel e-cigarette regulatory and policy control scale: results from the European Union.

Background: E-cigarette regulations vary considerably between countries though a standard approach for comparing regulatory frameworks does not exist. Additionally, there is no evidence on whether regulatory variations are associated with differences in e-cigarette use and smoking cessation. This study aims to develop a regulatory scale to measure and compare e-cigarette regulations between European Union countries and investigate whether scores are associated with e-cigarette use and smoking cessation. Methods: Data from a range of sources, such as ECigIntelligence, were used to develop a scale and score countries in the respective areas of e-cigarette scale. We used correlation analysis to investigate association between scale scores and e-cigarettes market, e-cigarette prevalence and use of e-cigarettes for smoking cessation. Results: An e-cigarette scale consisting of 10 domains was developed. Our analysis suggests that higher e-cigarette scale scores were associated with significantly greater use of e-cigarettes within countries, and greater increases in the prevalence of former smoking smokers between 2014 and 2017. Conclusions: Whilst further work is needed to develop the scale in line with rapidly changing regulatory landscape and product development, the current findings suggest that countries that have implemented e-cigarette regulations might be more successful in obtaining public health gains such as increase in the proportion of former smokers compared to countries where e-cigarette market and sales is not regulated.