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Nicotine Tob Res. 2019 Jan 25. doi: 10.1093/ntr/ntz008. [Epub ahead of print]

Awareness of changes in e-cigarette regulations and behaviour before and after implementation: A longitudinal survey of smokers, ex-smokers and vapers in the United Kingdom.

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GKT School of Medical Education, King's College London, London, UK.
Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.



In line with the European Union's Tobacco Products Directive (TPD), new regulations for e-cigarettes implemented in the UK between May 2016 and May 2017 included limiting refills to 10ml, tanks/cartridges to 2ml and nicotine concentrations to 20mg/ml. Aims: To investigate: 1) awareness of new regulations; 2) product use before and after implementation; 3) association between use of compliant products and subsequent smoking.


UK online longitudinal survey of smokers, ex-smokers and vapers, May/June 2016 (wave 4) and September 2017 (wave 5). Proportion aware by smoking and vaping status, n=1,606 Comparison of refill volume, tanks/cartridges volume, nicotine concentration at wave 4 and 5 (n: 199 to 388) Association between number of TPD-compliant products used at wave 4 and smoking at wave 5, adjusted for wave 4 vaping status, age, gender, income, urges to smoke, device type (n=480).


Awareness of regulations was highest for refill volume (10.1%; 37.4% among exclusive vapers) and nicotine concentration (9.5%; 27.3%). Higher proportions used TPD-compliant refill volumes (60.0% to 73.7%, χ2(1)=10.9, p=0.001) and nicotine concentrations (89.2% to 93.9%, χ2(1)=7.41, p=0.007) in wave 5 than wave 4, with little change for cartridge/tank volume (77.1% to 75.5%, χ2(1)=0.38, p=0.540). The likelihood of smoking was similar for those using no or one TPD-compliant products as it was for those using two (OR=1.10; 95% CI: 0.47-2.59) or three (OR 1.56, 95% CI: 0.69-3.55).


Several months after full implementation, awareness of new regulations was low and most vapers used TPD-compliant products. Use of compliant products was not associated with subsequent smoking.


Using a longitudinal survey at the beginning and a few months after the end of the transition period for implementation of new regulation on e-cigarettes, this is the first study to assess awareness of regulation and use of compliant products. After full implementation, awareness of changes was low overall (smokers, ex-smokers and vapers combined) although higher among those who vaped. Nevertheless, most vapers (74% - 94%) used products that were compliant with the new regulations and the use of products compliant with incoming regulations did not predict whether they were smoking cigarettes after implementation.


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