TA comparison of electronic cigarette regulation and associated influencing factors in the US and the UK : contextual similarities and potential regulatory implications for Nigeria

Abstract

Background Tobacco smoking (TS) is the leading preventable cause of premature mortality and morbidity in the world. The World Health Organisation’s (WHO) 2021 report on the global tobacco epidemic focused on addressing new and emerging products including e-cigarettes and highlighted dangers of e-cigarettes to youths. Countries with a large proportion of young people like Nigeria are likely to consider regulating e-cigarettes. The US and UK are two countries that can be said to be leading the way in communicating or promoting through research and policy the risks and benefits of e-cigarettes to public health. Comparing both countries’ e-cigarette policies and regulations can provide some valuable lessons for Nigerian regulators as they look to embark on their e-cigarette regulatory journey. Aim This PhD project aims to compare the US and UK e-cigarette regulatory policies and public health initiatives and policies, to inform policy approaches in the context of Nigeria. Methods This PhD project, which comprised three empirical studies, used a multimethod qualitative approach. Study one involved purposive sampling and collection of primary data through interviews of 4 UK-based participants (between February to November 2022) and collation of secondary data through conference audio recordings (4 US and 5 UK recording) from the conference series - ‘E-cigarette Summit: Science, Regulation and Public Health’ (between November 2017 to May 2021); thematic analysis was carried out for all the data. Study two involved collation of secondary data (Twitter™ data) across 4 time periods (25th April 2014 to 8th August 2014, 10th May 2016 to 23rd August 2016, 2nd January 2016 to 17th April 2016, and 20th May 2016 to 2nd September 2016) that corresponds with pre- and- post e-cigarette regulatory period in the US and the UK; thematic and sentiment analysis was carried out on the data using Atlas.Ti. Study three involved purposive sampling and collection of primary data through interview of 4 Nigerian-based participants (between November 2022 to February 2023), with thematic analysis carried out using Nvivo. Results This PhD project found that the US and the UK had similar regulatory measures with respect to Notification, Warning labelling, and Child safety packaging of e-cigarettes. By contrast the two countries had different regulatory measures with respect to Classification, Flavours, Nicotine concentration, General safety, Age of sale, and Advertising of e-cigarettes. Study one found that Existing regulatory frameworks, Guidance from available evidence, and Public health considerations, were the main factors that determined e-cigarette regulations in the US and the UK. Study two found six themes/ topics that were discussed by Twitter™ users in relation to e-cigarette regulations during the pre- and- post e-cigarette regulatory period in the US and the UK. The six themes are: Updates (or clarification) on e-cigarette regulations; E-cigarettea as a public health concern; E-cigarettes as a smoking cessation aid; Opposition to e-cigarette regulations and policies; Growing use and popularity of e- cigarettes; and Research on e-cigarettes. The Twitter™ discussions and associated sentiments of Twitter™ users in three of themes (E-cigarette as a public health concern, E- cigarette as a smoking cessation aid, Opposition to e-cigarette regulations and policies) were of a nature that had the potential to influence regulators’ regulatory decisions through reputational theory, whereby regulators respond to patient activism or media pressure to protect their reputation in the public sphere. Study three found six factors with the potential to influence e-cigarette regulation in Nigeria. These comprise: existing regulatory framework; research evidence; public health considerations; economic considerations; infrastructural insufficiency; and role of industry. Conclusion Regulating e-cigarettes with existing national regulations and policies are a quick means of imposing e-cigarette regulations but can bring in ineffective and non-targeted e-cigarette regulatory measures. Whatever approach is used in developing e-cigarette regulations, nations could maximize benefits by ensuring responsive regulations i.e., ongoing monitoring and promptly responding to e-cigarette related public health concerns. Although collection of research evidence should be done objectively, application of e-cigarette research evidence should be context-based with appropriate weighing of risks : benefits of regulatory measures. Nigerian (and other) e-cigarette regulators should be cautious of and prevent external factors such as media pressure and actions of commercial actors that may unduly influence e-cigarette regulatory decisions.