Supporting policymakers with a decision aid to evaluate the impact of e-cigarette flavour restrictions.

Abstract

Background: The UK Government has introduced a range of measures to tackle the rise in youth vaping, including the power to regulate flavours. Evidence is needed to inform how these measures should be implemented, but communication between health researchers and policymakers can be difficult. Policymakers need a simple, easy-to-digest synthesis of evidence to make policy decisions that benefit the public.

Methods: We designed a policy decision aid to support policymakers (commissioned by Public Health England), whereby existing data can be inputted to create a report (the decision aid). The report estimates whether restricting flavours other than tobacco or menthol flavours in e-cigarettes would have a net benefit due to reductions in youth vaping and smoking or a net detriment due to the negative impact on smoking cessation and relapse rates.

Results: Using the available evidence on 13 November 2024, the model estimated that 125,034 non-smoking youth experiment with e-cigarettes as a result of flavoured e-liquid availability, and 841,302 smokers and ex-smokers do not smoke due to flavoured e-liquid availability. The model estimated that 48,764 non-smoking youth subsequently smoke as a result of flavoured e-liquid availability. The algorithm indicated that if only unflavoured, tobacco flavoured or menthol flavoured vapes remained on the market, there would be a detrimental impact on smoking rates in adults that would outweigh the number of young people protected from vaping and later smoking.

Conclusions: This output suggests that restricting flavoured e-liquids in the United Kingdom could have a detrimental impact on public health when considering both youth vaping and smoking uptake due to flavoured vape availability. To provide timely advice to policymakers, the algorithm used is intentionally simple. The decision aid should be used alongside existing relevant evidence (e.g. from countries with similar regulatory environments) to inform policy decisions and/or used to highlight areas for research that warrant support. The reports have been used in policy documents and discussions, demonstrating an appetite for this type of communication aid. The tool can be used to assess this policy question within subpopulations and in other localities, and the framework can be adopted to address other policy questions.