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.

Introduction:
This text provides an analysis of the impact of the Tobacco Products Directive (TPD) regulations on young people's use of e-cigarettes in Wales, England, and Scotland. The study uses a mixed-method approach, combining quantitative and qualitative data to answer research questions about changes in e-cigarette use and perceptions of TPD regulations.

Key points:

* The study used data from the School health Research Network/health Behaviour in School-aged Children surveys in Wales and the Smoking Drinking and Drug Use surveys in England.
* quantitative data were analyzed using segmented logistic regression and before and after binary logistic regression comparisons, while qualitative data were analyzed using thematic analysis.
* The results showed that there was no significant change in the level or rate of growth for young people's e-cigarette experimentation after the introduction of TPD regulations.
* however, there was some evidence of a reduction in trend for ever use of e-cigarettes, particularly for boys, never smokers, and ever smokers.
* Regular e-cigarette use increased slightly from 2015 to 2017 in Wales, but there was no significant change in England from 2014 to 2016.
* Young people had limited interactions with components of TPD regulations and described e-cigarette use as a "fad" that had begun to run its course.
* There was little evidence of renormalization of smoking or a gateway effect of e-cigarettes on smoking uptake.

Main message:
The study suggests that young people's e-cigarette experimentation may be plateauing in UK nations. The impact of TPD regulations on e-cigarette use among young people is unclear, with some evidence of a reduction in trend for ever use but no significant change in level or rate of growth. The main message is that long-term monitoring of e-cigarette use trends and perceptions among young people remains vital, particularly in light of concerns about the potential harms of e-cigarette use.

Moore G, Brown R, Page N, et al. 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. The International journal on drug policy. 2020;85:102795. doi:10.1016/j.drugpo.2020.102795