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. 2022 Mar 5;32(3):131-138.
doi: 10.2188/jea.JE20200332. Epub 2021 Apr 23.

Regulation of Electronic Cigarette Use in Public and Private Areas in 48 Countries Within the WHO European Region: A Survey to In-country Informants

Beladenta Amalia  1   2   3   4 , Marcela Fu  1   2   3   4 , Ariadna Feliu  1   2   3   4 , Olena Tigova  1   2   3   4 , Ranti Fayokun  5 , Kristina Mauer-Stender  6 , Esteve Fernández  1   2   3   4
Affiliations

Regulation of Electronic Cigarette Use in Public and Private Areas in 48 Countries Within the WHO European Region: A Survey to In-country Informants

Beladenta Amalia et al. J Epidemiol. .

Abstract

Background: The objective of this study is to describe the legislation regulating the use of electronic cigarettes (e-cigarettes) in various places in European countries.

Methods: A survey among experts from all countries of the World Health Organization (WHO) European Region was conducted in 2018. We collected and described data on legislation regulating e-cigarette use indoors and outdoors in public and private places, the level of difficulties in adopting the legislation, and the public support and compliance. Factors associated with the legislation adoption were identified with Poisson and linear regression analyses.

Results: Out of 48 countries, 58.3% had legislation on e-cigarette use at the national level. Education facilities were the most regulated place (58.3% of countries), while private areas (eg, homes, cars) were the least regulated ones (39.6%). A third of countries regulated e-cigarette use indoors. Difficulty and support in adopting the national legislation and its compliance were all at a moderate level. Countries' smoking prevalence and income levels were linked to legislation adoption.

Conclusions: Although most WHO European Region countries had introduced e-cigarette use legislation at the national level, only a few of the legislation protect bystanders in indoor settings.

Keywords: ENDS/ENNDS; FCTC; e-cigarettes; legislation; secondhand exposure.

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Conflict of interest statement

Conflicts of interest: None declared.

Figures

Figure 1.
Figure 1.. Proportion and number of countries within the World Health Organization European Regiona restricting the use of electronic cigarettes (e-cigarettes) in indoor and outdoor places, 2018. EU, European Union. aAmong all countries (Total n = 48; EU n = 26; Non-EU n = 22). Either partial or total ban for the use of any type of e-cigarettes (with or without nicotine). *EU vs Non-EU, indoors; P < 0.001; estimated using Kruskal-Wallis post-hoc test. **EU vs Non-EU, outdoors; P = 0.011; estimated using Kruskal-Wallis post-hoc test. Absolute numbers of countries are shown on the right side of each bar.
Figure 2.
Figure 2.. Proportion and number of countries within the World Health Organization European Region restricting the use of electronic cigarettes (e-cigarettes)c in various places (a) among all countriesa and (b) only among countries with national e-cigarette legislation in placeb, 2018. aAmong all countries (Total n = 48; EU n = 26; Non-EU n = 22). bAmong countries with the national legislation on e-cigarette use (Total n = 28; EU n = 19; Non-EU n = 9). cEither partial or total ban for the use of any type of e-cigarettes (with or without nicotine). Absolute numbers of countries are shown on top of each bar. “Others” includes places such as tunnels, sporting facilities, elevators, and markets.
Figure 3.
Figure 3.. Median number of places covered by national legislation on e-cigarette use in the countries of the World Health Organization European Region, 2018
See this image and copyright information in PMC

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