E-cigarettes an evidence update A report commissioned by Public Health England

E-cigarettes: an evidence update12. International perspectivesOverviewInternationally, countries have taken a wide variety of approaches to regulating EC[156]. Current approaches range from complete bans on the sale of any EC, to applyingexisting laws on other products to EC (poison, nicotine, and/or tobacco laws), toallowing EC to be sold under general consumer product regulations. Similarly, withincountries, different laws have also been applied at the state/provincial level, along withmunicipal by-laws, extending into areas including taxes on EC, and bans on use inplaces where smoking is banned. Furthermore, several nuances in laws exist, making itdifficult to make broad statements about the regulations in a given country. This sectionfocuses on presenting (1) studies that have compared the use of EC internationallyacross countries using representative samples and comparable methods, (2) a briefreview of adolescent surveys internationally, and (3) the cases of Australia and Canada,two countries that have very similar tobacco control policies to the UK but very differentpolicies relating to EC.Use of e-cigarettes among adults internationallyThree studies have compared the use of EC internationally: (1) International TobaccoControl Project (described in the Methodology section), (2) Eurobarometer study and (3)Global Adult Tobacco Survey.The International Tobacco Control Project compared EC use (use defined as less thanmonthly or more often) among smokers and ex-smokers across 10 countries [157].Gravely et al., 2014 found significant variability in use across countries, but data weregathered across different years. Gravely et al., 2014 concluded that the study providedevidence of the rapid progression of EC use globally, and that variability was due partlyto the year the survey was conducted, but also market factors, including differentregulations on EC. Notably, EC use was highest in Malaysia at 14%, where a ban onEC was in place.Two studies using secondary data from the 2012 Eurobarometer 385 survey haveexamined EC use. Vardavas, et al., 2014 [158] examined ever use (tried once or twice)of EC among smokers, ex-smokers and never smokers aged 15 years and over across27 EU countries. The study found wide variation in ever EC use among smokers andnon-smokers, with ever use varying from 20.3% among smokers, 4.4% among exsmokers,and 1.1% among never smokers. Of those who had tried, 69.9% reportedusing EC once or twice, and 21.1% and 9% reported ever using or currently usingoccasionally or regularly (use or used regularly or occasionally). It is important to notethat the question asked about ever using or currently using occasionally or regularly,85