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Abstract
Background The WHO Framework Convention on Tobacco Control (WHO FCTC) Article 13 requires countries to ban tobacco advertising, promotion and sponsorship (TAPS), and bans are recommended to cover electronic cigarettes (e-cigarettes). We examined youth e-cigarette prevalence by TAPS regulations in countries with different income levels.
Methods We analysed data on 165 299 respondents from 48 countries with 2016/2018 WHO FCTC implementation reports and 2016–2019 Global Youth Tobacco Survey. We used multilevel logistic regressions to examine associations between TAPS regulations and current e-cigarette use, stratified by country income.
Results About 1 in 10 respondents was currently using e-cigarettes. Respondents in countries with TAPS bans on the internet were less likely to use e-cigarettes (adjOR=0.58; 95% CI 0.39 to 0.86) than youth in countries without such bans. In lower middle-income and low-income countries, bans on displaying tobacco products at the point of sale (adjOR=0.55; 95% CI 0.34 to 0.90), bans on product placement (adjOR=0.44; 95% CI 0.28 to 0.69) and strength of additional TAPS measures were associated with lower prevalence of e-cigarette use among students. Being taught about the dangers of the use of tobacco in school was associated with lower odds of e-cigarette use. No differences in the use of e-cigarettes were observed by types of TAPS among respondents in high-income countries.
Conclusions Strengthening implementation of TAPS policies and assuring they cover new and emerging products, online channels and points of sales are essential, especially in lower income countries. Maintaining tobacco health education is also important to protect youth from e-cigarette use.
- Public policy
- Electronic nicotine delivery devices
- Advertising and Promotion
- Low/Middle income country
- Surveillance and monitoring
Data availability statement
Data are available in a public, open access repository. Data are available in public, open access repository. The Global Youth Tobacco Survey (GYTS) are publicly available at the (https://extranet.who.int/ncdsmicrodata/index.php/catalog/GYTS/?page=1&ps=15&repo=GYTS) and WHO FCTC Implementation Database (https://extranet.who.int/fctcapps/fctcapps/fctc/implementation-database/parties-list). Additional public databases used were the Global Health Observatory:https://www.who.int/data/gho/data/indicators/indicator-details/GHO/gho-tobacco-control-raise-taxes-r-afford-gdp and https://databank.worldbank.org/source/world-development-indicators.
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- Public policy
- Electronic nicotine delivery devices
- Advertising and Promotion
- Low/Middle income country
- Surveillance and monitoring
Data availability statement
Data are available in a public, open access repository. Data are available in public, open access repository. The Global Youth Tobacco Survey (GYTS) are publicly available at the (https://extranet.who.int/ncdsmicrodata/index.php/catalog/GYTS/?page=1&ps=15&repo=GYTS) and WHO FCTC Implementation Database (https://extranet.who.int/fctcapps/fctcapps/fctc/implementation-database/parties-list). Additional public databases used were the Global Health Observatory:https://www.who.int/data/gho/data/indicators/indicator-details/GHO/gho-tobacco-control-raise-taxes-r-afford-gdp and https://databank.worldbank.org/source/world-development-indicators.
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Footnotes
Contributors HO and YT conceptualised the study. YT conducted the formal analysis. TY wrote the first draft of the manuscript in collaboration with HO, YT and OR. HH and PP revised the manuscript. HO is the guarantor. All authors reviewed and approved the manuscript for submission.
Funding Funding provided by the Bloomberg Initiative to Reduce Tobacco Use through the CDC Foundation with a grant from Bloomberg Philanthropies.
Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC Foundation.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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