Abstract
Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent of, and basis for, divisions between health-focused actors with regard to the harms and benefits of e-cigarettes and appropriate approaches to regulation in Scotland. The results demonstrated considerable engagement in e-cigarette policy development by health-focused actors and a widely held perception of strong disagreement. They show that actors agreed on substantive policy issues, such as age-of-sale restrictions and, in part, the regulation of advertising. Points of contestation were related to the harms and benefits of e-cigarettes and the regulation of vaping in public places. The topicality, limitations of the evidence base and underlying values may help explain the heightened sense of division. While suggesting that some opportunities for joint advocacy might have been missed, this analysis shows that debates on e-cigarette regulation cast a light upon differences in thinking about appropriate approaches to health policy development within the public health community. Constructive debates on these divisive issues among health-focused actors will be a crucial step toward advancing public health.
Highlights
Electronic cigarettes (e-cigarettes) or electronic nicotine delivery systems (ENDS), devices that “heat a solution (e-liquid) to create an aerosol which frequently contains flavourants” [1] and often nicotine, have received increased public and policy attention since their invention in 2003
Their rapid proliferation and use by smokers and non-smokers has led to controversial public health and political debates, with proponents and opponents of e-cigarettes taking different positions on the potential implications of e-cigarettes and on the appropriate approach to regulation [2–4]. These controversies extend to organisations and individuals with an interest in public health that have, for decades, jointly worked to reduce the harms caused by tobacco through political advocacy
It shows that organisations that, in the context of previous tobacco control policy debates, had pursued common goals and aligned key messages [26] were divided with regard to their assessment of the harms and benefits of e-cigarettes as well as on aspects of e-cigarette regulation, including vaping in public places and, to a lesser degree, the promotion of e-cigarettes
Summary
Electronic cigarettes (e-cigarettes) or electronic nicotine delivery systems (ENDS), devices that “heat a solution (e-liquid) to create an aerosol which frequently contains flavourants” [1] and often nicotine, have received increased public and policy attention since their invention in 2003. Their rapid proliferation and use by smokers and non-smokers has led to controversial public health and political debates, with proponents and opponents of e-cigarettes taking different positions on the potential implications of e-cigarettes and on the appropriate approach to regulation [2–4]. Public Health 2019, 16, 3103; doi:10.3390/ijerph16173103 www.mdpi.com/journal/ijerph
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