Background:
Emerging tobacco products including electronic nicotine delivery systems (ENDS) present an opportunity and a challenge with respect to charting a pathway to the demise of tobacco use. As of June 2017, 35 countries ban the retail sale of ENDS. The current study sought to understand the associations between countries banning sales of ENDS and the country's stage of the tobacco epidemic in the Lopez (1994) model.

Methods:
Data on the policy choices of 186 countries to ban retail sales of ENDS was combined with daily cigarette smoking prevalence and death figures from tobacco smoking by country, sex, and year. Countries in 2015, were classified as being in stages 1 to 4 of the Lopez epidemic model, according to whether tobacco smoking prevalence and attributable deaths were rising or falling over the prior decade. Logistic regression analysis on the final cross-sectional dataset was performed to test the hypothesis that countries in the earlier stages of the tobacco epidemic and countries with relatively smaller populations of female smokers were more likely to ban the sale of ENDS.

Results:
18.8% of countries in the total sample banned the retail sale of ENDS. Countries in stages 1, 2, and 3 of the epidemic had odds ratios of 1.024, 1.106, and 0.633 relative to countries in the final stage of the epidemic of adopting a ban on retail sales of ENDS. Although statistically insignificant (all p>0.05), the proportions suggest that those jurisdictions at the height of the epidemic (stage 3) are slightly less likely to ban e-cigarettes.

[Country ENDS Sale Ban by Stage of Tobacco Epidemic]



Conclusions:
Countries in early stages of the tobacco epidemic may be less likely to ban e-cigarettes, because there may be little to no presence of the products. Countries in the latter stages of the tobacco epidemic may be more able to regulate e-cigarettes, rather than ban them.