National-level regulation of e-cigarettes, heated tobacco products, nicotine pouches, and combustible tobacco in high-income countries: a comparative policy review
File(s)
Accepted version
Author(s)
Li, Charlotte
Brose, Leonie
Feliu Josa, Ariadna
Laverty, Anthony
Filippidis, Filippos
Type
Journal Article
Abstract
Emerging tobacco and nicotine products have expanded rapidly in high-income countries (HICs), yet regulation remains fragmented. We systematically mapped national-level, legally binding regulations for heated tobacco products (HTPs), e-cigarettes, and nicotine pouches
across 51 HICs as of February 2026, using combustible tobacco as comparator. We assessed eight regulatory domains: five adapted from WHO MPOWER plus product classification, minimum-age-of-sale, and flavour restrictions. HTPs and e-cigarettes were prohibited or not
authorised in five countries each, compared with 14 for nicotine pouches. Among countries permitting general retail sale, health-warning requirements were most common, whereas cessation support was least often underpinned by national legislation. HTP flavour restrictions were concentrated in the European Union, whereas e-cigarette flavour restrictions were often
absent. Even where domains were covered, their scope varied across countries and products, including warning formats and settings subject to public-use restrictions. Clearer regulatory pathways and more coherent, proportionate, and product-specific policies are needed.
across 51 HICs as of February 2026, using combustible tobacco as comparator. We assessed eight regulatory domains: five adapted from WHO MPOWER plus product classification, minimum-age-of-sale, and flavour restrictions. HTPs and e-cigarettes were prohibited or not
authorised in five countries each, compared with 14 for nicotine pouches. Among countries permitting general retail sale, health-warning requirements were most common, whereas cessation support was least often underpinned by national legislation. HTP flavour restrictions were concentrated in the European Union, whereas e-cigarette flavour restrictions were often
absent. Even where domains were covered, their scope varied across countries and products, including warning formats and settings subject to public-use restrictions. Clearer regulatory pathways and more coherent, proportionate, and product-specific policies are needed.
Date Acceptance
2026-10-20
Citation
The Lancet Public Health
ISSN
2468-2667
Publisher
Elsevier
Journal / Book Title
The Lancet Public Health
Copyright Statement
Copyright © 2026 Elsevier. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
License URL
Publication Status
Accepted