Who says what about e-Cigarette regulation? A content analysis of UK newspapers

Mass media are an important source of influence on public and political awareness of, and attitudes to, health issues, as well as a powerful vessel for policy stakeholders to present their arguments. This research comprises a content analysis of UK newspaper representations of the media debate about e-cigarette regulation in 2013 and 2014, identifying how frequently different categories of stakeholder were cited, the stances towards different types of e-cigarette regulation with which they were associated, and the rationales they employed in justifying those stances. We show that reporting on e-cigarette regulation grew significantly (p < 0.001) throughout the sample period, and we identify that governments and regulatory bodies were the most frequently cited stakeholders, and uniformly supportive of regulation, while other stakeholders were less uniform in their positions. Arguments for e-cigarette regulation greatly outnumbered arguments against regulation. Regulating purchasing age, restricting marketing and regulating e-cigarettes as medicine were broadly supported, while stakeholders disagreed about prohibiting e-cigarette use in enclosed public spaces. In rationalising their stances, supporters of regulation cited child protection and concerns about the safety of e-cigarette products, while opponents highlighted the potential of e-cigarettes in tobacco cessation and questioned the evidence base associating e-cigarette use with health harms. We argue that media representations of the debate may exaggerate the extent to which the public health community are divided, and we present recommendations to avoid this distortion in ongoing and future media debates. We also suggest that the divisions that do exist highlight ideological differences about the remit and goals of public health, and argue that these differences represent a barrier to evidence-based policymaking.