E-cigarette regulations in Italy: fluctuating and confusing

The regulation of electronic cigarette (e-cigarette) sales and use in public places largely varies by country and within countries.1–3 In view of the scarcity of the evidence on e-cigarette’s efficacy, safety, and ability to pollute indoor environment, any approach around e-cigarettes is likely to generate a debate. The Italian legislation on e-cigarette use in public places turned over three times within 6 months, during which time the evidence on the indoor pollution related to electronic smoking did not vary substantially. In June, 2013, e-cigarettes were banned from public places by a law decree. In September, 2013, a new law allowed e-cigarette smoking both indoors and outdoors, with the exclusion of schools. 3 months later, the Italian Parliament approved another e-cigarette ban, together with a 200% increase in taxation. Finally, because of controversies around norms included in the Government decree, unrelated to smoking, such regulation was then withdrawn by the government. Fluctuating approaches are likely to create confusion in the population and among health-care professionals, and decrease the trust in and adherence to regulations. More caution is required by governments in issuing of policies on e-cigarette smoking, and, once a strategy is decided, this should be maintained until solid confuting evidence is available. Certainly, further data are eagerly awaited.