Aiding communication between public health researchers and policymakers through policy decision aids

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Evidence is needed to inform how these measures should be implemented, but communication between health researchers and policymakers can be difficult. Policymakers need a simple, easy-to-digest synthesis of evidence to make policy decisions that benefit the public. Methods We designed a policy decision aid to support policymakers (commissioned by Public Health England), whereby existing data can be inputted to create a report (the decision aid). The report estimates whether one potential policy action, restricting flavours other than tobacco or menthol flavours in e-cigarettes, would have a net benefit due to reductions in youth vaping and smoking or a net detriment due to the negative impact on smoking cessation and relapse rates. Results Using the available evidence on 13th November 2024, we estimated that 125,034 non-smoking youth experiment with e-cigarettes as a result of flavoured e-liquid availability, and 841,302 smokers and ex-smokers do not smoke due to flavoured e-liquid availability. We estimated that 48,764 non-smoking youth subsequently smoke as a result of flavoured e-liquid availability. The algorithm indicated that if only unflavoured, tobacco flavoured or menthol flavoured vapes remained on the market, there would be a detrimental impact on smoking rates in adults that would outweigh the number of young people protected from vaping and later smoking. Conclusions This output suggests that restricting flavoured e-liquids in the UK could have a detrimental impact on public health when considering both youth vaping and smoking uptake due to flavoured vape availability. To provide timely advice to policymakers, the algorithm used is intentionally simple. The decision aid should be used alongside existing relevant evidence (e.g., from countries with similar regulatory environments) to inform policy decisions and/or used to highlight areas for research that warrant support. The reports have been used in policy documents and discussions, demonstrating an appetite for this type of communication aid. The tool can be used to assess this policy question within subpopulations and in other localities, and the framework can be adopted to address other policy questions. policy communication e-cigarettes vaping UK legislation flavours Figures Figure 1 Background There have been substantial changes to e-cigarette regulation in the UK recently; in 2024, the UK government proposed a new Vaping Products Duty, a ban on disposable vapes (also known as e-cigarettes), and the Tobacco and Vapes Bill [1]. These policies were proposed in response to a rapid increase in youth vaping [2] and concerns that e-cigarettes may cause a range of health outcomes [3] and/or act as a gateway to smoking, given the strong association between the two behaviours [4, 5]. The UK government received substantial advice on these policies from researchers in response to calls for evidence and consultations, and via written and oral evidence submitted to the Tobacco and Vapes Bill Committee. One proposal within the Tobacco and Vapes Bill that has received particular attention is the introduction of new powers allowing Ministers to regulate the flavours of vapes. There have been many calls for a complete flavour ban in the UK Parliament, but those calling for action may not be aware of the potential unintended consequences of this policy. For example, qualitative interviews with UK adults who smoked and vaped suggest that some people may not stop smoking using e-cigarettes or may relapse if flavours (aside from menthol and tobacco) are banned from vaping products in the UK [6]. This is particularly concerning given e-cigarettes are a popular and effective aid to stop smoking in England; 40% of respondents in the Smoking Toolkit Study claimed to have used an e-cigarette in their most recent quit attempt, and those using an e-cigarette (versus not) are nearly twice as likely to stop smoking [7]. Evidence from other countries suggests that banning flavours (or allowing only tobacco and menthol flavours) could be effective in reducing the appeal of vaping to young people [8, 9], but there have been several studies that suggest this policy could also increase tobacco use and illicit product use [10-13]. Although these studies highlight the potential consequences of a flavour ban in the UK, policymakers cannot solely rely on this evidence to make decisions, as the impact may not be the same due to the different local social and regulatory environments. Policymakers need to make countless decisions that may impact the health of the population they serve without necessarily being an expert on the health topic or the corresponding evidence base. In contrast, public health researchers are experts in their topic area and can have substantial knowledge that could be used to inform policy decisions, but it is often difficult to communicate this information effectively [14]. Key barriers to the use of evidence in policy decisions include evidence not being submitted at the right time to influence policy, a lack of clarity in the submitted evidence, and policymakers not having the research skills needed to understand the evidence [15]. Furthermore, evidence needs to be integrated into context-sensitive decision-making processes to drive change [16]. In 2020, we were commissioned by Public Health England (now the Office of Health Improvements and Disparities) to create a decision-making aid to be used by policymakers in conjunction with other evidence. The aid aimed to estimate the impact of a flavour ban on never-smoking youth versus adults who vape and smoke, while providing information in a simple, easy-to-digest report. We created a tool that would automatically produce this report (the policy decision aid) when new data from a range of sources is entered into the tool, thus enabling us to quickly provide policymakers with updated reports based on the latest available data when needed. This tool provides brief, digestible guidance to policymakers who are developing e-cigarette policies in the UK, but the framework can be applied to subpopulations, other localities and other policy questions. Methods The policy decision aid was designed by the authors and refined in consultation with relevant stakeholders, including other UK vaping researchers, leads for national surveys that collect data on vaping, and UK policymakers interested in vaping regulations. The tool we created to automatically produce the policy decision aid when new data is entered uses a basic algorithm that requires data input to indicate: A. The extent to which flavours draw non-smoking youth to vape. B. How many non-smokers who vape as a result of e-liquid flavour availability may then go on to smoke. C. To what extent e-liquid flavour availability draws in smokers who would quit smoking using e-cigarettes (per year). D. The number of e-cigarette users who state they would relapse to smoking if flavoured e-liquid were not available on the UK market. A is estimated based on: a) the number of youth at smoking age in the UK × b) the proportion of youth at smoking age who do not smoke × c) the proportion of youth at smoking age who have never smoked but have vaped, × d) the proportion of the above who state they vape because of flavours. B is estimated based on: a) the estimation of A × b) the proportion of non-smoking youth who try vaping and later try smoking. C is estimated based on: a) the number of adult smokers in the UK × b) the proportion of smokers who quit smoking because of e-cigarettes × c) the proportion of smokers who vape who state that they would not quit or would smoke more if flavours were not available. D is estimated based on: a) the number of ex-smokers in the UK × b) the proportion of ex-smokers who vape × c) the proportion of ex-smokers who state they would relapse to smoking if flavours were not available. For the latest update (November 2024), we entered data from Action on Smoking and Health (ASH) youth and adult annual YouGov surveys [2, 17] (collected between February and April 2024), the monthly Smoking Toolkit Study (STS; collected between June and October 2023) [18], and publicly available figures from the Office of National Statistics [19, 20] and privately owned real-time statistics website Worldometer (estimates taken on 13 th November 2024) [21]. The ASH youth surveys collect data from respondents aged 11 – 17 years, and the adult surveys are conducted on adults aged 18+ years. STS surveys are conducted on adults aged 16+ years. The exact figures, sources, survey questions and code used to determine the data input can be found in on GitHub (https://github.com/jkhouj/PolicyDecisionAid). ASH and STS conduct surveys in Great Britain (which includes England, Scotland and Wales, but not Northern Ireland) and England, respectively; however, no relevant data were available for Northern Ireland. We merged data from ASH and STS (weighted to accurately represent sociodemographic characteristics in Great Britain [ASH] and England [STS]) to better estimate proportions in the UK (Great Britain and Northern Ireland). By combining these data, we aimed to gain a more accurate estimate of proportions, given that the two surveys have different biases. To estimate whether the number of non-smoking e-cigarette users introduced into the UK population because of flavoured e-liquid availability could outweigh the number of smokers and ex-smokers who might vape instead of smoke because of flavoured e-liquid availability, the following calculation is made: A - (C + D) To estimate whether the number of smokers introduced into the UK population because of flavoured e-liquid availability could outweigh the number of smokers and ex-smokers who might vape instead of smoke because of flavoured e-liquid availability, the following calculation is made: B - (C + D) Positive values would provide some support for a total ban on flavoured e-liquids, and negative values would provide some evidence that the detrimental consequences of a total ban would outweigh the potential benefits. Results Using the available evidence on 13 th November 2024, we estimated that 125,034 non-smoking youth experiment with e-cigarettes as a result of flavoured e-liquid availability and 841,302 smokers and ex-smokers do not smoke due to flavoured e-liquid availability (Figure 1). We also estimated that 48,764 non-smoking youth subsequently smoke as a result of flavoured e-liquid availability (Figure 1). This output suggests that restricting flavoured e-liquids in the UK could have a detrimental overall impact on public health when considering both youth vaping and smoking uptake due to flavoured vape availability. The full report (Supplementary Figure 1) was shared with the Office of Health Improvements and Disparities. Discussion Here, we have illustrated the potential of a policy decision aid to assist policymakers in deciding whether to ban flavours in vapes. The most recent report in November 2024 (and all prior reports) indicates that banning flavours in e-cigarettes would detrimentally impact smoking cessation and abstinence rates in the UK more than it would prevent youth uptake of vaping and smoking. The findings of this and earlier outputs of this decision aid (with the same broad conclusions) have been discussed in the UK Parliament, cited in responses to calls for evidence [ 22 ], and cited in the UK government Tobacco and Vapes Bill Impact Assessment conducted by the Department of Health and Social Care ( https://publications.parliament.uk/pa/bills/cbill/59-01/0121/impactassessment.pdf ). The impact assessment concluded (in line with the evidence we provided) that 87% of adults who vape could be impacted. The assessment also highlighted that the outputs echo the findings of Friedman and colleagues [ 23 ] whereby reductions in the sale of vapes following flavour restrictions coincided with increases in tobacco sales. Our previous work using this model to estimate the impact on the general United States population also indicated that there would be an increase in smoking rates [ 24 ]. The findings are also in line with our prior qualitative research, where participants described their intentions to smoke more in the hypothetical scenario where flavours are banned in the UK [ 6 ]. However, a review of anticipated and actual responses to banning flavours in e-cigarettes has shown mixed findings regarding the effectiveness and unintended consequences of a ban [ 25 ]. Although some of the evidence in the review contradicts the output from the policy decision aid, the review conclusions relied on evidence from the United States which may not apply to the UK given the different social and regulatory environments (e.g., flavoured tobacco products were banned at the same time as flavoured e-cigarettes whereas flavoured cigarettes, including menthol, have been banned since 2020 in the UK). The use of the decision aid output in government discussions, reports, and impact assessments demonstrates that it is accessible for policymakers. The output is also relatively quick to produce when new data becomes available, meaning we have been able to supply policymakers with eight updates in three years. However, data availability has been scarce and thus far required additional funding for data collection, as national surveys do not routinely include questions about flavours and e-cigarette flavour restrictions. The output is also intended to guide policy decisions in the context of other available evidence, and is not to be used as the sole determining factor when making policy decisions due to the simplicity of the model and potential bias due to sampling biases in the data collected. If no relevant evidence is available, the decision aid output could be used to guide governmental support for future research by highlighting areas for research. For example, if the tool showed a beneficial impact when including menthol and tobacco flavours versus excluding them from the ban, the government could support further research in this area to improve the evidence base for this policy decision. The simplistic model is necessary to provide the timely estimates that policymakers require [ 15 ], but consequently, the output cannot account for many nuances in behaviour. For example, the decision aid does not consider the impact of the role of e-cigarettes in displacing cigarette smoking among young people or of second-hand smoke exposure. Additionally, the model assumes that e-cigarettes act as a gateway to smoking, as this is a concern for policymakers. However, despite the consistent association between vaping and later smoking among young people and adults, it is unlikely that the gateway hypothesis provides a complete explanation for the association; there is substantial evidence that the relationship is partly explained by a shared liability to use either product, perhaps due to an underlying genetic propensity for risk-taking [ 4 , 26 , 27 ]. This decision aid provides a worst-case scenario for policymakers given their concerns, but may overestimate the harm to youth. The data used is also restricted to respondents from Great Britain, and although we have scaled this to the UK, there may be differential impacts in Northern Ireland that are not accounted for. Furthermore, there is some overlap in the age of our adult and youth groups; ASH collected youth data on 11–17 year olds and adult data on 18 + years, whereas we stratified the STS data for youth on 16–20 year olds and for adults on 21 + given that initiation of e-cigarettes and cigarettes is occurring later in life than in previous generations [ 28 , 29 ] and policymakers were concerned about young adult behaviour. The youth responses were then scaled to the number of 11- to 20-year-olds in the UK, and the adult responses were scaled to the estimated number of current and ex-smokers who are 18 years or over in the UK. Therefore, the estimates could be an overestimation whereby young adults aged 18 to 20 who vaped before they smoked and have transitioned between smoking and vaping multiple times may be included in both the estimation of B and either C or D. Finally, the survey questions that underly the data used in this tool estimate anticipated behaviour in the event of a flavour ban and could therefore underestimate individuals’ ability to refrain from smoking. However, until a ban is introduced, it will not be possible to observe actual behaviour in the UK's unique social and policy context. As highlighted by these limitations, effective and timely policy communication requires researchers to provide less complex, precise, and nuanced results in favour of providing results that can be easily interpreted by policymakers. This framework can be used to explore the potential impact on different subpopulations and the impact of flavour restrictions in other localities. Additionally, the tool can be adapted to answer other policy questions, where there is a trade-off between policies protecting some individuals but potentially harming others. However, such adaptations need to identify the framework limitations in the context of the policy question, as they will likely differ from the limitations identified here. Conclusions When provided with simple, easy-to-digest information that is relevant to the current policy environment, policymakers can synthesise evidence from public health researchers to guide policy development. Abbreviations ASH – Action on Smoking and Health STS – Smoking Toolkit Study UK – United Kingdom Declarations Ethics approval and consent to participate This study used summary-level data collected by existing surveys, therefore did not require ethics approval for this work. We sought approval from Action on Smoking and Health and the Smoking Toolkit Study to conduct this work and have conducted this work in line with their consent regulations. The University College London Ethics Committee granted ethical approval for the Smoking Toolkit Study, (ID 0498/001). Participants in the surveys provided informed consent before participating. Consent for publication Not applicable. Availability of data and materials The data supporting the conclusions of this article are available in the GitHub repository, https://github.com/jkhouj/PolicyDecisionAid. For access to the original STS data, please use these forms: https://smokinginengland.info/resources/data-request-agreement-form; https://smokinginengland.info/resources/data-request-coi-form. For access to ASH YouGov data, please contact [email protected] . Competing interests The authors declare that they have no competing interests. Funding This work was originally supported by Public Health England via an honorary contract awarded to ASA. There is no grant number for this support as it was commissioned by Public Health England via the honorary academic framework. Further support was received from the University of Bristol via an Economic and Social Research Council Impact Acceleration Award (A100111) awarded to JNK, ASA and MRM and then from the Research England Policy Support Fund (PolicyBristol) awarded to JNK, ASA and MRM (H100026). JNK, MJG and MRM were supported by the Medical Research Council Integrative Epidemiology Unit (MC_UU_00011/7). JNK and ASA were supported by a Cancer Research UK programme grant (the Integrative Cancer Epidemiology Programme C18281/A29019). MD was employed by Public Health England and the Office for Health Improvement and Disparities during the project, but has now retired. Authors’ contributions ASA, MD and MRM were responsible for the original project conception. JNK developed the initial algorithm and output, led consultations and redeveloped the algorithm and output based on feedback. JNK acquired further funding to support data collection in existing surveys. MJG, JNK and JF contributed to code development to analyse the survey data. JNK drafted the manuscript and all authors contributed to the editing and finalisation of the submitted manuscript. Acknowledgements We would like to thank the participants of the surveys. We would like to thank the people who contributed to our consultations, the team at ResearchIT, including Serena Cooper and Tessa Alexander who created the tool using BitBucket, and Tom Waterhouse of 2DForever for his artistic contribution to the design of the report. We would also like to thank the temporary staff who contributed to this project, Katie De-Loyde, Muhsin Yesilada, and Lukas Sykes. References The Lancet Respiratory M. The UK Tobacco and Vapes Bill: a historic opportunity. The Lancet Respiratory Medicine . 2025;13(1):1. Action on Smoking and Health. Use of vapes (e-cigarettes) among young people in Great Britain . 2024. McNeill A, Simonavičius, E, Brose, LS, Taylor, E, East, K, Zuikova, E, Calder, R,, Robson D. 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Predictors of E-Cigarette Initiation: Findings From the Youth and Young Adult Panel Study. Tob Use Insights . 2020;13:1179173x20977486. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Mar, 2026 Reviews received at journal 17 Feb, 2026 Reviewers agreed at journal 27 Jan, 2026 Reviews received at journal 03 Nov, 2025 Reviewers agreed at journal 29 Oct, 2025 Reviewers invited by journal 27 Oct, 2025 Editor assigned by journal 30 Jul, 2025 Submission checks completed at journal 30 Jul, 2025 First submitted to journal 28 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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16:00:34","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":65321,"visible":true,"origin":"","legend":"","description":"","filename":"74ddc71ca6f5412d8008cf1d4225b14f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7233304/v1/2f865b90bed0192f2f351647.xml"},{"id":95317024,"identity":"618146b0-c3c1-4ae0-a247-55a67b0b0b63","added_by":"auto","created_at":"2025-11-06 16:00:33","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":71720,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7233304/v1/cab93819f4c6e5eca7ab3365.html"},{"id":95317086,"identity":"73f1a6ac-bdc3-4279-80b5-a30d6e8ec4db","added_by":"auto","created_at":"2025-11-06 16:00:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":269744,"visible":true,"origin":"","legend":"\u003cp\u003ePolicy Decision Aid Report to Support Policymaking on Flavour Restriction to Reduce Youth Vaping\u003c/p\u003e\n\u003cp\u003eThis report displays the November 2024 output.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7233304/v1/ad6dd9d7ac29a96f69f2d24a.png"},{"id":95523796,"identity":"72978855-50ac-49bb-94e1-828be3222f37","added_by":"auto","created_at":"2025-11-10 10:00:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":638827,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7233304/v1/67e0558d-c793-4bfc-ad66-3d9646041f68.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Aiding communication between public health researchers and policymakers through policy decision aids","fulltext":[{"header":"Background","content":"\u003cp\u003eThere have been substantial changes to e-cigarette regulation in the UK recently; in 2024, the UK government proposed a new Vaping Products Duty, a ban on disposable vapes (also known as e-cigarettes), and the Tobacco and Vapes Bill [1]. These policies were proposed in response to a rapid increase in youth vaping [2] and concerns that e-cigarettes may cause a range of health outcomes [3] and/or act as a gateway to smoking, given the strong association between the two behaviours [4, 5]. The UK government received substantial advice on these policies from researchers in response to calls for evidence and consultations, and via written and oral evidence submitted to the Tobacco and Vapes Bill Committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne proposal within the Tobacco and Vapes Bill that has received particular attention is the introduction of new powers allowing Ministers to regulate the flavours of vapes. There have been many calls for a complete flavour ban in the UK Parliament, but those calling for action may not be aware of the potential unintended consequences of this policy. For example, qualitative interviews with UK adults who smoked and vaped suggest that some people may not stop smoking using e-cigarettes or may relapse if flavours (aside from menthol and tobacco) are banned from vaping products in the UK [6]. This is particularly concerning given e-cigarettes are a popular and effective aid to stop smoking in England; 40% of respondents in the Smoking Toolkit Study claimed to have used an e-cigarette in their most recent quit attempt, and those using an e-cigarette (versus not) are nearly twice as likely to stop smoking [7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEvidence from other countries suggests that banning flavours (or allowing only tobacco and menthol flavours) could be effective in reducing the appeal of vaping to young people [8, 9], but there have been several studies that suggest this policy could also increase tobacco use and illicit product use [10-13]. Although these studies highlight the potential consequences of a flavour ban in the UK, policymakers cannot solely rely on this evidence to make decisions, as the impact may not be the same due to the different local social and regulatory environments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePolicymakers need to make countless decisions that may impact the health of the population they serve without necessarily being an expert on the health topic or the corresponding evidence base. In contrast, public health researchers are experts in their topic area and can have substantial knowledge that could be used to inform policy decisions, but it is often difficult to communicate this information effectively [14]. Key barriers to the use of evidence in policy decisions include evidence not being submitted at the right time to influence policy, a lack of clarity in the submitted evidence, and policymakers not having the research skills needed to understand the evidence [15]. Furthermore, evidence needs to be integrated into context-sensitive decision-making processes to drive change [16].\u003c/p\u003e\n\u003cp\u003eIn 2020, we were commissioned by Public Health England (now the Office of Health Improvements and Disparities) to create a decision-making aid to be used by policymakers in conjunction with other evidence. The aid aimed to estimate the impact of a flavour ban on never-smoking youth versus adults who vape and smoke, while providing information in a simple, easy-to-digest report. We created a tool that would automatically produce this report (the policy decision aid) when new data from a range of sources is entered into the tool, thus enabling us to quickly provide policymakers with updated reports based on the latest available data when needed. This tool provides brief, digestible guidance to policymakers who are developing e-cigarette policies in the UK, but the framework can be applied to subpopulations, other localities and other policy questions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe policy decision aid was designed by the authors and refined in consultation with relevant stakeholders, including other UK vaping researchers, leads for national surveys that collect data on vaping, and UK policymakers interested in vaping regulations. The tool we created to automatically produce the policy decision aid when new data is entered uses a basic algorithm that requires data input to indicate:\u003c/p\u003e\n\u003cp\u003eA. The extent to which flavours draw non-smoking youth to vape.\u003c/p\u003e\n\u003cp\u003eB. How many non-smokers who vape as a result of e-liquid flavour availability may then go on to smoke.\u003c/p\u003e\n\u003cp\u003eC. To what extent e-liquid flavour availability draws in smokers who would quit smoking using e-cigarettes (per year).\u003c/p\u003e\n\u003cp\u003eD. The number of e-cigarette users who state they would relapse to smoking if flavoured e-liquid were not available on the UK market.\u003c/p\u003e\n\u003cp\u003eA is estimated based on: a) the number of youth at smoking age in the UK \u0026times; b) the proportion of youth at smoking age who do not smoke \u0026times; c) the proportion of youth at smoking age who have never smoked but have vaped, \u0026times; d) the proportion of the above who state they vape because of flavours. B is estimated based on: a) the estimation of A \u0026times; b) the proportion of non-smoking youth who try vaping and later try smoking. C is estimated based on: a) the number of adult smokers in the UK \u0026times; b) the proportion of smokers who quit smoking because of e-cigarettes \u0026times; c) the proportion of smokers who vape who state that they would not quit or would smoke more if flavours were not available. D is estimated based on: a) the number of ex-smokers in the UK \u0026times; b) the proportion of ex-smokers who vape \u0026times; c) the proportion of ex-smokers who state they would relapse to smoking if flavours were not available.\u003c/p\u003e\n\u003cp\u003eFor the latest update (November 2024), we entered data from Action on Smoking and Health (ASH) youth and adult annual YouGov surveys [2, 17] (collected between February and April 2024), the monthly Smoking Toolkit Study (STS; collected between June and October 2023) [18], and publicly available figures from the Office of National Statistics [19, 20] and privately owned real-time statistics website Worldometer (estimates taken on 13\u003csup\u003eth\u003c/sup\u003e November 2024) [21]. The ASH youth surveys collect data from respondents aged 11 \u0026ndash; 17 years, and the adult surveys are conducted on adults aged 18+ years. STS surveys are conducted on adults aged 16+ years. The exact figures, sources, survey questions and code used to determine the data input can be found in on GitHub (https://github.com/jkhouj/PolicyDecisionAid). ASH and STS conduct surveys in Great Britain (which includes England, Scotland and Wales, but not Northern Ireland) and England, respectively; however, no relevant data were available for Northern Ireland. We merged data from ASH and STS (weighted to accurately represent sociodemographic characteristics in Great Britain [ASH] and England [STS]) to better estimate proportions in the UK (Great Britain and Northern Ireland). By combining these data, we aimed to gain a more accurate estimate of proportions, given that the two surveys have different biases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo estimate whether the number of non-smoking e-cigarette users introduced into the UK population because of flavoured e-liquid availability could outweigh the number of smokers and ex-smokers who might vape instead of smoke because of flavoured e-liquid availability, the following calculation is made:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eA - (C + D)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo estimate whether the number of smokers introduced into the UK population because of flavoured e-liquid availability could outweigh the number of smokers and ex-smokers who might vape instead of smoke because of flavoured e-liquid availability, the following calculation is made:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eB - (C + D)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePositive values would provide some support for a total ban on flavoured e-liquids, and negative values would provide some evidence that the detrimental consequences of a total ban would outweigh the potential benefits.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eUsing the available evidence on 13\u003csup\u003eth\u003c/sup\u003e November 2024, we estimated that 125,034 non-smoking youth experiment with e-cigarettes as a result of flavoured e-liquid availability and 841,302 smokers and ex-smokers do not smoke due to flavoured e-liquid availability (Figure 1). We also estimated that 48,764 non-smoking youth subsequently smoke as a result of flavoured e-liquid availability (Figure 1). This output suggests that restricting flavoured e-liquids in the UK could have a detrimental overall impact on public health when considering both youth vaping and smoking uptake due to flavoured vape availability. The full report (Supplementary Figure 1) was shared with the Office of Health Improvements and Disparities.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHere, we have illustrated the potential of a policy decision aid to assist policymakers in deciding whether to ban flavours in vapes. The most recent report in November 2024 (and all prior reports) indicates that banning flavours in e-cigarettes would detrimentally impact smoking cessation and abstinence rates in the UK more than it would prevent youth uptake of vaping and smoking.\u003c/p\u003e\u003cp\u003eThe findings of this and earlier outputs of this decision aid (with the same broad conclusions) have been discussed in the UK Parliament, cited in responses to calls for evidence [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and cited in the UK government Tobacco and Vapes Bill Impact Assessment conducted by the Department of Health and Social Care (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://publications.parliament.uk/pa/bills/cbill/59-01/0121/impactassessment.pdf\u003c/span\u003e\u003cspan address=\"https://publications.parliament.uk/pa/bills/cbill/59-01/0121/impactassessment.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The impact assessment concluded (in line with the evidence we provided) that 87% of adults who vape could be impacted. The assessment also highlighted that the outputs echo the findings of Friedman and colleagues [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] whereby reductions in the sale of vapes following flavour restrictions coincided with increases in tobacco sales. Our previous work using this model to estimate the impact on the general United States population also indicated that there would be an increase in smoking rates [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe findings are also in line with our prior qualitative research, where participants described their intentions to smoke more in the hypothetical scenario where flavours are banned in the UK [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, a review of anticipated and actual responses to banning flavours in e-cigarettes has shown mixed findings regarding the effectiveness and unintended consequences of a ban [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Although some of the evidence in the review contradicts the output from the policy decision aid, the review conclusions relied on evidence from the United States which may not apply to the UK given the different social and regulatory environments (e.g., flavoured tobacco products were banned at the same time as flavoured e-cigarettes whereas flavoured cigarettes, including menthol, have been banned since 2020 in the UK).\u003c/p\u003e\u003cp\u003eThe use of the decision aid output in government discussions, reports, and impact assessments demonstrates that it is accessible for policymakers. The output is also relatively quick to produce when new data becomes available, meaning we have been able to supply policymakers with eight updates in three years. However, data availability has been scarce and thus far required additional funding for data collection, as national surveys do not routinely include questions about flavours and e-cigarette flavour restrictions. The output is also intended to guide policy decisions in the context of other available evidence, and is not to be used as the sole determining factor when making policy decisions due to the simplicity of the model and potential bias due to sampling biases in the data collected. If no relevant evidence is available, the decision aid output could be used to guide governmental support for future research by highlighting areas for research. For example, if the tool showed a beneficial impact when including menthol and tobacco flavours versus excluding them from the ban, the government could support further research in this area to improve the evidence base for this policy decision. The simplistic model is necessary to provide the timely estimates that policymakers require [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], but consequently, the output cannot account for many nuances in behaviour. For example, the decision aid does not consider the impact of the role of e-cigarettes in displacing cigarette smoking among young people or of second-hand smoke exposure. Additionally, the model assumes that e-cigarettes act as a gateway to smoking, as this is a concern for policymakers. However, despite the consistent association between vaping and later smoking among young people and adults, it is unlikely that the gateway hypothesis provides a complete explanation for the association; there is substantial evidence that the relationship is partly explained by a shared liability to use either product, perhaps due to an underlying genetic propensity for risk-taking [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This decision aid provides a worst-case scenario for policymakers given their concerns, but may overestimate the harm to youth.\u003c/p\u003e\u003cp\u003eThe data used is also restricted to respondents from Great Britain, and although we have scaled this to the UK, there may be differential impacts in Northern Ireland that are not accounted for. Furthermore, there is some overlap in the age of our adult and youth groups; ASH collected youth data on 11\u0026ndash;17 year olds and adult data on 18\u0026thinsp;+\u0026thinsp;years, whereas we stratified the STS data for youth on 16\u0026ndash;20 year olds and for adults on 21\u0026thinsp;+\u0026thinsp;given that initiation of e-cigarettes and cigarettes is occurring later in life than in previous generations [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and policymakers were concerned about young adult behaviour. The youth responses were then scaled to the number of 11- to 20-year-olds in the UK, and the adult responses were scaled to the estimated number of current and ex-smokers who are 18 years or over in the UK. Therefore, the estimates could be an overestimation whereby young adults aged 18 to 20 who vaped before they smoked and have transitioned between smoking and vaping multiple times may be included in both the estimation of B and either C or D. Finally, the survey questions that underly the data used in this tool estimate anticipated behaviour in the event of a flavour ban and could therefore underestimate individuals\u0026rsquo; ability to refrain from smoking. However, until a ban is introduced, it will not be possible to observe actual behaviour in the UK's unique social and policy context.\u003c/p\u003e\u003cp\u003eAs highlighted by these limitations, effective and timely policy communication requires researchers to provide less complex, precise, and nuanced results in favour of providing results that can be easily interpreted by policymakers. This framework can be used to explore the potential impact on different subpopulations and the impact of flavour restrictions in other localities. Additionally, the tool can be adapted to answer other policy questions, where there is a trade-off between policies protecting some individuals but potentially harming others. However, such adaptations need to identify the framework limitations in the context of the policy question, as they will likely differ from the limitations identified here.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWhen provided with simple, easy-to-digest information that is relevant to the current policy environment, policymakers can synthesise evidence from public health researchers to guide policy development.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASH \u0026ndash; Action on Smoking and Health\u003c/p\u003e\n\u003cp\u003eSTS \u0026ndash; Smoking Toolkit Study\u003c/p\u003e\n\u003cp\u003eUK \u0026ndash; United Kingdom\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used summary-level data collected by existing surveys, therefore did not require ethics approval for this work. We sought approval from Action on Smoking and Health and the Smoking Toolkit Study to conduct this work and have conducted this work in line with their consent regulations. The University College London Ethics Committee granted ethical approval for the Smoking Toolkit Study, (ID 0498/001). Participants in the surveys provided informed consent before participating.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the conclusions of this article are available in the GitHub repository, https://github.com/jkhouj/PolicyDecisionAid. For access to the original STS data, please use these forms: https://smokinginengland.info/resources/data-request-agreement-form; https://smokinginengland.info/resources/data-request-coi-form. For access to ASH YouGov data, please contact [email protected].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was originally supported by Public Health England via an honorary contract awarded to ASA. There is no grant number for this support as it was commissioned by Public Health England via the honorary academic framework.\u0026nbsp;Further support was received from the University of Bristol via an\u0026nbsp;Economic and Social Research Council Impact Acceleration Award (A100111) awarded to JNK, ASA and MRM and then from the Research England Policy Support Fund (PolicyBristol) awarded to JNK, ASA and MRM (H100026). JNK,\u0026nbsp;MJG and MRM were supported by the Medical Research Council Integrative Epidemiology Unit (MC_UU_00011/7). JNK and ASA were supported by a Cancer Research UK programme grant (the Integrative Cancer Epidemiology Programme C18281/A29019). MD was employed by Public Health England and the Office for Health Improvement and Disparities during the project, but has now retired.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eASA, MD and MRM were responsible for the original project conception. JNK developed the initial algorithm and output, led consultations and redeveloped the algorithm and output based on feedback. JNK acquired further funding to support data collection in existing surveys. MJG, JNK and JF contributed to code development to analyse the survey data. JNK drafted the manuscript and all authors contributed to the editing and finalisation of the submitted manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the participants of the surveys. We would like to thank the people who contributed to our consultations, the team at ResearchIT, including Serena Cooper and Tessa Alexander who created the tool using BitBucket, and Tom Waterhouse of 2DForever for his artistic contribution to the design of the report. We would also like to thank the temporary staff who contributed to this project, Katie De-Loyde, Muhsin Yesilada, and Lukas Sykes.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThe Lancet Respiratory M. The UK Tobacco and Vapes Bill: a historic opportunity.\u003cem\u003e The Lancet Respiratory Medicine\u003c/em\u003e. 2025;13(1):1.\u003c/li\u003e\n\u003cli\u003eAction on Smoking and Health. \u003cem\u003eUse of vapes (e-cigarettes) among young people in Great Britain\u003c/em\u003e. 2024.\u003c/li\u003e\n\u003cli\u003eMcNeill A, Simonavičius, E, Brose, LS, Taylor, E, East, K, Zuikova, E, Calder, R,, Robson D. \u003cem\u003eNicotine vaping in England: an evidence update including health risks and perceptions, September 2022. \u003c/em\u003e. London; 2022.\u003c/li\u003e\n\u003cli\u003eKhouja JN, Suddell SF, Peters SE, Taylor AE, Munafo MR. Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis.\u003cem\u003e Tob Control\u003c/em\u003e. 2020.\u003c/li\u003e\n\u003cli\u003eBegh R, Conde M, Fanshawe TR, Kneale D, Shahab L, Zhu S, et al. Electronic cigarettes and subsequent cigarette smoking in young people: A systematic review.\u003cem\u003e Addiction\u003c/em\u003e. 2025.\u003c/li\u003e\n\u003cli\u003eKhouja JN, Dyer ML, Havill MA, Dockrell MJ, Munaf\u0026ograve; MR, Attwood AS. Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study.\u003cem\u003e Harm Reduct J\u003c/em\u003e. 2024;21(1):90.\u003c/li\u003e\n\u003cli\u003eJackson SE, Brown J, Buss V, Shahab L. Prevalence of Popular Smoking Cessation Aids in England and Associations With Quit Success.\u003cem\u003e JAMA Network Open\u003c/em\u003e. 2025;8(1):e2454962-e.\u003c/li\u003e\n\u003cli\u003eKennedy RD, Awopegba A, De Le\u0026oacute;n E, Cohen JE. Global approaches to regulating electronic cigarettes.\u003cem\u003e Tobacco Control\u003c/em\u003e. 2017;26(4):440-5.\u003c/li\u003e\n\u003cli\u003eLiu J, Hartman L, Tan ASL, Winickoff JP. Youth tobacco use before and after flavoured tobacco sales restrictions in Oakland, California and San Francisco, California.\u003cem\u003e Tobacco Control\u003c/em\u003e. 2023;32(e1):e118-e20.\u003c/li\u003e\n\u003cli\u003eFriedman AS. A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California.\u003cem\u003e JAMA Pediatrics\u003c/em\u003e. 2021;175(8):863-5.\u003c/li\u003e\n\u003cli\u003eWeng X, Song CY, Liu K, Wu YS, Lee JJ, Guo N, et al. Perceptions of and responses of young adults who use e-cigarettes to flavour bans in China: a qualitative study.\u003cem\u003e Tobacco Control\u003c/em\u003e. 2024:tc-2023-058312.\u003c/li\u003e\n\u003cli\u003eRuokolainen O, Ollila H, Karjalainen K. Correlates of e-cigarette use before and after comprehensive regulatory changes and e-liquid flavour ban among general population.\u003cem\u003e Drug and Alcohol Review\u003c/em\u003e. 2022;n/a(n/a).\u003c/li\u003e\n\u003cli\u003eTam J, Jimenez-Mendoza E, Buckell J, Sindelar J, Meza R. Responses to Real-World and Hypothetical E-Cigarette Flavor Bans Among US Young Adults Who Use Flavored E-Cigarettes.\u003cem\u003e Nicotine Tob Res\u003c/em\u003e. 2024;26(8):1113-7.\u003c/li\u003e\n\u003cli\u003eCairney P, Oliver K. Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?\u003cem\u003e Health Research Policy and Systems\u003c/em\u003e. 2017;15(1):35.\u003c/li\u003e\n\u003cli\u003eOliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers.\u003cem\u003e BMC Health Services Research\u003c/em\u003e. 2014;14(1):2.\u003c/li\u003e\n\u003cli\u003eBarreto JOM, de Melo RC, da Silva L, de Ara\u0026uacute;jo BC, de Freitas Oliveira C, Toma TS, et al. Research evidence communication for policy-makers: a rapid scoping review on frameworks, guidance and tools, and barriers and facilitators.\u003cem\u003e Health Res Policy Syst\u003c/em\u003e. 2024;22(1):99.\u003c/li\u003e\n\u003cli\u003eAction on Smoking and Health. \u003cem\u003eUse of vapes (e-cigarettes) among adults in Great Britain\u003c/em\u003e. 2024.\u003c/li\u003e\n\u003cli\u003eFidler JA, Shahab L, West O, Jarvis MJ, McEwen A, Stapleton JA, et al. \u0026apos;The smoking toolkit study\u0026apos;: a national study of smoking and smoking cessation in England.\u003cem\u003e BMC Public Health\u003c/em\u003e. 2011;11(1):479.\u003c/li\u003e\n\u003cli\u003eOffice for National Statistics. Adult smoking habits in the UK: 2023. Census 20212023.\u003c/li\u003e\n\u003cli\u003eOffice for National Statistics. Age by Single Year. 2021.\u003c/li\u003e\n\u003cli\u003eWorldometer. U.K. Population 2024 [updated 12/09/2022. Available from: https://www.worldometers.info/world-population/uk-population/.\u003c/li\u003e\n\u003cli\u003eOffice for Health Improvements and Disparities. \u003cem\u003eYouth vaping call for evidence analysis\u003c/em\u003e. 2023.\u003c/li\u003e\n\u003cli\u003eFriedman A, Liber, A. C., Crippen, A., and Pesko, M,.\u003cem\u003e E-cigarette Flavor Restrictions\u0026rsquo; Effects on Tobacco Product Sales\u003c/em\u003e. 2024.\u003c/li\u003e\n\u003cli\u003eGibson MJ, Munaf\u0026ograve; MR, Attwood AS, Dockrell MJ, Havill MA, Khouja JN. A decision aid for policymakers to estimate the impact of e-cigarette flavour restrictions on population smoking and e-cigarette use prevalence among youth versus smoking prevalence among adults.\u003cem\u003e medRxiv\u003c/em\u003e. 2023:2022.11.14.22282288.\u003c/li\u003e\n\u003cli\u003eCadham CJ, Liber AC, S\u0026aacute;nchez-Romero LM, Issabakhsh M, Warner KE, Meza R, et al. The actual and anticipated effects of restrictions on flavoured electronic nicotine delivery systems: a scoping review.\u003cem\u003e Bmc Public Health\u003c/em\u003e. 2022;22(1):2128.\u003c/li\u003e\n\u003cli\u003eKhouja JN, Wootton RE, Taylor AE, Davey Smith G, Munafo MR. Association of genetic liability to smoking initiation with e-cigarette use in young adults: A cohort study.\u003cem\u003e PLoS Med\u003c/em\u003e. 2021;18(3):e1003555.\u003c/li\u003e\n\u003cli\u003eKim MM, Steffensen I, Miguel RTD, Babic T, Carlone J. A systematic review and meta-analysis of the association between e-cigarette use among non-tobacco users and initiating smoking of combustible cigarettes.\u003cem\u003e Harm Reduction Journal\u003c/em\u003e. 2024;21(1):99.\u003c/li\u003e\n\u003cli\u003eBarrington-Trimis JL, Braymiller JL, Unger JB, McConnell R, Stokes A, Leventhal AM, et al. Trends in the Age of Cigarette Smoking Initiation Among Young Adults in the US From 2002 to 2018.\u003cem\u003e JAMA Network Open\u003c/em\u003e. 2020;3(10):e2019022-e.\u003c/li\u003e\n\u003cli\u003eJayakumar N, O\u0026apos;Connor S, Diemert L, Schwartz R. Predictors of E-Cigarette Initiation: Findings From the Youth and Young Adult Panel Study.\u003cem\u003e Tob Use Insights\u003c/em\u003e. 2020;13:1179173x20977486.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"health-research-policy-and-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrps","sideBox":"Learn more about [Health Research Policy and Systems](http://health-policy-systems.biomedcentral.com/)","snPcode":"12961","submissionUrl":"https://submission.nature.com/new-submission/12961/3","title":"Health Research Policy and Systems","twitterHandle":"@HarpsJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"policy communication, e-cigarettes, vaping, UK legislation, flavours","lastPublishedDoi":"10.21203/rs.3.rs-7233304/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7233304/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe UK Government has introduced a range of measures to tackle the rise in youth vaping, including the power to regulate flavours. Evidence is needed to inform how these measures should be implemented, but communication between health researchers and policymakers can be difficult. Policymakers need a simple, easy-to-digest synthesis of evidence to make policy decisions that benefit the public.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe designed a policy decision aid to support policymakers (commissioned by Public Health England), whereby existing data can be inputted to create a report (the decision aid). The report estimates whether one potential policy action, restricting flavours other than tobacco or menthol flavours in e-cigarettes, would have a net benefit due to reductions in youth vaping and smoking or a net detriment due to the negative impact on smoking cessation and relapse rates.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eUsing the available evidence on 13th November 2024, we estimated that 125,034 non-smoking youth experiment with e-cigarettes as a result of flavoured e-liquid availability, and 841,302 smokers and ex-smokers do not smoke due to flavoured e-liquid availability. We estimated that 48,764 non-smoking youth subsequently smoke as a result of flavoured e-liquid availability. The algorithm indicated that if only unflavoured, tobacco flavoured or menthol flavoured vapes remained on the market, there would be a detrimental impact on smoking rates in adults that would outweigh the number of young people protected from vaping and later smoking.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis output suggests that restricting flavoured e-liquids in the UK could have a detrimental impact on public health when considering both youth vaping and smoking uptake due to flavoured vape availability. To provide timely advice to policymakers, the algorithm used is intentionally simple. The decision aid should be used alongside existing relevant evidence (e.g., from countries with similar regulatory environments) to inform policy decisions and/or used to highlight areas for research that warrant support. The reports have been used in policy documents and discussions, demonstrating an appetite for this type of communication aid. The tool can be used to assess this policy question within subpopulations and in other localities, and the framework can be adopted to address other policy questions.\u003c/p\u003e","manuscriptTitle":"Aiding communication between public health researchers and policymakers through policy decision aids","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-06 15:54:32","doi":"10.21203/rs.3.rs-7233304/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-09T09:06:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T17:43:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107057468323249766421485405676176184407","date":"2026-01-27T22:49:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-03T21:51:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227828592467497872255182249117493607547","date":"2025-10-29T15:20:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-27T14:06:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-30T12:31:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-30T12:31:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Health Research Policy and Systems","date":"2025-07-28T11:14:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"health-research-policy-and-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrps","sideBox":"Learn more about [Health Research Policy and Systems](http://health-policy-systems.biomedcentral.com/)","snPcode":"12961","submissionUrl":"https://submission.nature.com/new-submission/12961/3","title":"Health Research Policy and Systems","twitterHandle":"@HarpsJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"67b90eb2-2899-4eb0-97cc-fe7fff56221f","owner":[],"postedDate":"November 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T14:43:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-06 15:54:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7233304","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7233304","identity":"rs-7233304","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}