E-cigarettes could be speeding up demise of smoking

E-cigarettes are not a “gateway to smoking”, according to a new major study.

In what is the most comprehensive research to date, investigating if e-cigarettes are a gateway into or out of smoking, the researchers from Queen Mary University of London, UK, said at the population level, there is no indication e-cigarettes and other alternative nicotine delivery products promote smoking.

The study, published in Public Health Research yesterday, found some evidence the products compete against cigarettes and the authors suggest they could be speeding up the demise of smoking, although they say this finding is only tentative and more data are needed to determine the size of this effect.

The researchers compared the length of use and sales of electronic cigarettes with that of smoking rates and cigarette sales in countries with historically similar smoking trajectories but differing current e-cigarette regulations.

They compared the UK and the USA with Australia, where sales of nicotine containing e-cigarettes are banned. The team also examined interactions between smoking and nicotine alternatives that are popular in other countries, such as oral nicotine pouches in Sweden and products that heat rather than burn tobacco in Japan and South Korea.

The decline in smokers has been slower in Australia than in the UK, and slower than in both the UK and the USA among young people and in lower socioeconomic groups. The slump in cigarette sales has also accelerated faster in the UK than in Australia, while the increase in heated tobacco product sales in Japan was accompanied by a significant decrease in cigarette sales.

The researchers say because people may use both cigarettes and alternative products, prevalence figures for these products overlap, and so longer time periods are needed to determine any effects of exclusive use of the new products on smoking prevalence.

They add the indications that alternative nicotine products are replacing smoking need to be confirmed when more data become available.

Professor Peter Hajek, director of the Health and Lifestyle Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, said: “The results of this study alleviate the concern that access to e-cigarettes and other low-risk nicotine products promote smoking. There is no sign of that, and there are some signs that they in fact compete against cigarettes, but more data over a longer time period are needed to determine the size of this effect.”

Co-author, Professor Lion Shahab, co-director of the UCL Tobacco and Alcohol Research Group, said: “This comprehensive analysis provides reassurance that countries which have adopted a more progressive stance towards e-cigarettes have not seen a detrimental impact on smoking rates.

“If anything, the results suggest that – more likely than not – e-cigarettes have displaced harmful cigarettes in those countries so far. However, as this is fast moving field, with new technologies entering the market every year, it remains important to continue monitoring national data.”

This research was funded by the National Institute for Health and Care Research.

Pesola F, Phillips-Waller A, Beard E et al. Effects of reduced-risk nicotine-delivery products on smoking prevalence and cigarette sales: the GIRO observational study. Public Health Res September 2023.


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