The most comprehensive study to date investigating whether e-cigarettes are a gateway into or out of smoking finds that, at the population level, there is no sign that e-cigarettes and other alternative nicotine delivery products promote smoking.
Funded by the NIHR, the study also found some evidence that these products compete against cigarettes, and so may be speeding up the demise of smoking, but this finding is tentative and more data are needed to determine the size of the effect.
The research compared the time course 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 (United Kingdom and United States versus Australia, where sales of nicotine containing e-cigarettes are banned). It also looked at interactions between smoking and use of oral nicotine pouches in Sweden and use of products that heat rather than burn tobacco in Japan and South Korea where they are widely used. The decline in smoking prevalence in Australia has been slower than in the UK, and slower than in both the UK and the USA among young people and in lower socioeconomic groups. The decline in cigarette sales has also accelerated faster in the UK than in Australia. The increase in heated tobacco product sales in Japan was accompanied by a significant decrease in cigarette sales.
Researchers note that because people may use both cigarettes and alternative products, prevalence figures for these products overlap, and so longer time periods are needed for any effects of exclusive use of the new products on smoking prevalence to emerge. They also say that the indications that alternative nicotine products are replacing smoking and especially the size of this effect need to be confirmed when more data become available. As further prevalence and sales data emerge, the analyses will become more informative.
Author Professor Peter Hajek, Director of Health and Lifestyle Research Unit at the Wolfson Institute of Population Health 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.'
Pesola F, Phillips-Waller A, Beard E, Shahab L, Sweanor D, Jarvis M, Hajek P. Effects of reduced-risk nicotine-delivery products on smoking prevalence and cigarette sales: an observational study. Public Health Res 2023;11(7). https://doi.org/10.3310/RPDN7327