There is no evidence that the use of e-cigarettes and other alternative nicotine delivery products serves as a gateway into smoking, according to an international study.
The study led by researchers from Queen Mary University of London and published in the journal Public Health Research and funded by the National Institute for Health and Care Research (NIHR) in fact found some evidence that smoke-free products such as vapes and heated tobacco compete against cigarettes and so may be speeding up the demise of smoking.
“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,” said Prof. Peter Hajek, Director of Health and Lifestyle Research Unit at Wolfson Institute of Population Health in Queen Mary University of London.
Consumer groups and tobacco harm reduction (THR) advocates in the Philippines welcomed the results of the study. Joey Dulay, president of the Philippine E-Cigarette Industry Association, said the study only shows that vapers are not eventually becoming smokers.
“Among our peers, I have not seen any vaper turn into smoker. It is either they continue to use e-cigarettes or quit altogether. In fact, I know a lot of former smokers who are now using e-cigarettes, which are far less harmful than combustible tobacco. It is not the other way around,” said Dulay.
Dr. Lorenzo Mata of advocacy group Quit for Good said this is why it is important to raise the awareness of consumers on the big difference in risk profiles between vapes and traditional cigarettes.
“If organizations like the World Health Organization would insist that smoke-free products and combustible cigarettes have the same risks, then smokers would be discouraged to switch to vapes and heated tobacco products. Fortunately, many Filipino vapers, based on their years of experience, are now aware that what they are using are 95-percent less harmful than cigarettes, as proven by scientific studies in the UK and other progressive countries around the world,” Dr. Mata said.
Dr. Mata said the results of the study should also provide valuable input to country representatives participating in the WHO Framework Convention on Tobacco Control’s 10th Conference of Parties happening in Panama City on November 20 to 25, 2023.
“The WHO’s main argument against e-cigarettes is that these products serve as a gateway into smoking. But the findings of this study reject this, and so countries should take a second look at the dogmatic and unscientific claim of the WHO before approving new prohibitionist proposals that would deprive smokers of better alternatives,” the doctor said.
Tobacco harm reduction advocacy groups in the Philippines said the WHO FCTC’s prohibitionist proposals in COP10 would go against the stance of countries such as the United States, United Kingdom, New Zealand, Canada, Japan, South Korea and Sweden which now accept tobacco harm reduction strategies.
The study 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. It compared the United Kingdom and United States with Australia, where sales of nicotine-containing e-cigarettes are banned.
It also looked at interactions between smoking and nicotine alternatives that are popular in other countries including the use of oral nicotine pouches in Sweden and products that heat rather than burn tobacco in Japan and South Korea where they are widely used.
The study found that the decline in smokers in Australia has been slower than in the UK. The decline 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.
Researchers, however, noted that 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 said indications that alternative nicotine products are replacing smoking – 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, according to the researchers.
“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,” said Prof. Lion Shahab, co-author of the study and co-Director of the UCL Tobacco and Alcohol Research Group.
Prof. Brian Ferguson, Director of the Public Health Research Programme (NIHR), said, “more research is needed in this area to understand further the impact that alternative nicotine delivery products, such as e-cigarettes, might have on smoking rates.”
