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Research suggests e-cigarettes are not a gateway into smoking

Published: 22 September 2023

NIHR funded research finds that there is no sign that e-cigarettes promote smoking.

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 only tentative and more research is needed to determine the size of this effect.

The study compared the time course of use and sales of electronic cigarettes, with that of smoking rates and cigarette sales in countries, with 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 the use of smoking and nicotine alternatives, that are popular in other countries. This included the use of oral nicotine pouches in Sweden. And products that heat rather than burn tobacco in Japan and South Korea.

The decline in smokers in Australia has been slower than in the UK, and slower than in both the UK and the USA among young people. The decline in cigarette sales has also accelerated faster in the UK than in Australia. The growth in heated tobacco sales in Japan was accompanied by a decrease in cigarette sales.

Researchers note that because people may use both cigarettes and alternative products, 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.

Professor Brian Ferguson, Director of the NIHR Public Health Research Programme, commented: “While the initial findings from this study are valuable, no firm conclusions can be drawn yet, and further research is needed in this area to understand the impact that alternative nicotine delivery products, such as e-cigarettes, might have on smoking rates.”

Indications that alternative nicotine products are replacing smoking need to be confirmed when more data become available. As further prevalence and sales data emerge, the analyses will become more informative.

The study was led by Queen Mary University of London.

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