The increasing use of e-cigarettes, or other new nicotine products, has not led to more people taking up smoking. This is according to the largest study to date, which examined the link between smoking and smoking in several countries with very different legislation.
"There are also indications that e-cigarettes directly inhibit the sale of cigarettes, but we need more long-term data to confirm this link," researchers from Queen Mary University in the UK said in a press release.
Researchers at Queen Mary University wanted to find out whether the so-called 'gateway' theory - that the use of a nicotine product is likely to lead to increased use of cigarettes - is true. To do this, they compared developments in different countries with very different legislation on alternative nicotine products.
"We can clearly see that the countries that have more liberal legislation around products such as e-cigarettes and snus have not had more smokers as a result." Lion Shahab, a professor of behavioural science specialising in nicotine and addiction, told Medical Express.
Compared different countries
The study focused on countries that have historically followed each other in terms of smoking rates, but have applied very different regulatory frameworks to manage the sale of e-cigarettes and other alternative nicotine products.
The United Kingdom and the United States, where legislation has been more relaxed, were compared to Australia, where e-cigarettes have long been banned from purchase without a doctor's prescription. From a historical perspective, these three countries have had a similar downward trend in smoking. Here, the study found that smoking in the UK and the US has declined much faster since e-cigarettes entered the market, while in Australia the decline has been much slower.
"This decrease is also true among young people and in socioeconomically disadvantaged groups, with fewer people smoking in the US and UK than in Australia," the researchers write.
Snus and heat-not-burn
In Japan, it is forbidden to sell e-cigarettes with nicotine. However, tobacco giants such as Philip Morris and Japan Tobacco International have launched similar schemes such as heating tobacco instead of e-liquid. The heat-not-burn technology is similar to e-cigarettes and, according to both UK and US health authorities, is likely to have a lower harm profile than traditional cigarette smoking. Again, the researchers found some correlation between the increasing sales of heat-not-burn products, at the expense of cigarette sales.
Sweden is also mentioned in the report, as the sale of nicotine pouches and snus has been extensive while the smoking rate has fallen sharply. "Today, the proportion of smokers in Sweden is close to five per cent, the lowest in Europe, and continues to decline despite more young people using snus, e-cigarettes and nicotine pouches," the researchers say.
E-cigs do not lead to more smokers
The researchers believe that the results of the study are convincing enough to reject the 'gateway' hypothesis. Previous studies, particularly among young people, have indicated that increased use of e-cigarettes, but also other nicotine products, among young people may lead to more people becoming smokers later in life. But this does not seem to be the case.
"The results of the study rather suggest that e-cigarettes, and other alternatives, have started to replace the more harmful cigarettes among those who buy nicotine products. At least for now. But this is a market that fluctuates rapidly as new technologies emerge. Therefore, it is important to follow up with more studies, spread over a longer period of time." says Lion Shahab to Medical Express.