E-Cigarettes not a gateway to smoking, helps reduce tobacco usage in population

A recent study conducted by National Institute for Health and Care Research (NIHR) suggests that e-cigarettes are not a gateway to smoking. In another survey, the US Centers for Disease Control and Prevention (CDC) & the US Food and Drug Administration (FDA) revealed that e-cigarette usage among high school students in the US has fallen from 14% in 2022 to 10% in 2023, while the youth smoking rates are at an all-time low of 1.6%. The stagnant smoking rates in the US are not in line with the theory that ENDS are a gateway to cigarettes but are helping flatten the trend.

The NIHR study compared the time course of use & sales of electronic cigarettes, with that of smoking rates and cigarette sales in countries, with similar smoking trajectories, but differing current e-cigarette regulations. The study also found some evidence that these products compete against cigarettes. And so may be speeding up the demise of smoking. Data from the UK & US was compared with Australia, where sales of nicotine containing e-cigarettes are banned. The decline in smokers in Australia has been slower than in the UK, and slower than in both the UK & the US among young people. The fall in cigarette sales has also accelerated faster in the UK than in Australia.

In another survey by the CDC & FDA called National Youth Tobacco Survey (NYTS 2023), it was found that e-cigarette use among U.S. high school students dropped significantly to 10 per cent this year from 14 per cent in 2022- and the cigarette use among youth are at an all-time low. The survey further revealed that about 10% students surveyed reported using a tobacco product during 2022-2023. Overall current tobacco use dropped among high school students, from 16.5% to 12.6%, while about 580,000 fewer high schoolers reported currently using e-cigarettes.

In the past, however the World Health Organization (WHO) has claimed that e-cigarette users who never smoked cigarettes have a higher chance of starting the habit later in life. A Q&A posted on WHO’s website on 25th May 2022 states that, ‘Nicotine is highly addictive and some evidence suggest that never-smoker minors who use Electronic Nicotine Delivery System (ENDS) can double their chance of starting to smoke tobacco cigarettes later in life.’ – which does not reflect in the findings of the NIHR study or the NYTS 2023.

Sharing his perspective, David T Sweanor, Faculty of Law, University of Ottawa, said, ‘These findings are important given the global burden of tobacco related diseases and deaths. Research today supports the argument that e-cigarettes do not promote smoking. It is essential to make policies on accurate & empirical evidence. They must prioritise science-based policies to mitigate risks & have a realistic impact towards tobacco control- as seen across multiple countries such as seen across Sweden, New Zealand & UK.’ India, with over 100 million smokers and the 2nd highest cancer burden in Asia, must identify the gaps in the present tobacco control policy and take inspiration from global economies who have not only controlled the harm from tobacco but reduced their spending on non communicable diseases (NCDs) over the years.

About NIHR: The NIHR was established in 2006 to ”create a health research system in which the NHS supports outstanding individuals, working in world-class facilities, conducting leading-edge research focused on the needs of patients and the public”. Since that time, NIHR has transformed research in and for the NHS and helped to shape the health and social care research landscape more broadly. Working in partnership with the NHS, universities, local government, other research funders, patients and the public, NIHR fund, enable and deliver world-leading health and social care research that improves people’s health and wellbeing and promotes economic growth. Funded by the Department of Health and Social Care, NIHR’s work focuses on early translational research, clinical research and applied health and social care research.