Dataset Information

Impact of vaping introduction on cigarette smoking in six jurisdictions with varied regulatory approaches to vaping: an interrupted time series analysis.

ABSTRACT:

Objective

We sought to quantify the impact of vaping introduction on cigarette smoking across settings with varied regulatory approaches to vaping.

Design

Interrupted time series analysis, adjusted for cigarette tax levels.

Setting

Four Canadian provinces, UK and Australia.

Participants

Entire population of smokers in each country.

Interventions

The year that vaping was widely introduced in each country.

Primary and secondary outcome measures

The primary outcome is cigarette consumption per adult, and the secondary outcome is smoking prevalence among young adults.

Results

Based on allowable nicotine levels, restrictions on e-cigarette advertising, sales and access, and taxation, the least to most restrictive jurisdictions were, in order, Alberta, Ontario, Quebec and British Columbia (all in Canada), UK and Australia. In most, but not all, settings where higher nicotine content was permitted in vaping products (66 mg/mL), vaping introduction led to a reduction in cigarette consumption per capita (Ontario: p=0.037, Quebec: p=0.007) or in smoking prevalence among young adults (Alberta men, p=0.027; Quebec men, p=0.008; Quebec women, p=0.008). In the UK, where the maximum permitted nicotine content in vaping products was 20 mg/mL, vaping introduction slowed the declining trend in cigarette smoking among men aged 16-24 years (p=0.031) and 25-34 years (p=0.002) but not in cigarette consumption per adult. In Australia, where nicotine was not permitted in e-cigarettes, e-cigarette introduction slowed the declining trend in cigarette consumption per capita and in smoking prevalence among men aged 18-24 years (cigarette consumption: p=0.015, prevalence: p=0.044).

Conclusion

In environments that enable substitution of cigarettes with e-cigarettes, e-cigarette introduction reduces overall cigarette consumption. Thus, to reduce cigarette smoking, policies that encourage adults to substitute cigarette smoking with vaping should be considered.

SUBMITTER: Wu DC

PROVIDER: S-EPMC9062808 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

Impact of vaping introduction on cigarette smoking in six jurisdictions with varied regulatory approaches to vaping: an interrupted time series analysis.

Wu Daphne C DC Essue Beverley M BM Jha Prabhat P

BMJ open 20220502 5

<h4>Objective</h4>We sought to quantify the impact of vaping introduction on cigarette smoking across settings with varied regulatory approaches to vaping.<h4>Design</h4>Interrupted time series analysis, adjusted for cigarette tax levels.<h4>Setting</h4>Four Canadian provinces, UK and Australia.<h4>Participants</h4>Entire population of smokers in each country.<h4>Interventions</h4>The year that vaping was widely introduced in each country.<h4>Primary and secondary outcome measures</h4>The primar ...[more]

PMID: 35501081

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Project description:Background: Compared to cigarette smoking, e-cigarette use is likely to present a reduced risk of smoking-related disease (SRD). However, several studies have shown that vaping predicts smoking initiation and might provide a gateway into smoking for those who otherwise would never have smoked. This paper considers various aspects of the gateway issue in youths. Methods: Here, we reviewed studies (N=15) of the gateway effect examining how extensively they accounted for confounders associated with smoking initiation in youths. We estimated how omitting a confounder, or misclassifying it, might bias the association between vaping and smoking initiation. We assessed how smoking prevalence might be affected by any true gateway effect, and examined trends in youth smoking and e-cigarette use from national surveys. Results: The list of smoking predictors adjusted for in studies reporting a significant gateway effect is not comprehensive, rarely considering internalising/externalising disorders, outcome expectancies, school performance, anxiety, parental smoking and peer attitudes. Furthermore, no study adjusted for residual confounding from inaccurately measured predictors. Better adjustment may substantially reduce the estimated gateway effect. Calculations showed that as any true gateway effects increase, there are much smaller increases in smoking prevalence, and that gateway effects increase only if initiating vaping is more frequent than initiating smoking. These effects on prevalence also depend on the relative odds of quitting vs. initiation. Data from five surveys in US/UK youths all show that, regardless of sex and age, smoking prevalence in 2014-2016 declined faster than predicted by the preceding trend, suggesting the absence of a substantial gateway effect. We also present arguments suggesting that even with some true gateway effect, introducing e-cigarettes likely reduces SRD risk. Conclusions: A true gateway effect in youths has not yet been demonstrated. Even if it were, e-cigarette introduction may well have had a beneficial population health impact.

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Dataset Information

Impact of vaping introduction on cigarette smoking in six jurisdictions with varied regulatory approaches to vaping: an interrupted time series analysis.

Objective

Design

Setting

Participants

Interventions

Primary and secondary outcome measures

Results

Conclusion

Publications

Impact of vaping introduction on cigarette smoking in six jurisdictions with varied regulatory approaches to vaping: an interrupted time series analysis.

Similar Datasets

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