E-cigarettes are not a gateway into smoking: global study

Faculty of Law
Research and innovation
E-cigarettes are not a gateway into smoking: global study
The most comprehensive study to date investigating whether e-cigarettes are a gateway into or out of smoking finds that, at the population level, there is no sign that vaping and alternative nicotine delivery products promote smoking.

The National Institute of Health Research (UK) 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 data are needed to determine the size of this effect. University of Ottawa Faculty of Law Professor and Advisory Committee Chair at the uOttawa Centre for Health Law, Policy David Sweanor is among the co-authors.

Impact of declining cigarette sales

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 (United Kingdom and United States versus Australia, where sales of nicotine containing e-cigarettes are banned). It also looked at interactions between smoking and use of oral nicotine pouches in Sweden and use of products that heat rather than burn tobacco in Japan and South Korea where they are widely used. The decline in smoking prevalence in Australia has been slower than in the UK, and slower than in both the UK and the USA among young people and in lower socioeconomic groups. The decline in cigarette sales has also accelerated faster in the UK than in Australia. The increase in heated tobacco product sales in Japan was accompanied by a significant decrease in cigarette sales.

Researchers note that because people may use both cigarettes and alternative products, prevalence figures for these products overlap, and so longer time periods are needed for any effects of exclusive use of the new products on smoking prevalence to emerge. They also say that the indications that alternative nicotine products are suppressing smoking and 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.


David Sweanor

“Replacing lethal cigarettes, the cause of over 8 million global deaths annually, would be a monumental public health breakthrough”

David Sweanor

— Faculty of Law Professor, uOttawa

Dispelling myths

“The results of this study alleviate the concern that access to e-cigarettes and other low-risk nicotine products promote smoking,” explains Professor Peter Hajek, Director of Health and Lifestyle Research Unit, Wolfson Institute of Population Health, Queen Mary University of London. “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.”

“A detailed analysis of global data shows no sign of vaping and other low risk alternatives to cigarettes acting as a gateway to smoking, dispelling one of the key arguments used to attack such products. But determining the extent to which these new products are replacing cigarettes requires more data,” adds uOttawa’s Professor David Sweanor, who has worked on international policy issues to reduce cigarette smoking and its devastating impact on health for over 40 years.

“Replacing lethal cigarettes, the cause of over 8 million global deaths annually, would be a monumental public health breakthrough,” concludes Sweanor. “Monitoring and shaping the market should be a high priority.”

The study Effects of reduced-risk nicotine delivery products on smoking prevalence and on cigarette sales: an observational study(Pesola F, Phillips-Waller A, Beard E, Shahab L, Sweanor D, Jarvis M, Hajek P.)  was published in the Public Health Research.