E-cigarettes are not a gateway into smoking
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 e-cigarettes and other alternative nicotine delivery products promote smoking.
The study, led by Queen Mary University of London and funded by the National Institute of Health and Care Research (NIHR), 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.
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. It compared the United Kingdom and United States with Australia, where sales of nicotine containing e-cigarettes are banned. It also looked at interactions between smoking and nicotine alternatives that are popular in other countries, including the use of oral nicotine pouches in Sweden and products that heat rather than burn tobacco in Japan and South Korea where they are widely used.
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 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 to determine any effects of exclusive use of the new products on smoking prevalence. They also say that the indications that alternative nicotine products are replacing smoking – 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.
Professor Peter Hajek, Director of Health and Lifestyle Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, said:
"The results of this study alleviate the concern that access to e-cigarettes and other low-risk nicotine products promote smoking. 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."
Co-author, Professor Lion Shahab, Co-Director of the UCL Tobacco and Alcohol Research Group, said:
"This comprehensive analysis provides reassurance that countries which have adopted a more progressive stance towards e-cigarettes have not seen a detrimental impact on smoking rates. If anything, the results suggest that - more likely than not - e-cigarettes have displaced harmful cigarettes in those countries so far. However, as this is fast moving field, with new technologies entering the market every year, it remains important to continue monitoring national data."
Professor Brian Ferguson, Director of the Public Health Research Programme (NIHR) commented:
"The initial findings from this study are valuable but no firm conclusions can be drawn yet. More research is needed in this area to understand further the impact that alternative nicotine delivery products, such as e-cigarettes, might have on smoking rates.”
This research, published in the journal Public Health Research, was funded by the National Institute for Health and Care Research.
END
NOTES FOR EDITORS
- Pesola F, Phillips-Waller A, Beard E, Shahab L, Sweanor D, Jarvis M, Hajek P. Effects of reduced-risk nicotine-delivery products on smoking prevalence and cigarette sales: the GIRO observational study. Public Health Res 2023;11(XX). https://doi.org/10.3310/RPDN7327
- For more information on this release, to receive a copy of the paper or to speak with the researcher, please contact Laurence Leong in Queen Mary’s press office: l.leong@qmul.ac.uk
About Queen Mary University of London
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At uOttawa we are driven by the urge to challenge the status quo, the will to make an impact, and the ambition to become a catalyst for change.
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JOURNAL
Public Health Research
Researchers discover potential treatment for nicotine dependence
Theta-burst transcranial magnetic stimulation therapy may reduce cigarette cravings
Peer-Reviewed PublicationNew research from the University of Missouri School of Medicine suggests there may be another way to treat cigarette cravings. Researchers found that theta-burst transcranial magnetic stimulation (TBS) – strong, rapidly fluctuating magnetic field pulses that can affect brain activity – can lead to improved self-control, reduced cravings and as a result, less smoking.
People with nicotine dependence tend to have significant structural and functional differences in the brain, compared to healthy non-smokers. Smoking cigarettes has been shown to be associated with less grey matter, which means they have less neurons and other cells in the brain.
Research suggests these differences may affect inhibitory control (IC), which is our control over automatic urges and response to stimuli – what enables humans to stop an impulsive reaction to something.
“Having difficulties with IC may make it harder to avoid smoking when the urge arises, in response to all the cues and contexts in the environment that trigger the behavior to light a cigarette,” said lead author Brett Froeliger, PhD, professor of Psychiatry.
TBS refers to when magnetic pulses are applied to the brain in bursts of three and come in two forms: continuous TBS (cTBS) and intermittent TBS (iTBS). cTBS consists of applying these three bursts repeatedly for 40 seconds, whereas iTBS applies the same number of pulses irregularly for more than 190 seconds.
Magnetic stimulation has been used to treat other mental illnesses and disorders. cTBS has been experimentally tested to treat generalized anxiety disorder, whereas iTBS to the left dorsolateral prefrontal cortex – a part of your brain responsible for cognitive processes – is FDA-approved for treating major depressive disorder.
The study involved 37 participants, mostly in their late 40’s, and examined the effects of both cTBS and iTBS to the right inferior frontal gyrus, a brain region heavily involved with IC. Researchers found that cTBS improved IC, whereas both cTBS and iTBS reduced cravings and, subsequently, smoking.
“Identifying treatments that improve IC may help reduce smoking and can potentially help with preventing relapse following when a person attempts to quit smoking,” Froeliger said. “Treatments that improve IC may also help disrupt the cycle of drug use among individuals with other substance use disorders; however, further research is needed to examine the clinical value of TBS for treating substance use disorders.”
“Effects of Hyperdirect Pathway Theta-Burst Transcranial Magnetic Stimulation on Inhibitory Control, Craving, and Smoking in Adults with Nicotine Dependence: A Double-Blind Randomized Crossover Trial” was recently published in Biological Psychiatry CNNI.
In addition to Froeliger, study authors include Muaid Ithman, MD, associate professor of clinical psychiatry; MU PhD student Spencer Upton; TBS technician and data analyst Alexander Brown and other researchers from the University of South Carolina and Stanford University. The authors claim no conflicts of interest.
JOURNAL
Biological Psychiatry
METHOD OF RESEARCH
Randomized controlled/clinical trial
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Effects of Hyperdirect Pathway Theta-Burst Transcranial Magnetic Stimulation on Inhibitory Control, Craving, and Smoking in Adults with Nicotine Dependence: A Double-Blind Randomized Crossover Trial
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