The most comprehensive analysis to date shows no evidence that e-cigarettes and other vaping products act as a gateway to tobacco cigarette smoking at the population level.
The large-scale study, led by Queen Mary University of London with funding from the National Institute of Health and Care Research (NIHR), compared smoking rates and sales data from the United Kingdom, United States, Australia, Sweden, Japan and South Korea.
Researchers examined whether access to e-cigarettes and alternative nicotine products promoted smoking uptake over time across different regulatory environments.
Australia's Strict E-Cig Regulations Linked to Slower Smoking Declines
In Australia, where nicotine e-cigarettes remain strictly banned from legal sale, the decline in smokers has progressed more slowly than the U.K. over the past decade. This slower rate of smoking reduction also occurred among Australian youth and lower income groups.
During the same 2012-2021 period, cigarette sales fell markedly faster in the U.K. compared to Australia as well.
"The results of this study alleviate the concern that access to e-cigarettes and other low-risk nicotine products promote smoking," said Professor Peter Hajek of Queen Mary University, study lead author. "There is no sign of that, and there are some signs that they in fact compete against cigarettes."
Heated Tobacco Use in Japan Aligned with Drop in Smoking Rates
Researchers also analyzed smoking and vaping trends in Asian countries. In Japan, significant growth in heated tobacco product adoption since 2016 occurred alongside a major decrease in cigarette sales over the same period.
Early evidence suggests vaping products may compete with and displace cigarette use rather than serve as a gateway to smoking. However, longer-term monitoring is required to confirm exclusive use patterns and impacts on future smoking rates.
More Data Needed to Quantify Smoking Substitution Effects
Because individuals may use both traditional cigarettes and alternative nicotine delivery methods concurrently, prevalence statistics for these products have overlapping user groups.
Determining the size of any nicotine product substitution effects on reducing smoking exclusively requires more years of observational data as consumer behaviors and industry offerings continue evolving rapidly.
"As further prevalence and sales data emerge, the analyses will become more informative," noted Professor Lion Shahab, study co-author from University College London.
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