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

Wu, Daphne; Essue, Beverley M; Jha, Prabhat

doi:10.1136/bmjopen-2021-058324

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…Regarding the between-countries comparison, an interrupted time series analysis that examined data from four Canadian provinces, the UK and Australia reported that in jurisdictions with permissive policies, the introduction of vaping has generally accelerated the decline in smoking. 47 Our tentative findings that the more liberal approach to ECs in the UK and USA may have led to a faster decline in smoking in both countries compared to banning nicotine-containing ECs in Australia tally with this.…”

Section: Discussionmentioning

confidence: 68%

Effects of reduced-risk nicotine-delivery products on smoking prevalence and cigarette sales: an observational study

Pesola,

Phillips-Waller,

Beard

et al. 2023

Public Health Res

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Background It is not currently clear what impact alternative nicotine-delivery products (electronic cigarettes, heated tobacco products and snus) have on smoking rates and cigarette sales. Objective To assess whether access to these products promotes smoking in the population. Design and data sources We examined associations of alternative nicotine product use and sales with smoking rates and cigarette sales overall, and in different age and socioeconomic groups, and compared smoking prevalence over time in countries with contrasting regulations of these products. For electronic cigarettes, we examined data from countries with historically similar smoking trajectories but differing current electronic cigarette regulations (United Kingdom and United States of America vs. Australia, where sales of nicotine-containing electronic cigarettes are banned); for heated tobacco, we used data from countries with state tobacco monopolies, where cigarette and heated tobacco sales data are available (Japan, South Korea), and for snus we used data from Sweden. Analysis methods We pre-specified dynamic time series analyses to explore associations between use and sales of alternative nicotine-delivery products and smoking prevalence and cigarette sales, and time series analyses to compare trends of smoking prevalence in countries with different nicotine product policies. Results Because of data and analysis limitations (see below), results are only tentative and need to be interpreted with caution. Only a few findings reached statistical significance and for most results the Bayes factor indicated inconclusive evidence. We did not find an association between rates of smoking and rates of the use of alternative nicotine products. The increase in heated tobacco product sales in Japan was accompanied by a decrease in cigarette sales. The decline in smoking prevalence seems to have been slower in Australia than in the United Kingdom overall, and slower than in both the United Kingdom and the United States of America among young people and also in lower socioeconomic groups. The decline in cigarette sales has also accelerated faster in the United Kingdom than in Australia. Limitations Most of the available data had insufficient data points for robust time series analyses. The assumption of our statistical approach that causal interactions are more likely to be detected when longer-term changes are screened out may not apply for short time series and in product interaction scenarios, where short-term fluctuations can be caused by, for example, fluctuations in prosperity or product supplies. In addition, due to dual use, prevalence figures for smoking and alternative product use overlap. The ecological study design limits the causal inferences that can be made. Longer time periods are needed for any effects of exclusive use of the new products on smoking prevalence to emerge. Conclusions We detected some indications that alternative nicotine products are competing with cigarettes rather than promoting smoking and that regulations that allow their sales are associated with a reduction rather than an increase of smoking, but the findings are inconclusive because of insufficient data points and issues with the assumptions of the pre-specified statistical analyses. Future work As further prevalence and sales data emerge the analyses will become more informative. Accessing sales figures in particular is the current research priority. Study registration The project is registered on Open Science Framework https://osf.io/bd3ah. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR129968) and will be published in full in Public Health Research; Vol. 11, No. 7. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 68%

Effects of reduced-risk nicotine-delivery products on smoking prevalence and cigarette sales: an observational study

Pesola,

Phillips-Waller,

Beard

et al. 2023

Public Health Res

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“…Stoklosa et al [ 36 , 41 ] evaluated the impact of entry of another combustible cigarette alternative, IQOS, at the province-level in Japan, by utilizing exogenous variation in product rollout they found that the introduction of IQOS likely reduced cigarette sales in Japan. Similar findings on IQOS entry were reported in trend analyses in Japan by Cummings, Nahhas and Sweanor [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…Wu et al examined smoking prevalence and per capita cigarette sales in three countries with various regulatory regimes. They found in Canada, where vaping products were largely unregulated preceding the Tobacco and Vaping Products Act (TVPA), there were some off-trend changes in several provinces [ 36 ]. Our research adds to these findings, indicating the broadening of the ENDS marketplace following the TVPA also lead to significant changes in cigarette sales in Canada.…”

Section: Discussionmentioning

confidence: 99%

“…East et al [ 35 ] compared two nationally representative, but methodologically different surveys fielded before and after vaping products were legislatively acknowledged and authorized federally in 2018 and found apparent decreases in combustible cigarette smoking with apparent increases in ENDS use. Another recent study found some suggestive evidence, though not consistent across regions, that cigarette smoking declined faster after ENDS introduction in Canada using the Canadian Tobacco Alcohol and Drugs Survey and cigarette sales data from Health Canada [ 36 ].…”

Section: Introductionmentioning

confidence: 99%

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The impact of JUUL market entry on cigarette sales: evidence from a major chain retailer in Canada

Xu¹,

Sen

Chen³

et al. 2023

Harm Reduct J

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Background Electronic nicotine delivery systems (ENDS), such as the JUUL system, are nicotine products for adults who currently smoke cigarettes but are looking for an alternative to combustible cigarettes. Sales of ENDS products were legislatively acknowledged and authorized federally in Canada with the Royal Assent of the Tobacco and Vaping Products Act in 2018. Methods With the unique dataset from a major chain retailer in Canada, we evaluated the impacts of JUUL market entry on cigarette sales across Canada from January 2017 to August 2019 using two-way fixed effects panel regression models by leveraging on the entry time variation at the city level. We conducted various robustness checks and a permutation test to validate our results. Results Our estimates suggested that JUUL market entry was, on average, significantly correlated with a 1.65% per-month decrease in cigarette sales during the initial months, and with a potentially larger impact on urban areas. Our results were robust across various specifications and tests. These findings implied that JUUL and combustible cigarettes act as economic substitutes during the study time period in Canada. Conclusions These results suggested that local availability of ENDS products, such as JUUL, has the potential to reduce local cigarette consumption.

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“…Regulations to encourage substitution by adults from cigarettes to reduced harm nicotine products are less prevalent. Wu et al (2022) study the impact of ENDS introduction on cigarette consumption in six regions and find that Similar common regulations for cigarettes are generally applicable to ENDS and, although there is limited evidence, advertisement restrictions seem to be effective (Hansen et al, 2018;Mantey et al, 2018;Padon et al, 2018).…”

Section: Smoking and Nicotinementioning

confidence: 99%

Innovation, Regulation, and Excise Taxation

van Oordt

2023

World Customs Journal

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Innovation and regulation may reduce the harm arising from the production and consumption of excisable goods, which may warrant lower excise rates. However, countries often rely on excise revenues and may face conflicting interests in supporting innovation through differential excise rates and regulation on reduced harm goods and collecting sufficient tax revenues. This paper summarises recent innovations and regulations of excisable goods, discusses their potential implications for the design of excise regimes, and calls for further debate on excise taxes in the face of recent innovations and regulations.

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

Cited by 6 publications

References 20 publications

Effects of reduced-risk nicotine-delivery products on smoking prevalence and cigarette sales: an observational study

Effects of reduced-risk nicotine-delivery products on smoking prevalence and cigarette sales: an observational study

The impact of JUUL market entry on cigarette sales: evidence from a major chain retailer in Canada

Innovation, Regulation, and Excise Taxation

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