I have been conducting research into smoking cessation and e-cigarettes for years, and I welcome a contribution from Germany (1). For the UK, comprehensive data are available on tobacco smoking as well as on the use of e-cigarettes (which do not contain tobacco), as we recently summarized (2). The data show that adult and adolescent users of e-cigarettes are almost exclusively smokers or former smokers. Data from 60 000 adolescents from representative surveys have shown that this group tries e-cigarettes, but that only very few never-smokers (0.1–0.5%) go over to regular e-cigarette consumption.
Furthermore, people change from smoking to the far less harmful e-cigarettes, and this also applies to adolescents (2, 3). In the past two years, 14 sometimes contradictory review articles on “e-cigarettes for smoking cessation” have been published in the international literature (2). In England, the data are clearer, and reliable estimates have shown that e-cigarettes have resulted in 22 000 to 57 000 additional quitters annually (2).
The main indicator for a “gateway effect” is the trend in smoking prevalence. The drop in prevalence has continued since e-cigarettes became popular, and now only about 16% of those aged 16 or over in the UK smoke (in Germany, this proportion is about 28%). This relative success is in large parts due to strong tobacco control policies. These include:
High and rising prices for tobacco products
A ban on tobacco advertising
Comprehensive smoke-free legislation
Health warnings on tobacco packaging (and standardized packaging)
Campaigns and treatment services for smokers.
When European countries are ranked according to their tobacco control policies, Germany and Austria occupy the bottom two places (4). Insufficient tobacco control policies constitute a higher risk for a sustained high prevalence of smoking than potential gateway effects.
References
Footnotes
Conflict of interest statement
The author declares that no conflict of interest exists.
References
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