Weak Tobacco Control Policy
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.
Dr. Leonie Brose, MSc, Dipl.-Psych., PhD
Institute of Psychiatry,
Psychology & Neuroscience (IoPPN)
King‘s College London
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Morgenstern M, Nies A, Goecke M, Hanewinkel R: E-cigarettes and the use of conventional cigarettes—a cohort study in 10th grade students in Germany. Dtsch Arztebl Int 2018; 115: 243–8 VOLLTEXT|
|2.||McNeill A, Brose LS, Calder R, Bauld L, Robson, DJ: Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England 2018.|
|3.||East K, Hitchman SC, Bakolis I, et al.: The association between smoking and electronic cigarette use in a cohort of young people. J Adolesc Health 2018; 62: 539–47 CrossRef MEDLINE PubMed Central|
|4.||Joosens L, Raw M: The tobacco control scale 2016 in Europe. Brussels: Association of European Cancer Leagues 2017 MEDLINE|