thesis introduction about smoking

Essay on Smoking

500 words essay on  smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

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235 Smoking Essay Topics & Examples

Looking for smoking essay topics? Being one of the most serious psychological and social issues, smoking is definitely worth writing about.

🏆 Best Smoking Essay Examples & Topic Ideas

🥇 good titles for smoking essay, 👍 best titles for research paper about smoking, ⭐ simple & easy health essay titles, 💡 interesting topics to write about health, ❓ essay questions about smoking.

In your essay about smoking, you might want to focus on its causes and effects or discuss why smoking is a dangerous habit. Other options are to talk about smoking prevention or to concentrate on the reasons why it is so difficult to stop smoking. Here we’ve gathered a range of catchy titles for research papers about smoking together with smoking essay examples. Get inspired with us!

Smoking is a well-known source of harm yet popular regardless, and so smoking essays should cover various aspects of the topic to identify the reasons behind the trend.

You will want to discuss the causes and effects of smoking and how they contributed to the persistent refusal of large parts of the population to abandon the habit, even if they are aware of the dangers of cigarettes. You should provide examples of how one may become addicted to tobacco and give the rationales for smokers.

You should also discuss the various consequences of cigarette use, such as lung cancer, and identify their relationship with the habit. By discussing both sides of the issue, you will be able to write an excellent essay.

Reasons why one may begin smoking, are among the most prominent smoking essay topics. It is not easy to begin to enjoy the habit, as the act of smoke inhalation can be difficult to control due to a lack of experience and unfamiliarity with the concept.

As such, people have to be convinced that the habit deserves consideration by various ideas or influences. The notion that “smoking is cool” among teenagers can contribute to the adoption of the trait, as can peer pressure.

If you can find polls and statistics on the primary factors that lead people to tweet, they will be helpful to your point. Factual data will identify the importance of each cause clearly, although you should be careful about bias.

The harmful effects of tobacco have been researched considerably more, with a large body of medical studies investigating the issue available to anyone.

Lung cancer is the foremost issue in the public mind because of the general worry associated with the condition and its often incurable nature, but smoking can lead to other severe illnesses.

Heart conditions remain a prominent consideration due to their lethal effects, and strokes or asthma deserve significant consideration, as well. Overall, smoking has few to no beneficial health effects but puts the user at risk of a variety of concerns.

As such, people should eventually quit once their health declines, but their refusal to do so deserves a separate investigation and can provide many interesting smoking essay titles.

One of the most prominent reasons why a person would continue smoking despite all the evidence of its dangers and the informational campaigns carried out to inform consumers is nicotine addiction.

The substance is capable of causing dependency, a trait that has led to numerous discussions of the lawfulness of the current state of cigarettes.

It is also among the most dangerous aspects of smoking, a fact you should mention.

Lastly, you can discuss the topics of alternatives to smoking in your smoking essay bodies, such as e-cigarettes, hookahs, and vapes, all of which still contain nicotine and can, therefore, lead to considerable harm. You may also want to discuss safe cigarette avoidance options and their issues.

Here are some additional tips for your essay:

• Dependency is not the sole factor in cigarette consumption, and many make the choice that you should respect consciously.
• Cite the latest medical research titles, as some past claims have been debunked and are no longer valid.
• Mortality is not the sole indicator of the issues associated with smoking, and you should take chronic conditions into consideration.

Find smoking essay samples and other useful paper samples on IvyPanda, where we have a collection of professionally written materials!

• How Smoking Is Harmful to Your Health The primary purpose of the present speech is to inform the audience about the detrimental effects of smoking. The first system of the human body that suffers from cigarettes is the cardiovascular system.
• Conclusion of Smoking Should Be Banned on College Campuses Essay However, it is hard to impose such a ban in some colleges because of the mixed reactions that are held by different stakeholders about the issue of smoking, and the existing campus policies which give […]
• Smoking: Problems and Solutions To solve the problem, I would impose laws that restrict adults from smoking in the presence of children. In recognition of the problems that tobacco causes in the country, The Canadian government has taken steps […]
• Should Smoking Be Banned in Public Places? Besides, smoking is an environmental hazard as much of the content in the cigarette contains chemicals and hydrocarbons that are considered to be dangerous to both life and environment.
• Advertisements on the Effect of Smoking Do not Smoke” the campaign was meant to discourage the act of smoking among the youngsters, and to encourage them to think beyond and see the repercussions of smoking.
• Should Cigarettes Be Banned? Essay Banning cigarette smoking would be of great benefit to the young people. Banning of cigarette smoking would therefore reduce stress levels in people.
• Quitting Smoking: Strategies and Consequences Thus, for the world to realize a common positive improvement in population health, people must know the consequences of smoking not only for the smoker but also the society. The first step towards quitting smoking […]
• Smoking Cigarette Should Be Banned Ban on tobacco smoking has resulted to a decline in the number of smokers as the world is sensitized on the consequences incurred on 31st May.
• On Why One Should Stop Smoking Thesis and preview: today I am privileged to have your audience and I intend to talk to you about the effects of smoking, and also I propose to give a talk on how to solve […]
• Smoking and Its Effects on Human Body The investigators explain the effects of smoking on the breath as follows: the rapid pulse rate of smokers decreases the stroke volume during rest since the venous return is not affected and the ventricles lose […]
• Causes and Effects of Smoking Some people continue smoking as a result of the psychological addiction that is associated with nicotine that is present in cigarettes.
• Smoking Cessation Programs Through the Wheel of Community Organizing The first step of the wheel is to listen to the community’s members and trying to understand their needs. After the organizer and the person receiving treatment make the connection, they need to understand how […]
• Hookah Smoking and Its Risks The third component of a hookah is the hose. This is located at the bottom of the hookah and acts as a base.
• Peer Pressure and Smoking Influence on Teenagers The study results indicate that teenagers understand the health and social implications of smoking, but peer pressure contributes to the activity’s uptake.
• Ban of Tobacco Smoking in Jamaica The first part of the paper will address effects of tobacco smoking on personal health and the economy. Cognizant of its international obligation and the aforementioned health effects of tobacco smoke, Jamaica enacted a law […]
• Teenage Smoking and Solution to This Problem Overall, the attempts made by anti-smoking campaigners hardly yield any results, because they mostly focus on harmfulness of tobacco smoking and the publics’ awareness of the problem, itself, but they do not eradicate the underlying […]
• Smoking Among Teenagers as Highlighted in Articles The use of tobacco through smoking is a trend among adolescents and teenagers with the number of young people who involve themselves in smoking is growing each day.
• Smoking Cessation and Patient Education in Nursing Pack-years are the concept that is used to determine the health risks of a smoking patient. The most important step in the management plan is to determine a date when the man should quit smoking.
• “Thank You For Smoking” by Jason Reitman Film Analysis Despite the fact that by the end of the film the character changes his job, his nature remains the same: he believes himself to be born to talk and convince people.
• Smoking and Its Negative Effects on Human Beings Therefore, people need to be made aware of dental and other health problems they are likely to experience as a result of smoking.
• Aspects of Anti-Smoking Advertising Thus, it is safe to say that the authors’ main and intended audience is the creators of anti-smoking public health advertisements.
• Health Care Costs for Smokers Higher Tobacco taxes Some of the smokers have the same viewpoint that the current level of taxes imposed on the tobacco is high, 68%, and most of them, 59%, are in agreement for the increase […]
• Smoking: Effects, Reasons and Solutions This presentation provides harmful health effects of smoking, reasons for smoking, and solutions to smoking. Combination therapy that engages the drug Zyban, the concurrent using of NRT and counseling of smokers under smoking cessation program […]
• Cigarette Smoking in Public Places Those who argue against the idea of banning the smoking are of the opinion that some of them opt to smoke due to the stress that they acquire at their work places.
• The Change of my Smoking Behavior With the above understanding of my social class and peer friends, I was able to create a plan to avoid them in the instances that they were smoking.
• Health Promotion for Smokers The purpose of this paper is to show the negative health complications that stem from tobacco use, more specifically coronary heart disease, and how the health belief model can help healthcare professionals emphasize the importance […]
• Gender-Based Assessment of Cigarette Smoking Harm Thus, the following hypothesis is tested: Women are more likely than men to believe that smoking is more harmful to health.
• Hazards of Smoking and Benefits of Cessation Prabhat Jha is the author of the article “The Hazards of Smoking and the Benefits of Cessation,” published in a not-for-profit scientific journal, eLife, in 2020.
• The Impact of Warning Labels on Cigarette Smoking The regulations requiring tobacco companies to include warning labels are founded on the need to reduce nicotine intake, limit cigarette dependence, and mitigate the adverse effects associated with addiction to smoking.
• Psilocybin as a Smoking Addiction Remedy Additionally, the biotech company hopes to seek approval from FDA for psilocybin-based therapy treatment as a cigarette smoking addiction long-term remedy.
• Investing Savings from Quitting Smoking: A Financial Analysis The progression of interest is approximately $50 per year, and if we assume n equal to 45 using the formula of the first n-terms of the arithmetic progression, then it comes out to about 105 […]
• Smoking as a Community Issue: The Influence of Smoking A review of the literature shows the use of tobacco declined between 1980 and 2012, but the number of people using tobacco in the world is increasing because of the rise in the global population.
• Smoking Public Education Campaign Assessment The major influence of the real cost campaign was to prevent the initiation of smoking among the youth and prevent the prevalence of lifelong smokers.
• Quitting Smoking and Related Health Benefits The regeneration of the lungs will begin: the process will touch the cells called acini, from which the mucous membrane is built. Therefore, quitting the habit of smoking a person can radically change his life […]
• Smoking and Stress Among Veterans The topic is significant to explore because of the misconception that smoking can alleviate the emotional burden of stress and anxiety when in reality, it has an exacerbating effect on emotional stress.
• Smoking as a Predictor of Underachievement By comparing two groups smoking and non-smoking adolescents through a parametric t-test, it is possible to examine this assumption and draw conclusions based on the resulting p-value.
• Smoking and the Pandemic in West Virginia In this case, the use of the income variable is an additional facet of the hypothesis described, allowing us to evaluate whether there is any divergence in trends between the rich and the poor.
• Anti-Smoking Policy in Australia and the US The anti-smoking policy is to discourage people from smoking through various means and promotion of a healthy lifestyle, as well as to prevent the spread of the desire to smoke.
• Smoking Prevalence in Bankstown, Australia The secondary objective of the project was to gather and analyze a sufficient amount of auxiliary scholarly sources on smoking cessation initiatives and smoking prevalence in Australia.
• Drug Addiction in Teenagers: Smoking and Other Lifestyles In the first part of this assignment, the health problem of drug addiction was considered among teens and the most vulnerable group was established.
• Anti-Smoking Communication Campaign’s Analysis Defining the target audience for an anti-smoking campaign is complicated by the different layers of adherence to the issue of the general audience of young adults.
• Smoking Cessation Project Implementation In addition, the review will include the strengths and weaknesses of the evidence presented in the literature while identifying gaps and limitations.
• Smoking Cessation and Health Promotion Plan Patients addicted to tobacco are one of the major concerns of up-to-date medicine as constant nicotine intake leads to various disorders and worsens the health state and life quality of the users.
• Maternal and Infant Health: Smoking Prevention Strategies It is known that many women know the dangers of smoking when pregnant and they always try to quit smoking to protect the lives of themselves and the child.
• A Peer Intervention Program to Reduce Smoking Rates Among LGBTQ Therefore, the presumed results of the project are its introduction into the health care system, which will promote a healthy lifestyle and diminish the level of smoking among LGBTQ people in the SESLHD.
• Smoking: Benefits or Harms? Hundreds of smokers every day are looking for a way to get rid of the noose, which is a yoke around the neck, a cigarette.
• The Culture of Smoking Changed in Poland In the 1980-90s, Poland faced the challenge of being a country with the highest rates of smoking, associated lung cancer, and premature mortality in the world.
• The Stop Smoking Movement Analysis The paper discusses the ideology, objective, characteristics, context, special techniques, organization culture, target audience, media strategies, audience reaction, counter-propaganda and the effectiveness of the “Stop Smoking” Movement.”The Stop Smoking” campaign is a prevalent example of […]
• Health Promotion Plan: Smokers in Mississippi The main strategies of the training session are to reduce the number of smokers in Mississippi, conduct a training program on the dangers of smoking and work with tobacco producers.
• Smoking Health Problem Assessment The effects of smoking correlate starkly with the symptoms and diseases in the nursing practice, working as evidence of the smoking’s impact on human health.
• Integration of Smoking Cessation Into Daily Nursing Practice Generally, smoking cessation refers to a process structured to help a person to discontinue inhaling smoked substances. It can also be referred to as quitting smoking.
• E-Cigarettes and Smoking Cessation Many people argue that e-cigarettes do not produce secondhand smoke. They believe that the e-fluids contained in such cigarettes produce vapor and not smoke.
• Introducing Smoking Cessation Program: 5 A’s Intervention Plan The second problem arises in an attempt to solve the issue of the lack of counseling in the unit by referring patients to the outpatient counseling center post-hospital discharge to continue the cessation program.
• Outdoor Smoking Ban in Public Areas of the Community These statistics have contributed to the widespread efforts to educate the public regarding the need to quit smoking. However, most of the chronic smokers ignore the ramifications of the habit despite the deterioration of their […]
• Nicotine Replacement Therapy for Adult Smokers With a Psychiatric Disorder The qualitative research methodology underlines the issue of the lack of relevant findings in the field of nicotine replacement therapy in people and the necessity of treatment, especially in the early stages of implementation.
• Smoking and Drinking: Age Factor in the US As smoking and drinking behavior were both strongly related to age, it could be the case that the observed relationship is due to the fact that older pupils were more likely to smoke and drink […]
• Smoking Cessation Clinic Analysis The main aim of this project is to establish a smoking cessation clinic that will guide smoker through the process of quitting smoking.
• Cigarette Smoking Among Teenagers in the Baltimore Community, Maryland The paper uses the Baltimore community in Maryland as the area to focus the event of creating awareness of cigarette smoking among the teens of this community.
• Advocating for Smoking Cessation: Health Professional Role Health professionals can contribute significantly to tobacco control in Australia and the health of the community by providing opportunities for smoking patients to quit smoking.
• Lifestyle Management While Quitting Smoking Realistically, not all of the set goals can be achieved; this is due to laxity in implementing them and the associated difficulty in letting go of the past lifestyle.
• Smoking in the Actuality The current use of aggressive marketing and advertising strategies has continued to support the smoking of e-cigarettes. The study has also indicated that “the use of such e-cigarettes may contribute to the normalization of smoking”.
• Analysis of the Family Smoking Prevention and Tobacco Control Act The law ensures that the FDA has the power to tackle issues of interest to the public such as the use of tobacco by minors.
• “50-Year Trends in Smoking-Related Mortality in the United States” by Thun et al. Thun is affiliated with the American Cancer Society, but his research interests cover several areas. Carter is affiliated with the American Cancer Society, Epidemiology Research Program.
• Pulmonology: Emphysema Caused by Smoking The further development of emphysema in CH can lead to such complications caused by described pathological processes as pneumothorax that is associated with the air surrounding the lungs.
• Smoking and Lung Cancer Among African Americans Primarily, the research paper provides insight on the significance of the issue to the African Americans and the community health nurses.
• Health Promotion and Smoking Cessation I will also complete a wide range of activities in an attempt to support the agency’s goals. As well, new studies will be conducted in order to support the proposed programs.
• Maternal Mental Health and Prenatal Smoking It was important to determine the variables that may lead to postpartum relapse or a relapse during the period of pregnancy. It is important to note that the findings are also consistent with the popular […]
• Nursing Interventions for Smoking Cessation For instance, the authors are able to recognize the need to classify the level of intensity in respect to the intervention that is employed by nurses towards smoking cessation.
• Smoking and Cancer in the United States In this research study, data on tobacco smoking and cancer prevalence in the United States was used to determine whether cancer in the United States is related to tobacco smoking tobacco.
• Marketing Plan: Creating a Smoking Cessation Program for Newton Healthcare Center The fourth objective is to integrate a smoking cessation program that covers the diagnosis of smoking, counseling of smokers, and patient care system to help the smokers quit their smoking habits. The comprehensive healthcare needs […]
• Risks of Smoking Cigarettes Among Preteens Despite the good news that the number of preteen smokers has been significantly reducing since the 1990s, there is still much to be done as the effects of smoking are increasingly building an unhealthy population […]
• Public Health Education: Anti-smoking Project The workshop initiative aimed to achieve the following objectives: To assess the issues related to smoking and tobacco use. To enhance the health advantages of clean air spaces.
• Healthy People Program: Smoking Issue in Wisconsin That is why to respond to the program’s effective realization, it is important to discuss the particular features of the target population in the definite community of Wisconsin; to focus on the community-based response to […]
• Health Campaign: Smoking in the USA and How to Reduce It That is why, the government is oriented to complete such objectives associated with the tobacco use within the nation as the reduction of tobacco use by adults and adolescents, reduction of initiation of tobacco use […]
• Smoking Differentials Across Social Classes The author inferred her affirmations from the participant’s words and therefore came to the right conclusion; that low income workers had the least justification for smoking and therefore took on a passive approach to their […]
• Cigarette Smoking Side Effects Nicotine is a highly venomous and addictive substance absorbed through the mucous membrane in the mouth as well as alveoli in the lungs.
• Long-Term Effects of Smoking The difference between passive smoking and active smoking lies in the fact that, the former involves the exposure of people to environmental tobacco smoke while the latter involves people who smoke directly.
• Smoking Cessation Program Evaluation in Dubai The most important program of this campaign is the Quit and Win campaign, which is a unique idea, launched by the DHCC and is in the form of an open contest.
• Preterm Birth and Maternal Smoking in Pregnancy The major finding of the discussed research is that both preterm birth and maternal smoking during pregnancy contribute, although independently, to the aortic narrowing of adolescents.
• Enforcement of Michigan’s Non-Smoking Law This paper is aimed at identifying a plan and strategy for the enforcement of the Michigan non-smoking law that has recently been signed by the governor of this state.
• Smoking Cessation for Patients With Cardio Disorders It highlights the key role of nurses in the success of such programs and the importance of their awareness and initiative in determining prognosis.
• Legalizing Electronic Vaping as the Means of Curbing the Rates of Smoking However, due to significantly less harmful effects that vaping produces on health and physical development, I can be considered a legitimate solution to reducing the levels of smoking, which is why it needs to be […]
• Inequality and Discrimination: Impact on LGBTQ+ High School Students Consequently, the inequality and discrimination against LGBTQ + students in high school harm their mental, emotional, and physical health due to the high level of stress and abuse of various substances that it causes.
• Self-Efficacy and Smoking Urges in Homeless Individuals Pinsker et al.point out that the levels of self-efficacy and the severity of smoking urges change significantly during the smoking cessation treatment.
• “Cigarette Smoking: An Overview” by Ellen Bailey and Nancy Sprague The authors of the article mentioned above have presented a fair argument about the effects of cigarette smoking and debate on banning the production and use of tobacco in America.
• “The Smoking Plant” Project: Artist Statement It is the case when the art is used to pass the important message to the observer. The live cigarette may symbolize the smokers while the plant is used to denote those who do not […]
• Dangers of Smoking While Pregnant In this respect, T-test results show that mean birthweight of baby of the non-smoking mother is 3647 grams, while the birthweight of smoking mother is 3373 grams. Results show that gestation value and smoking habit […]
• The Cultural Differences of the Tobacco Smoking The Middle East culture is connected to the hookah, the Native American cultures use pipes, and the Canadian culture is linked to cigarettes.
• Ban on Smoking in Enclosed Public Places in Scotland The theory of externality explains the benefit or cost incurred by a third party who was not a party to the reasoning behind the benefit or cost. This will also lead to offer of a […]
• How Smoking Cigarettes Effects Your Health Cigarette smoking largely aggravates the condition of the heart and the lung. In addition, the presence of nicotine makes the blood to be sticky and thick leading to damage to the lining of the blood […]
• Alcohol and Smoking Abuse: Negative Physical and Mental Effects The following is a range of effects of heavy alcohol intake as shown by Lacoste, they include: Neuropsychiatric or neurological impairment, cardiovascular, disease, liver disease, and neoplasm that is malevolent.
• Smoking Prohibition: Local Issues, Personal Views This is due to the weakening of blood vessels in the penis. For example, death rate due to smoking is higher in Kentucky than in other parts of the country.
• Ban Smoking in Cars Out of this need, several regulations have been put in place to ensure children’s safety in vehicles is guaranteed; thus, protection from second-hand smoke is an obvious measure that is directed towards the overall safety […]
• Smoking: Causes and Effects Considering the peculiarities of a habit and of a disease, smoking can be considered as a habit rather than a disease.
• Smoking and Its Effect on the Brain Since the output of the brain is behavior and thoughts, dysfunction of the brain may result in highly complex behavioral symptoms. The work of neurons is to transmit information and coordinate messengers in the brain […]
• Smoking Causes and Plausible Arguments In writing on the cause and effect of smoking we will examine the issue from the point of view of temporal precedence, covariation of the cause and effect and the explanations in regard to no […]
• Summary of “Smokers Get a Raw Deal” by Stanley Scott Lafayette explains that people who make laws and influence other people to exercise these laws are obviously at the top of the ladder and should be able to understand the difference between the harm sugar […]
• Smoking Qualitative Research: Critical Analysis Qualitative research allows researchers to explore a wide array of dimensions of the social world, including the texture and weave of everyday life, the understandings, experiences and imaginings of our research participants, the way that […]
• Motivational Interviewing as a Smoking Cessation Intervention for Patients With Cancer The dependent variable is the cessation of smoking in 3 months of the interventions. The study is based on the author’s belief that cessation of smoking influences cancer-treated patients by improving the efficacy of treatment.
• Factors Affecting the Success in Quitting Smoking of Smokers in West Perth, WA Australia Causing a wide array of diseases, health smoking is the second cause of death in the world. In Australia, the problem of smoking is extremely burning due to the high rates of diseases and deaths […]
• Media Effects on Teen Smoking But that is not how an adult human brain works, let alone the young and impressionable minds of teenagers, usually the ads targeted at the youth always play upon elements that are familiar and appealing […]
• Partnership in Working About Smoking and Tobacco Use The study related to smoking and tobacco use, which is one of the problematic areas in terms of the health of the population.
• Causes and Effects of Smoking in Public The research has further indicated that the carcinogens are in higher concentrations in the second hand smoke rather than in the mainstream smoke which makes it more harmful for people to smoke publicly.
• Quitting Smoking: Motivation and Brain As these are some of the observed motivations for smoking, quitting smoking is actually very easy in the sense that you just have to set your mind on quitting smoking.
• Health Effects of Tobacco Smoking in Hispanic Men The Health Effects of Tobacco Smoking can be attributed to active tobacco smoking rather than inhalation of tobacco smoke from environment and passive smoking.
• Smoking in Adolescents: A New Threat to the Society Of the newer concerns about the risks of smoking and the increase in its prevalence, the most disturbing is the increase in the incidences of smoking among the adolescents around the world.
• Smoking and Youth Culture in Germany The report also assailed the Federal Government for siding the interest of the cigarette industry instead of the health of the citizens.
• New Jersey Legislation on Smoking The advantages and disadvantages of the legislation were discussed in this case because of the complexity of the topic at hand as well as the potential effects of the solution on the sphere of public […]
• Environmental Health: Tabaco Smoking and an Increased Concentration of Carbon Monoxide The small size of the town, which is around 225000 people, is one of the reasons for high statistics in diseases of heart rate.
• Advanced Pharmacology: Birth Control for Smokers The rationale for IUD is the possibility to control birth without the partner’s participation and the necessity to visit a doctor just once for the device to be implanted.
• Legislation Reform of Public Smoking Therefore, the benefit of the bill is that the health hazard will be decreased using banning smoking in public parks and beaches.
• Smoking Bans: Protecting the Public and the Children of Smokers The purpose of the article is to show why smoking bans aim at protecting the public and the children of smokers.
• Clinical Effects of Cigarette Smoking Smoking is a practice that should be avoided or controlled rigorously since it is a risk factor for diseases such as cancer, affects the health outcomes of direct and passive cigarette users, children, and pregnant […]
• Public Health and Smoking Prevention Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over the past decades.
• Smoking Should Be Banned Internationally The questions refer to the knowledge concerning the consequences of smoking and the opinions on smoking bans. 80 % of respondents agree that smoking is among the leading causes of death and 63, 3 % […]
• Microeconomics: Cigarette Taxes and Public Smoking Ban The problem of passive smoking will be minimized when the number of smokers decreases. It is agreeable that the meager incomes of such families will be used to purchase cigarettes.
• Tobacco Debates in “Thank You for Smoking” The advantage of Nick’s strategy is that it offers the consumer a role model to follow: if smoking is considered to be ‘cool’, more people, especially young ones, will try to become ‘cool’ using cigarettes.
• Alcohol and Smoking Impact on Cancer Risk The research question is to determine the quantity of the impact that different levels of alcohol ingestion combined with smoking behavioral patterns make on men and women in terms of the risks of cancer.
• Indoor Smoking Restriction Effects at the Workplace Regrettably, they have neglected research on the effect of the legislation on the employees and employers. In this research, the target population will be the employees and employers of various companies.
• Hypnotherapy Session for Smoking Cessation When I reached the age of sixty, I realized that I no longer wanted to be a smoker who was unable to take control of one’s lifestyle.
• Social Marketing: The Truth Anti-Smoking Campaign The agreement of November 1998 between 46 states, five territories of the United States, the District of Columbia, and representatives of the tobacco industry gave start to the introduction of the Truth campaign.
• Smoking Experience and Hidden Dangers When my best college friend Jane started smoking, my eyes opened on the complex nature of the problem and on the multiple negative effects of smoking both on the smoker and on the surrounding society.
• South Illinois University’s Smoking Ban Benefits The purpose of this letter is to assess the possible benefits of the plan and provide an analysis of the costs and consequences of the smoking ban introduction.
• Smoking Cessation in Patients With COPD The strategy of assessing these papers to determine their usefulness in EBP should include these characteristics, the overall quality of the findings, and their applicability in a particular situation. The following article is a study […]
• Smoking Bans: Preventive Measures There have been several public smoking bans that have proved to be promising since the issue of smoking prohibits smoking in all public places. This means it is a way of reducing the exposure to […]
• Ban Smoking Near the Child: Issues of Morality The decision to ban smoking near the child on father’s request is one of the demonstrative examples. The father’s appeal to the Supreme Court of California with the requirement to prohibit his ex-wife from smoking […]
• The Smoking Ban: Arguments Comparison The first argument against banning smoking employs the idea that smoking in specially designated areas cannot do harm to the health of non-smokers as the latter are supposed to avoid these areas.
• Philip Morris Company’s Smoking Prevention Activity Philip Morris admits the existence of scientific proof that smoking leads to lung cancer in addition to other severe illnesses even after years of disputing such findings from health professionals.
• Tobacco Smoking and Its Dangers Sufficient evidence also indicates that smoking is correlated with alcohol use and that it is capable of affecting one’s mental state to the point of heightening the risks of development of disorders.
• Virginia Slims’ Impact on Female Smokers’ Number Considering this, through the investigation of Philip Morris’ mission which it pursued during the launch of the Virginia Slims campaign in 1968-1970 and the main regulatory actions undertaken by the Congress during this period, the […]
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A study on effects of smoking on society: a case study

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• International Journal of Current Research 10(10):74323-74325
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Original research

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

1 Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Beverley M Essue

2 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Prabhat Jha

Associated data.

bmjopen-2021-058324supp001.pdf

Data used in this study are available in public, open access repositories. Data are available upon reasonable request to the corresponding author. The dataset used in the study is publicly available from the countries’ government website (see the Data sources subsection in the Methods section) or by request to the last author (PJ).

We sought to quantify the impact of vaping introduction on cigarette smoking across settings with varied regulatory approaches to vaping.

Interrupted time series analysis, adjusted for cigarette tax levels.

Four Canadian provinces, UK and Australia.

Participants

Entire population of smokers in each country.

Interventions

The year that vaping was widely introduced in each country.

Primary and secondary outcome measures

The primary outcome is cigarette consumption per adult, and the secondary outcome is smoking prevalence among young adults.

Based on allowable nicotine levels, restrictions on e-cigarette advertising, sales and access, and taxation, the least to most restrictive jurisdictions were, in order, Alberta, Ontario, Quebec and British Columbia (all in Canada), UK and Australia. In most, but not all, settings where higher nicotine content was permitted in vaping products (66 mg/mL), vaping introduction led to a reduction in cigarette consumption per capita (Ontario: p=0.037, Quebec: p=0.007) or in smoking prevalence among young adults (Alberta men, p=0.027; Quebec men, p=0.008; Quebec women, p=0.008). In the UK, where the maximum permitted nicotine content in vaping products was 20 mg/mL, vaping introduction slowed the declining trend in cigarette smoking among men aged 16–24 years (p=0.031) and 25–34 years (p=0.002) but not in cigarette consumption per adult. In Australia, where nicotine was not permitted in e-cigarettes, e-cigarette introduction slowed the declining trend in cigarette consumption per capita and in smoking prevalence among men aged 18–24 years (cigarette consumption: p=0.015, prevalence: p=0.044).

In environments that enable substitution of cigarettes with e-cigarettes, e-cigarette introduction reduces overall cigarette consumption. Thus, to reduce cigarette smoking, policies that encourage adults to substitute cigarette smoking with vaping should be considered.

Strengths and limitations of this study

• This study uses an interrupted time series (ITS) design, which provides credible evidence on the longitudinal effects of interventions where randomisation is not possible.
• We are able to assess e-cigarette introduction in the context of permissible nicotine levels and regulations for their use, which is appropriate when considering substitution effects of vaping on cigarette demand.
• Since our definition of the intervention year is based on the first year when nationally representative surveys included questions on e-cigarette use, there may be a delay in capturing the effect of the intervention, and the ITS results are sensitive to the intervention year.

Introduction

Use of electronic nicotine delivery systems (ENDS) (also called ‘vaping’), particularly electronic cigarettes (e-cigarettes), has increased rapidly in many high-income countries since about 2010, especially among youths and young adults. 1 2 As an e-cigarette contains fewer of the toxic and carcinogenic chemicals that are in a conventional cigarette, e-cigarette use is believed to be less harmful than smoking, but not completely harmless, and the long-term risks of vaping remain unknown. 3 The net effect of e-cigarette use will depend on its harms and if e-cigarettes reduce cigarette smoking (harms for cigarette use are well documented, including a typical loss of a decade of life among lifelong cigarette smokers). 1 4

Numerous studies have found or supported the view that among youths and young adults, vaping acts as a substitute for cigarette smoking. 5–8 However, the degree of substitution also depends on government regulations on vaping such as whether nicotine is permitted in vaping devices, maximum permissible nicotine content, minimum age for purchase and tax on e-cigarettes, as well as the regulatory and taxation environment for cigarettes. To date, to the best of our knowledge, no studies have examined the impact of vaping introduction on cigarette smoking across settings with varied regulatory approaches to vaping.

This study aims to quantify the impact of vaping introduction on cigarette smoking in six high-income jurisdictions that vary in regulatory approaches to vaping: four provinces of Canada and UK and Australia, using interrupted time series (ITS) analysis. We hypothesise that in settings where regulations favour the uptake of vaping (such as higher permissible nicotine level in vaping devices, greater access to e-cigarettes, and low or no tax on e-cigarettes), vaping introduction has led to a faster decline in cigarette smoking based on aggregate sales of legal (non-contraband) cigarettes. Our secondary outcome is smoking prevalence among youths and young adults, stratified by sex.

Choice of jurisdictions

We selected Canada, UK and Australia as jurisdictions that have adopted varied regulatory approaches to vaping based on differential levels of vaping regulations 9 10 and availability of data on e-cigarette use and smoking. In Canada, vaping regulations vary substantially across provinces, hence necessitating a province-specific examination. We selected Alberta, British Columbia (BC), Ontario and Quebec provinces in Canada, as they account for about 85% of Canada’s young adult population (aged between 18 and 34 years) and total cigarette sales. 11 12 For each of the six selected jurisdictions, we examined the regulations on vaping products as they pertain to the maximum permissible nicotine content in the products, minimum age for purchase and sales, marketing, and advertisement of the products. Based on these criteria, we then classified the jurisdictions along the range from ‘less restrictive’ to ‘most restrictive’. Across these settings, regulation of cigarette smoking is fairly similar, with generally high excise taxes on cigarettes (for which we adjust in our analysis); restrictions on tobacco advertising, sales and promotion; and use of prominent health warning labels on cigarette packaging. 13

Measure of e-cigarette use and cigarette smoking

We examined the trends in prevalence of current e-cigarette use or e-cigarette use in the past 30 days, reported by national surveys in Canada, UK and Australia from 2012 (or the year when surveys first collected data on e-cigarette use) to 2019. The survey sources are presented in the Data sources section.

Our primary outcome was annual cigarette consumption per adult, which we defined as individuals aged 18 years and over. Annual cigarette consumption is measured as the number of legal (non-contraband) cigarette sticks sold; in the UK and Australia, where these data were not available, we used the monetary value of cigarettes consumed per adult (at inflation-adjusted price). Out of the total annual cigarette consumption, consumption by youths and young adults, which we defined as individuals aged between 15 years and 30 years, accounted for about 30% across Canadian provinces (authors’ calculation, insufficient data to estimate for the UK and Australia). For cigarette smoking among youths and young adults, we used prevalence of cigarette smoking between the age of 15 years and 30 years (age range varies by country, depending on data availability; see the Smoking prevalence section), stratified by sex. For countries where prevalence of cigarette smoking was not available, we used prevalence of any tobacco smoking, assuming that the majority of tobacco smoking comprises cigarette smoking. 14

Data sources

Prevalence of current e-cigarette use.

In Canada, we obtained prevalence of past 30 days’ e-cigarette use, by province, from the Canadian Tobacco, Alcohol and Drugs Survey, which is the first national survey in Canada that included questions on e-cigarette use in 2013. 15 In the UK, we used prevalence of current e-cigarette use reported by Action on Smoking and Health based on annual surveys carried out online on over 12 000 adults aged 18 years and over in Great Britain. 16 The survey included questions on e-cigarette use for smokers from 2010 and for all adults from 2012. 16 For Australia, we used data from the National Drug Strategy Household Survey (NDSHS), which collects information on alcohol and tobacco consumption and illicit drug use every 2–3 years among Australians aged 14 years and older. 17 The NDSHS began reporting prevalence of e-cigarette use among the general population from 2016.

Cigarette consumption

We estimated the annual cigarette consumption per adult in the Canadian provinces as the number of cigarette sticks consumed per adult, using cigarette sales data from Health Canada 12 and population data from Statistics Canada. 11 For the UK, we used cigarette retail sales value per adult using sales data, expressed as retail value in US dollars of 2018, from Euromonitor. For Australia, we used chain volume (which measures changes in quantity by holding price constant) of cigarettes and other tobacco products per adult expressed in Australian dollars of 2018, estimated by the Australian Bureau of Statistics. 18 The total cigarette consumption in the UK and Australia was then divided by the number of adults aged 18 years and older, estimated in the United Nations World Population Prospects 2019, 19 to obtain cigarette consumption per adult.

Smoking prevalence

For Canada, we obtained prevalence of current cigarette smoking (daily or occasional) by province from the Canadian Community Health Survey. 20 In our study, we used the prevalence of cigarette smoking among individuals aged 18–34 from 2008 to 2018. Smoking prevalence estimates among younger age groups are unreliable due to small sample sizes 20 ; hence, they were not used. For UK, we obtained cigarette smoking prevalence from the Opinions and Lifestyle Survey. 21 Although the Annual Population Survey collects smoking data in the UK, data prior to 2010 are not available. We used cigarette smoking prevalence among those aged 16–24 years and 25–34 years from 2007 to 2019. For Australia, we used prevalence of tobacco smoking among individuals aged 18–24 years and 25–34 years from 2001 to 2017 from the Australian National Health Survey (AHS). 22 The AHS is conducted every 2–3 years and reports prevalence of any tobacco smoking but not cigarette smoking. 22 As cigarette sales comprise about 85% of the overall sales of tobacco products in Australia, 23 we used tobacco smoking prevalence as a proxy for cigarette smoking prevalence.

Tobacco tax/cigarette price

Our ITS model adjusted for tobacco tax or cigarette price as a potential confounder. For Canada, we obtained the annual federal and provincial tobacco tax rates from 2008 to 2018 from the Canadian Cancer Society 24 and Non-Smokers’ Rights Association/Smoking and Health Action Foundation (2018). 24 25 For UK, we used data on the price of a 20-cigarette pack of the most sold brand obtained from the WHO Tobacco taxes and prices database. 26 For Australia, we used cigarette tax rates, as Australian dollar per kilogram of cigarettes, obtained from the Australian Bureau of Statistics. 27 All taxes and prices were adjusted for inflation by converting them to local currency units of 2018. 28 29

Statistical analysis

Its analysis.

We used ITS analysis to examine changes in the secular trend (slope change) in (1) cigarette consumption per adult and (2) smoking prevalence among youths and young adults, stratified by sex, after e-cigarette introduction in the selected settings with differential levels of vaping regulations. Details of the ITS methodology used and choice of intervention year can be found in the online supplemental material .

Supplementary data

As a potential confounder for changes in cigarette consumption and smoking prevalence, we adjusted our model for major tobacco control measures implemented during the period examined in our study: plain packaging for cigarettes which was implemented in the UK in 2017 and in Australia in 2012 (entered as a categorical variable with ‘0’ for the years prior to the implementation and ‘1’ for years after the implementation), 30 and tobacco tax increase using inflation-adjusted tobacco tax or cigarette price, thereby allowing for expected non-linearity in the ITS regression curve. 31 We did not control for smoke-free public places and bans on tobacco advertising, promotion and sponsorship, as they were already enforced before the period of our analysis. Any change in the slope (the rate of change) in cigarette sales or smoking prevalence with p<0.05 was considered statistically significant. All analyses were carried out in Stata V.15.1. 32

Sensitivity analysis

We conducted a sensitivity analysis by (1) using the relative rate of change in cigarette consumption and in smoking prevalence per year as the outcomes and (2) changing the intervention year such that the intervention year is the year prior to the intervention year used in the main analysis. Data were insufficient for carrying out sensitivity analysis by moving the intervention year 1 year ahead of the year used in the main analysis.

Patient and public involvement

Patients or the public were not involved in this study.

Table 1 shows the vaping regulations, in terms of maximum permissible nicotine content, minimum age for purchase and sales, marketing, and advertisement of e-cigarettes, in the six selected jurisdictions. Based on these regulations, the least restrictive to the most restrictive vaping environments are in order: Alberta, Ontario, Quebec, BC, UK and Australia. In Canada, the maximum nicotine level allowed in vaping devices during our study period was 66 mg/mL, which is more than three times the maximum allowed in the UK of 20 mg/mL. 1 10 In Australia, nicotine-containing e-cigarettes were not permitted unless prescribed for therapeutic purposes by a registered medical practitioner. 33 In Canada, UK, and Australia, where e-cigarettes were permitted, sales to persons under 18 years were prohibited, and marketing, advertisement and promotion of e-cigarettes were restricted. 10

Vaping regulations by country and Canadian provinces during the study period 10 16 30 34

E-cigarettes are taxed only in the UK, where as consumer products they are subject to 20% value added tax (VAT), and if they are regulated as medicinal products, the VAT levied is 5%. 10 In contrast to more homogenous regulation across subregions in the UK and Australia, Canadian vaping regulations vary across provinces. 34

Figure 1 shows the trend in prevalence of current e-cigarette use in the six selected jurisdictions for the years for which data were available. Across all study settings, the prevalence of current e-cigarette use was variable over time, but low overall (<7%).

Prevalence of current e-cigarette use in the UK (aged 18+), Canada (aged 15+, by province) and Australia (aged 18+).

The coefficients for the underlying linear time trend and slope change after vaping introduction, and the tax (or price) and plain packaging variables from the ITS analysis of the impact of vaping introduction on cigarette consumption and smoking prevalence in the six selected jurisdictions are shown in tables 2 and 3 , respectively. In the ITS analysis, a slope change represents a change in the trend in smoking after vaping introduction relative to the trend before the introduction which we expect would have been unchanged had there been no e-cigarettes. 35 The trends in cigarette consumption per adult and smoking prevalence among youths and young adults are presented in online supplemental figure S1 . All analyses are adjusted for changes in cigarette price or tax. In most settings, we found a secular decline in cigarette consumption per adult before vaping introduction except in Quebec where it increased modestly between 2008 and 2015 ( table 2 ).

Impact of vaping introduction on cigarette consumption from interrupted time series analysis, after adjusting for cigarette tax/price and plain packaging

Cigarette consumption is measured as number of cigarette sticks sold per adult in Canada, cigarette retail value per adult (2018 US$) in the UK, and cigarette chain volume per adult (2018 $A) in Australia.

The constant terms are 2516.83 for Alberta, 767.52 for Ontario, 1290.18 for Quebec, 918.38 for BC, 500.59 for UK and 1843.70 for Australia.

Values in bold are statistically significant at 95% CI.

*For cigarette tax/price, we used cigarette tax per 200 sticks (in $C) in Canada, price of a 20-cigarette pack of the most sold brand (in British £) for the UK and tax per kilogram of cigarettes (in $A) in Australia. All taxes and prices are inflated to currency units of 2018.

BC, British Columbia.

Impact of vaping introduction on smoking prevalence from interrupted time series analysis, after adjusting for cigarette tax/price and plain packaging

*Among young adults aged 18–34 years from 2008 to 2014 and 20–34 years from 2015 to 2018.

†Cigarette smoking prevalence in Canada and UK, and tobacco smoking prevalence in Australia.

AHS, Australian National Health Survey.

Less restrictive vaping environment (+)

In Alberta, between 2008 and 2011, cigarette consumption per adult declined significantly annually by 27 sticks (95% CI −50 to −4). After the introduction of e-cigarettes in 2012, the rate of decline in cigarette consumption slowed by 34 sticks per year (95% CI −13 to 80) and was not significant. In Ontario, after e-cigarette introduction in 2015, cigarette consumption per adult declined significantly faster during 2015–2018 relative to during 2011–2014 by 90 sticks per year (95% CI −171 to −10).

Environment with somewhat restrictive regulations on vaping (++)

In Quebec, cigarette consumption per adult was increasing significantly during 2011–2014 by 86 sticks per year (95% CI 35 to 138) but declined significantly faster annually after e-cigarette introduction compared with before (−117 sticks per year, 95% CI −172 to −61). In BC, after e-cigarette introduction, cigarette consumption per adult declined faster but was not statistically significant (−7 sticks, 95% CI −2 to 16).

More restrictive vaping environment (+++)

In the UK, between 2007 and 2010, cigarette consumption, in terms of retail sales value per adult, declined by US$9 annually (95% CI −20 to 2) but was not significant. With e-cigarette introduction in 2011, the declining trend in cigarette consumption slowed by US$7 per adult annually (95% CI −2 to 16), although this difference in the rate of decline was not statistically significant.

Most restrictive vaping environment (++++)

In Australia, between 2011 and 2014, cigarette consumption, in terms of chain volume per adult, was declining significantly by $A75 per year (95% CI −$A148 to −$A2). After e-cigarette introduction in 2015, the declining trend significantly slowed during 2015–2018 compared with during 2011–2014 ($A120, 95% CI $A56 to $A184).

In the sensitivity analysis when we examined the impact of vaping introduction on the relative rate of decline in cigarette consumption over time, similar results were found across jurisdictions ( online supplemental table S1 ). In Alberta, BC and the UK, there was insufficient evidence to detect a difference in cigarette consumption patterns before and after e-cigarette introduction. In Ontario and Quebec, the relative rate of decline in cigarette consumption per adult increased significantly after e-cigarette introduction, whereas in Australia, it decreased significantly after e-cigarette introduction. However, in the sensitivity analysis when the intervention is moved back 1 year from the year used in the main analysis, we found insufficient evidence to detect any difference in cigarette consumption per adult across the six jurisdictions ( online supplemental table S2 ).

Smoking prevalence among young adults

In Alberta, after e-cigarette introduction in 2012, the secular declining trend in smoking prevalence among men aged 18–34 years accelerated significantly by 3.21% per year (95% CI −5.74 to −0.69, table 3 ). For young adult women in Alberta and young adult men and women in Ontario, we found insufficient evidence to detect any difference in smoking prevalence before and after e-cigarette introduction. Sensitivity analyses conducted by moving back the intervention year 1 year from the year used in the main analysis showed similar results ( online supplemental table S2 ).

Somewhat restrictive vaping environment (++)

In Quebec, after e-cigarette introduction in 2012, smoking prevalence among young adults declined significantly faster during 2012–2015 relative to during 2008–2011 for both men and women. In BC, the declining trend in smoking prevalence slowed by 0.05% for men (95% CI −3.38% to 3.48%) but accelerated by 0.12% for women (95% CI −2.62% to 2.37%), although the changes in the trend for both are insignificant.

In the UK, after e-cigarette introduction in 2011, the declining trend in smoking prevalence among men aged 16–24 during 2007–2010 slowed significantly by 1.88% per year (95% CI 0.33% to 3.42%) during 2011–2014. Among men aged 25–34 years, smoking prevalence was increasing by 4.28% (95% CI 3.23% to 5.34%) annually between 2007 and 2010. With e-cigarette introduction in 2011, the increasing trend in smoking prevalence increased significantly by 2.07% (95% CI 1.46% to 2.68%) during 2011–2014.

In Australia, after e-cigarette introduction in 2015, compared with those during 2011–2014, smoking prevalence among men aged 18–24 years declined significantly slower annually for men. Sensitivity analysis using the relative rate of change over time as the outcome showed similar results. However, when the intervention year is changed to 2014, we found insufficient evidence to detect a difference in the rate of change in prevalence before and after e-cigarette introduction.

In the sensitivity analysis using the relative rate of change in cigarette consumption and smoking prevalence over time as the outcomes, we found similar results across all six jurisdictions. However, when the intervention year is changed to 1 year prior to the intervention year used in the main analysis, we found insufficient evidence of the impact of e-cigarette introduction on the change in the trend of smoking prevalence among young adults.

This study used ITS to analyse the impact of vaping introduction on cigarette smoking in six jurisdictions with varied approaches to vaping regulations. Across the Canadian provinces of Alberta, Ontario, Quebec and BC, where vaping regulations are less or somewhat restrictive, we found evidence that cigarette smoking (in terms of consumption or prevalence among young adults or both) declined significantly faster following e-cigarette introduction. In the UK, where vaping regulations are more restrictive, and in Australia, where vaping regulations were (and still are) highly restrictive, we found that vaping introduction has slowed the secular declining trends in cigarette smoking. Our findings suggest that, while e-cigarettes may be substitutes for cigarettes, actual substitution depends on the regulatory environment around vaping, such as nicotine content and tax on vaping products in the setting, and supports our hypothesis that in settings where regulations favour the uptake of vaping, vaping introduction had led to a faster decline in cigarette smoking.

Unlike Canada and the UK, where nicotine is permitted in e-cigarettes (although the maximum permissible content varies by country), in Australia, sale of e-cigarettes containing nicotine is banned under the argument that nicotine in vaping products would lead young people who would otherwise not take up cigarette smoking to smoke. 33 36 Our finding that e-cigarette introduction has slowed the declining trends of smoking in Australia, which could be attributed to the nicotine ban in e-cigarettes, falls in line with several studies among adolescents in the USA that found that banning e-cigarette sales is significantly associated with an increase in smoking, 37–39 and supports Lillard’s (2020) model on the economics of nicotine consumption in which nicotine is the primary object that e-cigarette consumers demand. 40 This limits the number of data points post intervention in our analysis, particularly with data from the AHS survey, which is only conducted every 2–3 years. Hence, continued monitoring of both cigarette and e-cigarette use among youths and young adults is needed in order to examine the impact of e-cigarette uptake on smoking more precisely.

Based on our findings from the perspective of tobacco harm reduction, at least in Canada and the UK where e-cigarette use has accelerated the rate of smoking decline among youths and young adults, controlled access to vaping could contribute to further curbing smoking rates in the long run. The net reduction in overall smoking was small—less than 2% vs baseline trends in Canada (data not shown)—consistent with the low level of e-cigarette use. Across Canada and the UK, the total volume of cigarettes consumed in 2017 was 63 billion sticks. Given that every 1.0–1.2 million sticks will eventually cause one death, 1 this means that about 63 000 deaths can be expected eventually, unless there are notable increases in cessation from current levels. Any meaningful reduction in cigarette consumption will reduce the leading cause of adult death in these countries, and the net benefit or harm of vaping must consider offsetting decreases in cigarettes. Imposing differential taxes on ENDS to encourage switching from the most harmful tobacco products (ie, cigarettes) to the least harmful ones could be another strategy. 41 42 Our study also found different impacts of vaping introduction on smoking among men and women. Further studies are needed to examine whether there are differential impacts by socioeconomic status, race and other characteristics.

Our study has several limitations. First, our definition of the intervention period for Canada, UK and Australia, which plays a major role in the ITS model, is based on the first year when national surveys included questions on e-cigarette use in the general population. Hence, there may be a delay in capturing the effect of the intervention, particularly as countries were experiencing significant declines in smoking prevalence in the years preceding the assigned intervention date in the ITS. However, sensitivity analysis using relative rate of decline over time as the outcome found similar results. In addition, based on the first national survey that collected data on e-cigarette use, the prevalence was under 3% across all settings included in this study. Second, in this study, the ITS model assumes that without the introduction of e-cigarettes, the trend in smoking (cigarette consumption and smoking prevalence) would remain unchanged during the postintervention period. However, across the jurisdictions selected for this study, there has been a long-term secular decline in smoking. Hence, the decline in smoking observed preintervention is likely to continue post intervention. Third, our main outcome was legal cigarette consumption measured using legal sales and did not include contraband sales, which account for about 15%–20% of total cigarette sales. 43–45 Fourth, our secondary outcomes, age-specific and sex-specific smoking prevalence among youths and young adults, were obtained from self-reported surveys. Hence, there could be an under-reporting of smoking due to social desirability bias, which might be greater in younger adults. Similarly, the prevalence of e-cigarette use could also be under-reported. Fifth, while examining the impact of vaping introduction on smoking prevalence, we did not account for the impact on smoking intensity and frequency. Additionally, we did not perform a test to examine the relationship between restrictions defined by maximum permissible nicotine content in vaping products to other variables such as minimum age for purchase, and restrictions around marketing of vaping products and the trend in smoking. As of 23 July 2021, Canada lowered the maximum permissible nicotine content in vaping products to 20 mg/mL. 46 Future studies would need to examine the impact of this restriction and restrictions on sales, advertisement and marketing of vaping products on the trend in smoking prevalence to directly establish a link between vaping restrictions and cigarette smoking. Finally, we did not control for vaping regulations which may indirectly impact smoking behaviour.

Despite these limitations, our study showed the impact of vaping introduction on cigarette consumption and smoking prevalence among youths and young adults in four high-income countries that have adopted different approaches to vaping regulation, using ITS while controlling for the secular trends in smoking decline and major tobacco control measures adopted by jurisdictions during the period examined.

This study used ITS analysis to examine the impact of vaping introduction on smoking in six high-income jurisdictions that have adopted varied regulatory approaches to vaping. Our findings showed that in most, but not all, settings where policies enable substitution of cigarettes with e-cigarettes, vaping introduction has accelerated the rate of decline in smoking, whereas in settings that restrict the uptake of e-cigarettes or do not permit the use of nicotine in e-cigarettes, vaping introduction has slowed the secular rate of decline in smoking.

Supplementary Material

Contributors: DCW and PJ designed the study. PJ conceived the study, led the study design as principal investigator, acquired funding for the study, and planned and supervised the study. DCW obtained, cleaned, analysed and interpreted the data, and drafted the paper. DCW, BME and PJ conducted and reported the work in the manuscript, and reviewed, revised and approved the final manuscript. DCW and PJ are guarantors. The corresponding author attests that all listed authors meet the authorship criteria and that no other authors meeting the criteria have been omitted.

Funding: This work was supported by the Canadian Institutes of Health Research Foundation scheme (grant number FDN 154277).

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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