AVA Synopsis:
Researchers examined the effects of e-cigarette regulations on the use of products and their effectiveness as a cessation tool for smokers.
The authors used data from the Tobacco Control Four surveys in Australia, Canada, the United Kingdom and the United States and compared the effectiveness of both e-cigarettes and nicotine replacement therapy (NRT) in smoking cessation and compared the use of products in countries with varying degrees of restrictive e-cigarette regulations.
The authors defined Australia and Canada as countries with restrictive e-cigarette regulations and the United Kingdom and the United States as having less restrictive e-cigarette regulatory environments.
The authors found that in less restrictive countries, use of e-cigarettes in quitting attempts lead to cessation, but in more restrictive regulatory environments, use of e-cigarettes is lower and “appears to inhibit, short-term sustained smoking abstinence.” The authors note the findings suggest that using e-cigarettes “for smoking cessation may be dependent on the regulatory environment.”
Implications:
Although the data examined smoking cessation rates from 2010 to 2014, the findings are significant as states implement more restrictive regulatory policies concerning e-cigarette use and sales. It is necessary for policymakers to understand e-cigarettes’ effectiveness as a cessation tool for smokers and refrain from implementing draconian prohibitions as this study finds increased regulations decrease e-cigarette use.
Abstract:
Introduction: To date, no studies have explored how different regulatory environments may influence the effectiveness of electronic cigarettes (ECs) as a smoking cessation aid.
Objective: This study compares the real-world effectiveness of adult smokers using ECs for quitting compared with quitting unassisted or quitting with nicotine replacement therapy (NRT) and/or prescription medications in two countries with restrictive policies towards ECs (ie, Canada and Australia) versus two countries with less restrictive policies (ie, United States and United Kingdom).
Methods: Data were drawn from the International Tobacco Control Four Country surveys, from the United States and Canada (2 waves, n = 318 and 380, respectively), the United Kingdom (3 waves, n = 439) and Australia (4 waves, n = 662), collected 2010–2014. Smokers at baseline wave who reported making a quit attempt at follow-up were included. The primary outcome was self-reported abstinence for at least 30 days regardless of smoking status at follow-up assessment. Data across waves were combined and analyzed using generalized estimating equations.
Results: Compared to unassisted quitting (ie, no medications or ECs), smokers who used ECs for quitting from countries with less restrictive EC policy environments were more likely (OR = 1.95, 95%CI = 1.19–3.20, p < .01), whereas smokers who used ECs for quitting from countries with more restrictive EC policies were less likely (OR = 0.36, 95%CI = 0.18–0.72, p < .01), to report sustained abstinence for at least 30 days.
Conclusions: Use of ECs in the real world during a quit attempt appears only effective for sustaining smoking abstinence in a less restrictive EC environment suggesting that the benefits of ECs for smoking cessation are likely highly dependent on the regulatory environment.
Implications: What this study adds: This is the first study to examine the impact of regulatory environment for ECs on their real-world effectiveness for smoking cessation. This study shows that in a less restrictive EC regulatory environment, use of ECs during a quit attempt facilitates, but in a more restrictive environment, it inhibits, short-term sustained abstinence. The findings underscore the need for careful consideration on how best to regulate this emerging product so that EC benefits for smoking cessation are maximized and its risks to public health are minimized.
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