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Hand holding a cigarette

New research led by Oxford Population Health indicates which policies could be more effective in encouraging persistent tobacco smokers to switch from their own cigarettes to e-cigarettes.

Tobacco smoking is the most significant cause of premature death in the EU, responsible for nearly 700,000 deaths every year. Around half of smokers die prematurely (on average 14 years earlier than non-smokers). Yet despite these risks, and the clear health benefits of giving up smoking, many tobacco smokers remain reluctant to quit entirely, even with the support of nicotine replacement therapies, counselling services and self-help tools. For these people, an alternative may be to use e-cigarettes, which allow the user to inhale nicotine without tar or carbon monoxide (two of the most harmful compounds in standard cigarettes). E-cigarettes are often flavoured (for instance, with fruit flavourings, mint or menthol) to appeal to those who dislike a strong tobacco taste.

Various government policies have been proposed to encourage tobacco smokers to switch to using e-cigarettes, including increased taxes on tobacco-based cigarettes; subsidising e-cigarettes as an aid to quit smoking; and banning the sale of tobacco-based cigarettes flavoured with menthol. But whilst these can provide an added incentive for those already trying to quit tobacco smoking, it was unclear whether such measures are also effective for those who are reluctant to stop.

To investigate this, Dr John Buckell from the Health Economics Research Centre at Oxford Population Health, with collaborators from Yale University’s Tobacco Center of Regulatory Science, led a study which investigated whether tobacco policies could encourage this group to switch to e-cigarettes. The results have been published today in Tobacco Control.

The study was based on an online experiment involving 2,000 tobacco smokers in the USA, who reported having little interest in quitting smoking. Respondents were presented with a series of scenarios which asked them to choose between their usual cigarette, disposable e-cigarettes, or rechargeable ‘pod-style’ e-cigarettes. For each scenario, the e-cigarettes were described by five attributes: their flavour (tobacco, menthol/ mint, fruit, or sweet); the level of nicotine; whether they were healthier than cigarettes; whether they helped people to quit cigarettes; and price. The responses were used to generate a model to simulate the effect of introducing specific policies to encourage switching to e-cigarettes.

Key findings

The respondents fell into two main types:

NON-SWITCHERS (68% of the sample) who had very strong preferences for their own cigarettes across all the attributes studied. These people were more likely to be older, have a lower income, be lower educated, and not already be using e-cigarettes alongside tobacco-based cigarettes.

SWITCHERS (32% of the sample), who did not have particularly strong preferences for their own cigarettes and were more open to using e-cigarettes. These people were more likely to be younger, have a higher income, be more educated, and already be dual users of cigarettes and e-cigarettes.

  • Both non-switchers and switchers preferred e-cigarettes when they were cheaper than their usual cigarettes, but not when they were the same price or more expensive.
  • Both non-switchers and switchers disliked e-cigarettes that had non-tobacco flavourings and/or could help individuals to quit smoking. Non-switchers additionally disliked e-cigarettes that were healthier than tobacco-based cigarettes.
  • Both groups preferred e-cigarettes if they contained no nicotine at all; non-switchers were also more likely to choose e-cigarettes if they still contained some nicotine, but less than their regular cigarettes.
  • The policy simulations indicated that banning menthol flavoured cigarettes would have no impact on the choices of non-switchers, and only modestly increase switchers’ choices of e-cigarettes.
  • For switchers, the model indicated that increasing the relative price of cigarettes would result in an increased number of choices made for both pod e-cigarettes (3.1%) and disposable e-cigarettes (11.5%). For non-switchers, a price increase appeared to have no impact on their choices.

According to the research team, since only 19% of the respondents currently used e-cigarettes yet 32% were open to switching, this suggests that effective policies could theoretically encourage a significant number of people to switch.

Dr Buckell said: ‘Our study indicates that neither a ban on menthol-flavoured cigarettes nor higher taxes on cigarettes are likely to encourage much switching to e-cigarettes for those who are reluctant to give up cigarettes. However, some of these smokers were somewhat responsive to lower e-cigarette prices, suggesting that governments might consider policies that cover the costs of e-cigarettes as an aid to quit tobacco smoking. Further research is needed, some of which is being done at Oxford University’s Nuffield Department of Primary Care Health Sciences, on how to persuade more of these smokers to use e-cigarettes or give up smoking entirely.’

(Research reported in this publication was supported by grant number [U54DA036151] from the NIH and FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.)