■目前尚不清楚替代尼古丁递送产品(电子烟,加热的烟草产品和鼻烟)对吸烟率和卷烟销售有影响。
■评估获得这些产品是否会促进人群吸烟。
■我们研究了尼古丁替代产品的使用和销售与吸烟率和总体卷烟销售的关系,在不同的年龄和社会经济群体中,并比较了这些产品在不同时期的吸烟率。对于电子烟,我们检查了来自历史上吸烟轨迹相似但当前电子烟法规不同的国家的数据(英国和美国与澳大利亚,禁止销售含尼古丁的电子烟);对于加热烟草,我们使用了国家烟草垄断国家的数据,有香烟和加热烟草销售数据的地方(日本,韩国),对于鼻烟,我们使用了瑞典的数据。
■我们预先指定了动态时间序列分析,以探索替代尼古丁递送产品的使用和销售与吸烟流行和卷烟销售之间的关联。和时间序列分析,以比较不同尼古丁产品政策国家的吸烟率趋势。
■由于数据和分析的局限性(见下文),结果只是暂时的,需要谨慎解释。只有少数发现达到统计学意义,对于大多数结果,贝叶斯因子表明尚无定论。我们没有发现吸烟率和替代尼古丁产品使用率之间的关联。日本加热烟草产品销售的增加伴随着卷烟销售的减少。澳大利亚的吸烟率下降速度似乎总体上比英国慢,在年轻人和社会经济地位较低的群体中,比联合王国和美利坚合众国慢。英国的卷烟销量下降速度也快于澳大利亚。
■大多数可用数据不足以进行稳健的时间序列分析。我们的统计方法的假设是,当筛选出长期变化时,因果相互作用更有可能被检测到可能不适用于短时间序列和产品相互作用场景,短期波动可能是由,例如,繁荣或产品供应的波动。此外,由于双重用途,吸烟和替代产品使用的患病率数据重叠。生态研究设计限制了可以做出的因果推断。新产品的独家使用对吸烟率的任何影响都需要更长的时间。
我们发现一些迹象表明,替代尼古丁产品正在与香烟竞争,而不是促进吸烟,并且允许其销售的法规与减少而不是增加吸烟有关。但是由于数据不足和预先指定的统计分析的假设存在问题,因此调查结果尚无定论。
■随着进一步的流行和销售数据的出现,分析将变得更加翔实。特别是获取销售数据是当前的研究重点。
该项目已在OpenScienceFrameworkhttps://osf.io/bd3ah上注册。
■该项目由美国国立卫生与护理研究所(NIHR)公共卫生研究计划(NIHR129968)资助,并将在《公共卫生研究》(第一卷)中全文发表。11号7.有关更多项目信息,请参阅NIHR期刊库网站。
现在可以获得比香烟危害小得多的替代尼古丁递送产品。其中包括电子烟(不含烟草),瑞典鼻烟(含有低水平致癌化学物质的口服烟草)和加热的烟草产品。有人担心这些产品会吸引年轻人吸烟,劝阻吸烟者戒烟(即增加吸烟),但它们也有可能帮助吸烟者戒烟,引导那些发现尼古丁有吸引力的年轻人远离吸烟,或者它们对吸烟没有影响。为了澄清这些最终结果中的哪一个是可能的,我们查看了吸烟和这些替代产品使用的数据,并比较了有类似烟草控制史的国家的吸烟数据,但要么允许(即英国和美利坚合众国)或禁止销售电子烟(即澳大利亚)。随着日本加热烟草制品的销售增加,香烟的销量似乎下降了,这表明该产品与香烟竞争,而不是鼓励他们使用。我们还发现,澳大利亚的吸烟率下降速度可能比英国慢。特别是对于年轻人和低收入人群,澳大利亚的吸烟率下降速度低于英国和美国.允许销售替代尼古丁产品似乎与降低而不是增加吸烟率有关。我们的发现,然而,是不确定的,因为只有有限的数据可用。随着收集更多关于使用的数据,特别是关于替代尼古丁产品的销售的数据,将有可能得出更清晰的结论。
It is not currently clear what impact alternative nicotine-delivery products (electronic cigarettes, heated tobacco products and
snus) have on smoking rates and cigarette sales.
To assess whether access to these products promotes smoking in the population.
We examined associations of alternative nicotine product use and sales with smoking rates and cigarette sales overall, and in different age and socioeconomic groups, and compared smoking prevalence over time in countries with contrasting regulations of these products. For electronic cigarettes, we examined data from countries with historically similar smoking trajectories but differing current electronic cigarette regulations (United Kingdom and United States of America vs. Australia, where sales of nicotine-containing electronic cigarettes are banned); for heated tobacco, we used data from countries with state tobacco monopolies, where cigarette and heated tobacco sales data are available (Japan, South Korea), and for
snus we used data from Sweden.
We pre-specified dynamic time series analyses to explore associations between use and sales of alternative nicotine-delivery products and smoking prevalence and cigarette sales, and time series analyses to compare trends of smoking prevalence in countries with different nicotine product policies.
Because of data and analysis limitations (see below), results are only tentative and need to be interpreted with caution. Only a few findings reached statistical significance and for most results the Bayes factor indicated inconclusive evidence. We did not find an association between rates of smoking and rates of the use of alternative nicotine products. The increase in heated tobacco product sales in Japan was accompanied by a decrease in cigarette sales. The decline in smoking prevalence seems to have been slower in Australia than in the United Kingdom overall, and slower than in both the United Kingdom and the United States of America among young people and also in lower socioeconomic groups. The decline in cigarette sales has also accelerated faster in the United Kingdom than in Australia.
Most of the available data had insufficient data points for robust time series analyses. The assumption of our statistical approach that causal interactions are more likely to be detected when longer-term changes are screened out may not apply for short time series and in product interaction scenarios, where short-term fluctuations can be caused by, for example, fluctuations in prosperity or product supplies. In addition, due to dual use, prevalence figures for smoking and alternative product use overlap. The ecological study design limits the causal inferences that can be made. Longer time periods are needed for any effects of exclusive use of the new products on smoking prevalence to emerge.
We detected some indications that alternative nicotine products are competing with cigarettes rather than promoting smoking and that regulations that allow their sales are associated with a reduction rather than an increase of smoking, but the findings are inconclusive because of insufficient data points and issues with the assumptions of the pre-specified statistical analyses.
As further prevalence and sales data emerge the analyses will become more informative. Accessing sales figures in particular is the current research priority.
The project is registered on Open Science Framework https://osf.io/bd3ah.
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR129968) and will be published in full in Public Health Research; Vol. 11, No. 7. See the NIHR Journals Library website for further project information.
Alternative nicotine-delivery products are now available which are much less hazardous than cigarettes. These include electronic cigarettes (which contain no tobacco), Swedish
snus (oral tobacco with low levels of cancer-causing chemicals) and heated tobacco products. There is concern that these products attract young people to smoking and discourage smokers from quitting (i.e. increase smoking), but it is also possible that they help smokers quit and steer young people who find nicotine attractive away from smoking, or that they have no effect on smoking. To clarify which of these end results is likely, we looked at data on smoking and on the use of these alternative products over time, and also compared data on smoking from countries that have similar tobacco control history, but that either allow (i.e. United Kingdom and United States of America) or ban the sale of electronic cigarettes (i.e. Australia). As the sale of heated tobacco products increased in Japan, sales of cigarettes seem to have gone down, suggesting that this product is competing with cigarettes rather than encouraging their use. We also found that the drop in smoking may have been slower in Australia than in the United Kingdom. For young people and those on low income specifically, the reduction in smoking was slower in Australia than in both the United Kingdom and United States of America. Allowing alternative nicotine products to be sold seems to have been linked with lowered rather than increased rates of smoking. Our findings, however, are uncertain because only limited data were available. Clearer conclusions will become possible as more data on the use and especially on the sales of alternative nicotine products are collected.