The team (Robert West, Martin Jarvis, Susan Michie, and Jamie Brown) explain that declines in smoking prevalence are believed to slow over time naturally. This is because it is felt the smoking population “hardens”, therefore “progress has come primarily from reducing uptake rather than increasing cessation.”
“Hardening’ is the idea that decreases in prevalence result in a greater proportion of remaining smokers having lower motivation to quit and/or greater dependence. This ‘hardening hypothesis’ is relevant to the debate about how far innovation in tobacco control is required to move to the ‘endgame’, where only a tiny minority of people smoke.”
The paper constitutes the first one to look at the hardening hypothesis across the whole population, something the team believes is important “for informing future tobacco control policies internationally.”
They note: “A further contentious issue that has arisen more recently is whether the increase in prevalence of e-cigarette use in countries such as the UK and the US may be renormalising smoking and preventing declines in smoking prevalence that might otherwise have occurred. Conversely, e-cigarette use may be accelerating the decline in smoking prevalence because of smokers switching to these products. If e-cigarettes are promoting smoking cessation, this is important in terms of national and international policies regarding regulation of e-cigarettes.”
They modelled trends in “cigarette smoking, ever-smoking in young people and quit ratios using annual data collected between 1973 and 2016 from the General Household Survey (GHS)/General Lifestyle Survey (GLF), the Annual Population Survey (APS) and the Integrated Household Survey (IHS). These surveys cover the population of Great Britain (England, Wales and Scotland).”
The results led the team to conclude: “The persistence of a near linear decline in smoking prevalence does not support concerns that increase in prevalence of e-cigarette use—as has been observed in Great Britain since 2011—would renormalise smoking and prevent declines that might otherwise have occurred.”
“In fact, the trend observed is consistent with a time series analysis conducted in 2016 over a time period of 10 years, which suggested that e-cigarettes have contributed to the decline in smoking prevalence by helping some smokers to quit successfully. That study showed an increase in the success rate of quit attempts associated with the increase in prevalence of e-cigarette use, after adjusting for a wide range of potentially confounding factors including policy initiatives.”
The findings amount to a sixfold increase in quit rates as vaping gained in popularity in Great Britain. No doubt the Daily Telegraph and Mail Online will cover this story later on today.