April 14, 2016

expert reaction to study looking at e-cigarettes, point-of-sale displays, and teenagers

E-cigarettes are a relatively new technology and their positive and negative effects are subject to extensive debate. Publishing in the BMC Public Health journal a group of researchers have reported that in their study adolescents who recalled seeing e-cigarettes in shops were more likely to have tried vaping.

All of our previous work on this subject can be found here. The SMC also produced a Factsheet on e-cigarettes.

Prof. Paul Aveyard, Professor of Behavioural Medicine, University of Oxford, said:

“This is a useful study to monitor exposure to advertising, but the study design is not appropriate to make causal inferences despite the careful analysis. The authors found that young people who recalled e-cigarette advertising were more likely to intend to use e-cigarettes in the future and suggest this could be because the advertising prompts them to intend to do so. However, an obvious explanation is that people with no interest in smoking or e-cigarettes will tend not to notice them on display, whereas those who do will notice them. We look at what we are interested in and this is the most likely explanation of the study’s findings.

“It is also important to remember what else this study found. The main group of young people that use e-cigarettes are those young people that already smoke. Switching to e-cigarettes is likely to benefit younger smokers, just as it does older smokers. The study provides no evidence that point of sale displays are creating a generation of young people who do not smoke but regularly use e-cigarettes. Given the impact of point of sale displays on adults wanting to reduce the harm from smoking, it is important to maintain these unless there is clear evidence of unintended consequences, which this study does not provide.”

Prof. Peter Hajek, Director of the Tobacco Dependence Research Unit, Queen Mary University of London (QMUL), said:

“The study reports two findings. Firstly, it found that vaping appeals primarily to adolescents who smoke. This corresponds to numerous other studies that confirm that e-cigarettes can attract smokers but that they have very little appeal to non-smokers who may try them but rarely if ever progress to daily vaping.

“Secondly, there is a rather obvious finding that interest in vaping is linked to noticing e-cigarettes in shops. It is not clear which comes first, but even if seeing e-cigarettes generated such interest, it would not warrant much concern. Such exposure affects primarily smokers and as vaping is much safer than smoking, smokers of any age benefit greatly if they switch to vaping.”

Prof. Robert West, Professor of Health Psychology, UCL, said:

“As phrased, the conclusions of the study could easily mislead readers. First, almost everyone in the sample who used an e-cigarette was already smoking, so the study has no bearing on whether point-of-sale advertising of e-cigarettes leads young non-smokers to use them, which is the inference most people are likely to draw (there being no obvious reason to be concerned about smokers trying e-cigarettes in an attempt to stop).

“Secondly, the results could simply be due to people who have tried e-cigarettes being better able to recall having seen e-cigarette advertising. Researchers need to set a higher bar for methodological quality when deciding whether to press-release findings in this area.”

‘Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study’ by Catherine Best et al. published in BMC Public Health on Thursday 14 April 2016. 

Declared interests

Prof. Paul Aveyard: “Paul Aveyard receives research funding from the MRC, NIHR, ESRC, and Cambridge Weight Plan and has no consultancy or other financial relationships with any private companies.  He is chair of Cancer Research UK Tobacco Advisory Group.”

Prof. Peter Hajek: “I received research funding and provided consultancy for manufacturers of stop-smoking medications (nicotine replacement products and varenicline). I have no links with any e-cigarette manufacturers, my research into safety and effects of e-cigarettes is funded by MHRA, PHE, NIHR and UKCTAS.”

Prof. Robert West: “I have not and will not accept any kind of funds, payments or hospitality from companies that make e-cigarettes because of the risk of being perceived as tainted on that count. I undertake research and consultancy for companies that manufacture smoking cessation medications and licensed nicotine replacement products. My salary is funded by Cancer Research UK.”