A Multi-disciplinary Study into the Drivers of Smoking Cessation in Great Britain

Abstract

Since 2010, several nations with impressive histories of smoking cessation have witnessed the proliferation of Alternative Nicotine Delivery Systems (ANDS). Different nations have taken radically different policy approaches to ANDS, ranging from outright bans to actively encouraging use by current smokers. ANDS regulations inherit a legacy of their nations’ historical tobacco control policies, and national policies help determine the benefit or harm that ANDS confer. But the relationship between policies and ANDS-related outcomes is not well-understood. Applying the ‘lessons learned’ in one locale to drive cessation elsewhere requires that we account for these contextual specifics.

This paper presents the findings from a case study of Great Britain. It draws on an interdisciplinary framework for investigation combining sociological, ethnographic, policy analytic and econometric disciplinary approaches into a schema for studying the drivers of smoking cessation at the individual, micro, meso and macro levels. Data on ANDS use, smoking, and cessation from four decades is used to investigate the relationship between tobacco control policies, ANDS use and smoking cessation, as well as other salient aspects of the national tobacco control landscape. Specific policy recommendations are developed.

Tobacco use continues to be concentrated in socially and economically disadvantaged groups. Where regulations allowed, ANDS (e-cigarettes and heated tobacco in particular) were associated with smoking cessation. Moreover, instances of tobacco use declining even as e-cigarette use increased suggests that e-cigarettes do not necessarily re-normalize tobacco use as feared. The results demonstrate how policy decisions affect ANDS use and the latter’s value as a cessation mechanism.

The authors recommend that regulators continue to increase tobacco taxes carefully and study how to integrate ANDS with well-funded SSS. Regulators should also seek policies that differentiate among nicotine products with respect to their harms profiles. Future cessation programs should target socially and economically disadvantaged groups where tobacco harms continue to be concentrated. This research also highlights the need for high quality open-access data collection and analysis, especially regarding use of ANDS.

Keywords: Smoking, e-cigarettes, Great Britain, smoking cessation