E-cigarettes are considerably safer than combustible cigarettes and help people to stop smoking. However, numerous researchers in the field have raised concerns that e-cigarettes may cause unintended harm for other smokers. They argue that exposure to other people using e-cigarette may be ‘renormalizing’ smoking, which could make smokers less inclined to stop.
These concerns have been supported by evidence from small experiments that shown that asking smokers to watch video advertisements depicting e-cigarette use, or having someone use an e-cigarette in front of them in person, increases their desire both to use e-cigarettes and to smoke combustible cigarettes.
But what wasn’t known until now was whether regular exposure to other people using e-cigarettes affects motivation or attempts to stop smoking in the general population of people who smoke. This is important because it is likely that the impact of single exposure to an unknown person using an e-cigarette differs to the impact of regular exposure to e-cigarette use by a close social connection such as a friend, relative or colleague. It is also important to assess the extent to which experimental findings generalize into real-world situations.
A key factor underpinning these differences was that smokers who are regularly exposed to e-cigarette use by others were more than twice as likely to use e-cigarettes themselves.
In a new study published today in BMC Medicine, we explored relationships between regular exposure to e-cigarette use by other people and smokers’ motivation to quit and attempts to stop smoking. The research involved 12,787 smokers who took part in the Smoking Toolkit Study, an ongoing monthly survey of adults living in England.
We found that one in four smokers were regularly exposed to someone else using e-cigarettes in their presence. Contrary to expectations, those who were regularly exposed to e-cigarette use by others were in fact more likely to be highly motivated to quit (16.6%) than those who were not (14.2%). In addition, more had tried to stop smoking in the past year (32.3% vs. 26.8%, respectively).
A key factor underpinning these differences was that smokers who are regularly exposed to e-cigarette use by others were more than twice as likely to use e-cigarettes themselves. Once we took people’s own use of e-cigarettes into account, there was no evidence of an independent association between exposure to e-cigarette use by others and either motivation to stop smoking or quit attempts.
Interestingly though, people who were exposed to use of combustible cigarettes by others were less motivated to quit even after accounting for a range of personal and smoking-related characteristics.
The results of this study may help to alleviate concern that the surge in popularity of e-cigarettes may be renormalizing smoking in England and discouraging smokers from trying to stop. Having found no evidence for an adverse impact of e-cigarette exposure on non-users, our findings should offer some reassurance in terms of the wider public health impact of e-cigarettes; particularly given evidence that the alternative, cigarette smoking, may reduce other smokers’ motivation to quit.