A conceptual model for measuring and understanding the possible role of alternative nicotine products and policies for reducing smoking

Research over the past decade has provided evidence for the potential of harm reduction from e-cigarettes, but there are considerable challenges along the path from potential to reality, of which a key component is the extent to which e-cigarettes can help smokers quit. Clinical trials have demonstrated the efficacy of e-cigarettes as a cessation aid, but ultimately, studies of the effectiveness of e-cigarettes for quitting smoking in the real world will tell us whether the potential of harm reduction is being realized. This presentation describes the conceptual model underlying the ITC Project’s longitudinal cohort studies being conducted across key countries where e-cigarettes and/or heated tobacco products hold an important presence in the tobacco/nicotine product marketplace. At the centre of the conceptual model is the individual user and his/her transitions (or lack of transitions) between products over time.  The possible causal forces that influence those transitions, among others, include those within the individual (e.g., history of smoking, dependence), those within the social environment (e.g., product use of close others, norms), product characteristics (e.g., nicotine delivery, flavours, ease of use), and policies and regulations on alternative products, and on cigarettes. The model is structurally symmetric in that policies and regulations on both cigarettes and on alternative products can have an impact on the individual and his/her transitions.  This presentation, which will review some recent ITC findings, will discuss important implications of this conceptual model for measuring and understanding the possible role of alternative nicotine products and policies on those products and on cigarettes in reducing smoking. It will also highlight important limitations in the role of policies in shaping those transitions.