Inside the Nudge Unit: How small changes can make a big difference by David Halpern

Author:David Halpern [Halpern, David]
Language: eng
Format: epub
ISBN: 9780753551387
Publisher: Ebury Publishing
Published: 2015-08-27T05:00:00+00:00

One concern was that e-cigs might pull in non-smokers, but, again, the numbers did not suggest this. There was a tiny fraction of non-smokers who had used e-cigs, but this number was similar to that of non-smokers who, perhaps surprisingly, sometimes used NRT (for example, the BBC’s Sherlock Holmes). There was also the concern, voiced particularly in the USA, that e-cigs were being used by some smokers instead of quitting. With two million e-cig users in the UK, and around 12 million in the USA, it was clear that there was a growing population of smokers who were using a mixture of e-cigs and smoking. But the evidence still suggested that this was still better than just smoking, and more importantly, the rising quit rate strongly suggested that the overall effect was positive.

We took the evidence back to the PM and the Cabinet Secretary. As it happens, David Cameron was one of the only people in No. 10 who had been a smoker, and had once even tried an e-cig (he wasn’t especially impressed). We took the decision to stick to our line: to ensure that, for now at least, e-cigs should be widely available; to push for light-touch regulation to ensure that they were free of other toxins but had enough nicotine to satisfy smokers’ cravings; and to legislate to ensure that they were not to be sold to under-18s. Available, but safe, was to be our line.

Based on behavioural and other evidence, and with the help of a new Public Health Minister and our European and Global Issues Secretariat (EGIS), this is the line we took and pushed and more or less secured in the UK and Europe. It is a situation we continue to watch. Depending on your assumptions, estimates suggest that from 20,000 to 200,000 extra smokers are quitting a year as a result of the availability of e-cigs in the UK alone. It is difficult to be completely sure about the precise effect, since other changes, such as restricting the visibility of tobacco products sold in stores, also occurred over this period, though estimates of the impact of this change are much smaller than that of e-cigs. We also cannot be sure what their impact would be in other countries that have less aggressive tobacco control than the UK. Nonetheless, the pivotal gain from e-cigs seems to be that they make quit attempts more frequent and more likely to be successful.

The evidence also suggests that, unlike conventional information campaigns to encourage quitting, e-cigs appear to be encouraging increased quitting in all socio-economic groups. For higher socioeconomic groups, smoking rates fell 2 percentage points from 2008–9 to 2014 (from around 15 to 13 per cent). For lower socio-economic groups, they fell 4 percentage points (from around 29 to 25 per cent) – a bigger absolute fall but proportionately similar. The net effect, given the extensive harm caused by smoking, will be to reduce health inequalities. E-cigs seem to be able to help people quit across all

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