Product transitions among smokers before and after implementation of the European Tobacco Products Directive: Cohort study findings from the EUREST-PLUS ITC Europe Surveys

Background Product transitions among smokers may be due to many factors, including shifts in the tobacco control regulatory environment. In the European Union (EU), the implementation of the European Tobacco Products Directive (TPD) in May 2016 precipitated the possibility for consumer transitions between products. Objectives The aim of this study was to examine trends and transitions in types and combinations of products used from 2016 to 2018, before and after TPD implementation, in six EU Member States. Methods Longitudinal data come from Wave 1 (pre-TPD) and Wave 2 (post-TPD) of the EUREST-PLUS ITC Six European Country Surveys, a cohort study of adults who at the time of recruitment were smokers, from Germany, Greece, Hungary, Poland, Romania, and Spain (n=3195). Bivariate and logistic regression analyses of weighted data were conducted using SAS-callable SUDAAN. Results At Wave 2, the majority of respondents smoked factory-made (FM) cigarettes only (61.5%), followed by roll-your-own tobacco (RYO) only (15.2%), both FM and RYO (7.5%), and any cigarette plus electronic cigarettes (e-cigarettes) (3.3%), while 0.8% quit and used e-cigarettes and 11.8% quit. Overall, among those who smoked FM only at Wave 1, 4.3% switched to RYO only. Among RYO only users at Wave 1, 17.0% switched to FM only. However, compared to all other countries, respondents from Hungary had the highest percentage of FM only users at Wave 1 switch to RYO only at Wave 2 (18.0%). Conclusions The most prominent transition overall was from smoking RYO exclusively at Wave 1 to smoking FM tobacco exclusively at Wave 2. In Hungary, however, nearly one-fifth of exclusive FM smokers transitioned to RYO tobacco, significantly higher than the other countries. As the tobacco control regulatory environment of the EU develops, it is important to continue to monitor transitions between types of products, as well as trends in cessation.