Smoking alternatives need to be reconsidered

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Earlier this year, the American Lung Association (ALA) concluded that the U.S. is not doing enough to help Americans stop smoking.

A quick glance at the statistics and those findings appear slightly harsh. Smoking rates in the US have tumbled from 20.9 percent of adults in 2005 to 15.5 percent in 2016.

This decline has undoubtedly been a major public health success, yet the ALA is still not satisfied.

The State of Tobacco Control report was highly critical of the US’ taxing and regulation and decidedly lukewarm about the work was done at state level. “To complete the promise of a tobacco-free America, we need to do more to ensure that policies have proven to reduce tobacco use and the harms of second-hand smoke reach all Americans,” said ALA national president and CEO Harold P Wimmer. Mr. Wimmer went on to discuss smoking prevention, hiking tobacco taxes, increasing tobacco sales to those aged 21 or over, medication and counseling for quitters, and the issue of second-hand smoke.

Conspicuous by their absence were electronic cigarettes and heat-not-burn tobacco products. In late 2017, New York became the 11th state to ban electronic cigarettes indoors, with others expected to follow. It highlights American skepticism towards a product which many other countries view as a blessing in the battle against smoker numbers.

Across the pond in the UK, electronic cigarette use is now somewhere between 4-6 percent of the population. The UK has also seen smoking numbers plunge – a fall which has been linked to such an extent with electronic cigarettes that Public Health England (PHE) has started encouraging their use as a quitting aid.

It is an approach often viewed with suspicion in the US – particularly amid fears that such a tolerant view will normalize smoking for children. In December, the annual Monitoring the Future survey concluded that more US teenagers had tried vaping than cigarettes. That is made all the more pertinent given studies such as that found in the journal Tobacco Control last year claim that some 6.6m premature deaths could be avoided by 2100 if the majority of US smokers switched to electronic cigarettes.

Put bluntly, a review of America’s approach to smoking alternatives is in order.

The picture is set to become even hazier with the rise of heat-not-burn alternatives, which work by heating tobacco to a far lower temperature than a standard cigarette to give off a vapor. A number of public health bodies – from Germany’s Federal Institute for Risk Assessment (BfR) and the independent Committee on Toxicity of Chemicals (CoT) – have given favorable reactions to heat-not-burn technology.

Analyzing two high-profile models, the CoT found that users are exposed to between 50 and 90 percent fewer ‘harmful and potentially harmful compounds’ found in regular cigarettes. The BfR also concluded that the emission of volatile organic compounds decreased by 90 to 99 percent.

PHE is the latest to wade into the debate, claiming in its most recent report that heat not burn products are ‘likely to expose users and bystanders to lower levels of particulate matter and harmful and potentially harmful compounds’. Even the US Food & Drug Administration has accepted that switching entirely from cigarettes to heat-not-burn ‘significantly reduces your body’s exposure to harmful or potentially harmful chemicals’.

With heat-not-burn products being marketed as a half-way house between traditional cigarettes and their electronic counterparts, those findings make for positive reading for those hoping to see the US adopt more of a harm reduction strategy towards smoking.

Australia – a country with some of the strictest laws regarding smoking in public, electronic cigarette distribution and tobacco taxation – earlier this year made the shock announcement that the consumption of cigarettes has risen for the first time in more than a decade, despite having seen numbers fall steadily in recent years.

There is no evidence to suggest the US will follow suit, but there is the very real danger that the huge strides made in cutting smoking numbers could go to waste if the ongoing resistance towards viable smoking alternatives is not addressed.