Innovative and aggressive measures urgently needed to facilitate quitting smoking — E-cigarette Summit 2022

As cigarette smoking continues to claim millions of lives each year innovative and aggressive measures are urgently needed to facilitate quitting smoking among the almost 70% of smokers who want to quit.

This was amongst the topics under discussion on Tuesday during the E-Cigarette Summit USA, 2022 under the topic ‘Nicotine product standard for combusted tobacco: support and barriers’, that took cognizance of the fact that cigarettes are killing more than 480,000 smokers each year in the US alone.

Presenter Prof Dorothy Hatsukami – Professor in the department of psychiatry and associate director of cancer prevention and control for the Masonic Cancer Center at University of Minnesota — proposed that the innovative methods for smoking cessation include eliminating or reducing the attractiveness of a product — such as banning characterizing menthol flavour.

Prof Dorothy Hatsukami

“However, the approach that will lead to the greatest reduction in the prevalence of smoking is likely to be reducing the addictiveness of cigarettes,” she said. “Recently, researchers have been systematically and comprehensively examining the potential effects of a nicotine level product standard for cigarettes.

“To date, results from randomized clinical trials indicate that, compared to smokers assigned to smoking normal nicotine content cigarettes, those who are assigned to very low nicotine content (VLNC) cigarettes reduce the number of cigarettes per day, and as such lower exposure to toxicants and cigarette dependence. They also exhibit a comparatively higher rate of cessation and quit attempts.

“These results are found among smokers with the greatest prevalence of smoking who experience the greatest health disparities.” Prof Hatsukami further said “results also suggest that reducing the reinforcing value of cigarettes facilitates the uptake of alternative nicotine delivery systems, such as e-cigarettes”.

“This uptake augments the beneficial effects of VLNC cigarettes. Modelling population impact showed that 8 million tobacco-related deaths could be averted by the turn of the century.

“However, despite these promising findings, several barriers against a nicotine product standard exist such as:
1) a sentiment that reducing nicotine in cigarettes is a draconian measure and smacks of prohibition and that access to alternative products under the right circumstances should be sufficient;
2) similarly, the belief that such a standard would be an infringement on a person’s rights and freedom to choose whether to smoke or not;
3) the potential for a flourishing illegal market to emerge;
4) misconceptions about nicotine (e.g., nicotine causes cancer so reducing nicotine will reduce cancer risk); and
5) inadequate resources for those who need or want to continue to use nicotine more safely.

In his presentation, Ben Youdan – Director of Youdan Consulting in New Zealand — also highlighted New Zealand’s harm reduction plans to end smoking, saying “vaping has had a profound impact on reducing smoking rates” in that country in recent years.

“Even though this has been accompanied by youth uptake, the Government has not been deterred from seeing vaping as an important tool for reducing the disproportionate toll of smoking on public health.

“In late 2021, the New Zealand Government published their smokefree plan to get adult smoking rates under 5% by 2025. The plan is notable in that it considers harm reduction and vaping a perquisites for success.

He quoted the New Zealand Government as declaring: “We will not achieve our goal of Smokefree 2025, however, until our current regulatory settings reflect a more risk-proportionate framework. We can ensure this by making smoked tobacco products more regulated and less available than vaping products”.

The plans to dramatically reduce nicotine content, additives, flavourings and severely limit access will focus exclusively on combustibles, with the deliberate intention to ensure vaping products remain more affordable, accessible, and ultimately the main source of non-pharmacological nicotine for adult users.

Youdan went on to unpack New Zealand’s approach to vaping and smoking; the evidence, the experiences and ideologies that have informed it, and how harm reduction has become a cornerstone of their plans for a smokefree nation.

Latest developments on vaping from England indicate that the current tobacco control plan ends in 2022 and plans and consultations are underway to inform the next one which is due to be published in the spring.

Last autumn the Medicines and Healthcare products Regulatory Agency published updated guidance on e-cigarettes with an intent of facilitating and expediting progress on making licensed e-cigarettes available in the UK.

He also highlighted that the last evidence update of e-cigarettes commissioned by the Office for Health Improvement and Disparities is underway and will be the largest ever — covering health effects of e- cigarettes as well as the usual chapters on current use among adults and youth, as well as health perceptions.

In his keynote address under the theme: ‘Thinking Outside the Box on E-cigarettes’ David L. Ashley — Research Professor (Department of Population Health Sciences, School of Public Health, Georgia State University) — said substantially reducing the number of people smoking combusted tobacco products and minimizing the initiation of their use by non-smokers, especially youth, presents an objective that would have a profound impact on reducing the preventable disease and premature death from tobacco product use.

“Because their use mimics smoking, delivers substantial amounts of nicotine quickly, and delivers significantly less harmful and potentially harmful constituents during exclusive use compared to smoking, e-cigarettes are a tool that could make a major positive impact on overall population health.

“However, to date, e-cigarettes have not met their potential with too many adolescents starting their use and too many smokers either becoming dual-users or rejecting e-cigarettes and relapsing to smoking.

He discussed some of the current approaches and proposed some out-of-the-box ideas for consideration that are intended to encourage the conversation of how to maximize the potential benefits of e-cigarettes for reducing morbidity and mortality of tobacco smoking while minimizing the unintended consequences.


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