Access to smoke-free products to curb smoking — expert

Easier access to better smoking alternatives will usher the decline of smoking prevalence, according to a British physician and tobacco control expert. 

“Governments should make e-cigarettes easily available, introduce modest regulations to reduce the risk of irresponsible marketing and product safety approaches, and give a medical endorsement,” said Dr. John Britton, the director of the UK Centre for Tobacco and Alcohol Studies. 

Britton said these are considered the key approaches for countries to adopt if they want to see smoking rates decline.

A member of the Royal College of Physicians Tobacco Advisory Group and of the board of trustees of Action on Smoking and Health, Britton said, “clinical trials have demonstrated that vaping is probably the most effective way to quit smoking. The long-term harms of e-cigarette use are not known, but they will be substantially less than those of continued smoking or of attempting to quit unaided and then, as is usually the case, failing.”

“Electronic cigarettes are a game changer―there is no going back from that. The whole market in nicotine delivery has been revolutionized by these products and I just hope that there are even more exciting products on the way,” he said. 

“Smoking prevalence in the UK is falling fast, and faster than in the US and Australia where vaping is not endorsed by national authorities. Smoking decline in the UK will have generated savings to the National Health Service,” Britton said.

Public Health England and the RCP both concluded that e-cigarettes are around 95-percent less harmful than combustible cigarettes and can serve as a potential smoking cessation aid. ASH data suggest that there are currently 3.6 million vapers in the UK―about half the number of smokers. 

According to the March 2020 PHE “Vaping in England” evidence update, smoking among adults in England has continued to decline over the past 10 years and in 2019 was around 15 percent. Most adults use vaping products to help them quit smoking. The PHE concluded that e-cigarettes may be contributing to falling smoking rates among adults and young people in the UK. 

The UK Tobacco Control Plan 2017-2022 clearly states the British government’s intention to support consumers in stopping smoking and adopting the use of less harmful nicotine products, particularly e-cigarettes. The British government said it welcomes innovation that will reduce the harms caused by smoking.

Japan has seen a remarkable drop in its smoking rate, which has accelerated in recent years with the entry of heated tobacco products in the market. In 2005, 49 percent of men and 14 percent of women in Japan smoked. In 10 years, the country’s smoking rate has decreased to 18.2 percent of the total population, results of the 2018 State of Smoking Survey show. 

Based on a new study published in the International Journal of Environment Research and Public Health on May 20, 2020, the accelerated five-fold decline in cigarette only sales in Japan since 2016 corresponds to the introduction and growth in the sales of HTPs. Cigarette sales in Japan were declining slowly and steadily before HTPs were introduced in 2015.

“If we try to put a figure on the relative risk of electronic cigarettes compared with smoking, my view is that it’s going to be well under 5 percent of the risk,” Britton said. 

Anti-vaping advocates have expressed concern over the effects of e-liquid ingredients such as propylene glycol and glycerol, as well as secondhand exposure from vaping “clouds”. 

“The lung is a delicate organ and it is best to avoid inhaling anything unnatural. But relative to tobacco smoke, glycerol and propylene glycol represent a much-reduced risk. The same is true for passive exposure to e-cigarette vapor,” Britton said. 

He said it is not yet certain how much harm is reduced when a smoker switches to better nicotine alternatives. 

“The best evidence is for snus, which has been used in Sweden for decades and for which the long-term risks are very low. The same is probably true for e-cigarettes. HTPs are also likely to be lower risk than smoked tobacco,” Britton said.