BY OWN CORRESPONDENT The switch from combustible cigarettes to tobacco harm-reducing alternatives such as snus a moist powdered tobacco usually held between the mouth and lips has demonstrably led to a “decline in smoking by reducing initiation and increasing cessation” in countries such as Norway and Sweden, experts say.
However, policymakers in public health, some of who continue to be influenced by the prohibitionist tobacco control movement, seem reluctant to acknowledge the positive public health outcomes.
While there were fears that the decline in smoking would lead to the unintended consequence of an increased uptake in non-combustible alternatives such as snus among ‘never-smokers’, this has been disproved by experiences in Norway over the past two decades.
“Nicotine products have an important role to play within the tobacco harm reduction paradigm and as long as ‘ever-smokers’ make up the majority of users among these products, it’s okay, benefits are huge, but, as smoking declines . . . there is a risk that eventually ‘never-smokers’ may start to make up the majority among users, and this might tip the net public health benefit from positive to negative,” said Karl Lund, a senior researcher at the Norwegian Institute of Public Health, at the recent Virtual E-Cigarette Summit.
However, as of 2020, the proportion of ‘ever-smokers’ among snus users in Norway stood at 60%, while ‘never-smokers’ made up 40%, representing an overall substantial decline in risk.
Literature reviews indicate that snus is 90 percent less harmful than smoking.
nus makes up 5% of the risk from smoking, then approximately 20 ‘never-smokers’ will have to start using snus to balance out public health gain for every smoker who completely switches to snus.
“Therefore the proportion of ‘never-smokers’ among snus users will have to be approximately 20 times greater than the proportion of former smokers in order to tip the net public health effect from positive to negative.
- Chamisa under fire over US$120K donation
- Mavhunga puts DeMbare into Chibuku quarterfinals
- Pension funds bet on Cabora Bassa oilfields
- Councils defy govt fire tender directive
Keep Reading
“Snus has clearly contributed to the decline in smoking by reducing initiation and increasing cessation and this has had a positive effect on public health.”
It is, however, believed that policymakers continue to implement market restrictions on snus and other non-combustible nicotine products from the markets “because of their redundancy to cure smoking”.
In her presentation at the same summit, Robbie Robson, a senior lecturer in tobacco harm reduction at King’s College London, said the meaning of tobacco harm reduction has evolved since the 1980s and there was need to expand the definition to the type of harm people who smoke would like to see reduced.
She said all smokers those who are able to, those who try to quit but cannot and those who do not want to quit nicotine have to be supported.
“Let’s take the people back to the centre of what we do.
“The conversations on tobacco harm reduction have largely focused on the products and what I think is increasingly overlooked is the person, they get caught in the crossfire of our debates,” Robson said.
According to latest data from the STS, Smoking Toolkit Study, which is run by University College London, 37% of smokers tried to quit in the last 12 months – the highest number of quit attempts in England since 2014 but less than a tenth (nine out of 100) managed to stop smoking.
It means 91 out of 100 could not quit or did not want to quit, and yet they could switch to less harmful alternatives.
Clive Bates, the director of Counterfactual Consulting Limited, says “promoting harm-reducing alternatives is being resisted by ‘huge coalitions of organisations’ led by people who perceive themselves as warriors in battle against an evil tobacco industry.
A massive machine was constructed to fight smoking consisting of research infrastructure, a whole international treaty (FCTC), conferences and so on, regulators who are involved in regulation and engaged in this, philanthropists who have put over US$1 billion into it, philanthropists that are also influential and under the skin of the World Health Organization (WHO).
Huge coalitions of organizations have been formed around this. You put those things together – the cultural inertia and the institutional inertia and you have a very formidable complex force that is dedicated to fighting smoking,” said Bates.
He said the WHO Framework Convection on Tobacco Control (FCTC) is based on a playbook that is static, coercive, punitive and obsessed with restriction, punishment and stigma.
But banning tobacco is not the solution.
In the early 2000s, a ban in cigarettes in Bhutan once regarded as a poster child for prohibitionists led to a growing illegal trade in tobacco and its products.
Similarly, a January 1, 2019 ban on e-cigarette flavours in San Francisco resulted in an increase in teenage smoking.
However, there is growing optimism that non-combustible products driven by new technologies would likely obsolete smoking in the same way electric vehicles are replacing combustible engines.
Bates ended by stating that “In the end, the underlying benefits of these technologies will prevail and all of this noise and vitriol will subside and be forgotten, and we will have much more sensible ways of using nicotine.”
