Smoking Reduction Tools: Harmful or Helpful?

Smoking Reduction

Current smoking reduction tools such as the electronic cigarette (e-cigarette) are being debated in terms of being more harmful or helpful to smokers, given the release of the latest Surgeon General’s 32nd report on tobacco. In the report, Dr. Boris Lushniak, the acting surgeon general, shared his intent to fully eliminate the use of cigarettes and tobacco – and that “enough is enough.”

However, part of this year’s controversial report stems around the harm-reduction strategy advocated in the report distinguishing between tobacco-burning products such as cigarettes, which should be eliminated, and smoking reduction tools which are surrounded by continual controversy as to whether they remain more harmful or helpful to smokers.

According to the report, the avenues of “less harmful nicotine delivery systems” include e-cigarettes, nicotine patches, nasal sprays and lozenges.

Smoking’s Deadly Impacts

In the latest report, thirteen cancers are now linked to smoking, including liver and colorectal cancer. Secondhand smoke exposure is a toxic byproduct for the smoker’s associated companions, increasing their risk for stroke by 20 – 30 percent.

The report notes the findings that while the prevalence of cigarette smoking has decreased from 42 percent in 1965 to 18 percent in 2012, it has been responsible for the premature deaths of over 20 million people since the release of the first Surgeon General’s report in 1964. Also “the burden of smoking-attributable mortality is expected to remain at…unacceptable levels for decades to come unless urgent action is taken,” according to the forward statement by Dr. Thomas Frieden, Director for the Centre of Disease Control and Prevention.

E-Cigarettes: Part of A Potential “End-Game” Strategy

The concept of “achieving a vision of a society free of tobacco-related death and disease” involves an endgame strategy that has been developed since 1994. The strategy incorporates the declining use of cigarettes and combustible tobacco products amidst a range of intervention techniques.

In 1994, Benowitz and Henningfield proposed a policy of gradual nicotine reduction in cigarettes to non-addicting levels. This approach, one of the numerous proposals set forth over the course of the years which is seen with the greatest plausibility. In 2009, the Tobacco Control Act provided the FDA with the authority to address product toxicity, amongst other tools to regulate cigarettes and smokeless tobacco products.

Products such as e-cigarettes are viewed as strategies to complement an end game strategy – however, as the report notes, “the potential risks of continuing the use of [these products with] addictive levels of nicotine on the population” still requires a considerable evaluation.

Electronic Cigarette Adoption Has Risen Rapidly Over Time

The electronic cigarette has been rapidly adopted in both the young adult and adult population and the Surgeon General report recommends continuous rigor in monitoring of the level of adoption and consumer uptake. A large amount of data is indicative that the adoption of the electronic cigarettes is increasing in usage. HealthStyles Survey data reveals that the usage of electronic cigarettes doubled for adults between 2010 – 2011, from 3.3 percent to 6.2 percent. In the same year, for current cigarette smokers, their electronic cigarette usage increased from 9.8 percent to 21.2 percent, while for ex-smokers, their usage also increased from 2.5 percent to 7.4 percent.

Electronic cigarettes are battery-operated imitation cigarettes containing nicotine. Currently, both New York and now Chicago have instituted bans on e-cigarettes from most public indoor places. Chicago has also instituted rules making it more difficult for retailers to sell to minors.

“It might be possible that things like e-cigarettes in the future will have a positive role,” notes Frieden. However, right now he remains skeptical. “As they’re being rolled out now, I have grave concerns that they’re doing more harm than good.” The ultimate conclusion? While smoking reduction tools such as the electronic cigarette are currently available, whether they are more harmful or helpful continues to be cause for a debate which still remains to be solved.

By Joscelyne Yu

US Department of Health and Human Services
Time Magazine

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