With global smoking estimated to reach 1.5 billion smokers by 2050, the World Health Organization and other public health stakeholders are attempting to manage this epidemic by proposing comprehensive tobacco control policies, such as banning cigarette advertising, regulating the appearance of traditional cigarettes and implementing tax increases.
In addition to public and NGO efforts to achieve the goals we advocate, such as preventing smoking initiation and promoting smoking cessation, more diverse approaches among public health experts and regulators are on the agenda around the world. There is growing support for the view that providing cigarette consumers with access to less harmful alternatives and encouraging them to switch to these products can reduce individual risk and harm to society, and thus provide a significant public health benefit. This approach is called the “tobacco harm reduction approach”. This means that there is a growing consensus that adult smokers should have access to smokeless alternatives to cigarettes and should be informed about these products.
Thousands of chemicals are released during the combustion process of cigarettes. These chemicals are the primary cause of smoking-related diseases. The tobacco in cigarettes burns at temperatures exceeding 600 C° and at such high temperatures the tobacco turns to ash and more than 7,000 chemical compounds form harmful cigarette smoke (Rodgman and Perfetti, 2013). Among these, there are high levels of Harmful or Potentially Harmful Constituents (HPHC).
As the U.S. Surgeon General (“U.S. Department of Health and Human Services, 2010”) notes, “inhaling the complex mixture of chemical compounds that form in tobacco smoke as a result of combustion has adverse health consequences, including cancer and heart and lung disease, through mechanisms that include DNA damage, inflammation and oxidative stress.
Reducing the total number and levels of harmful and potentially harmful constituents has been a promising method to reduce toxicity and risk compared to continued smoking. Fifteen years ago, the US Institute of Medicine (US IOM, 2001) commented that “for many diseases attributable to tobacco use, reducing disease risk by reducing exposure to toxicants in tobacco is a biologically and clinically feasible approach”.
All Electronic Nicotine Delivery Systems (ENDS) products contain nicotine. Although these products are often considered a single class of products, they are a diverse group with significant potential differences in the generation of toxic substances and nicotine delivery.
If the vast majority of tobacco smokers who are unable or unwilling to stop using tobacco switch without delay to an alternative source of nicotine that is less risky to health and eventually stop using this source, this would be a significant public health achievement. This requires that the proportion of minors and non-smokers joining the nicotine-dependent population should not be higher than the proportion joining the smoking population and should decrease to zero over time. The issue of whether ENDS can do this work is a matter of debate between those who want the use of these products to be promoted and approved quickly, based on the available evidence, and those who want caution, given the existing scientific uncertainties, variations in the performance of the products and the diversity of user behavior.
Also in 2021, the US Food and Drug Administration (FDA) announced that it had licensed products that encourage users to quit and reduce smoking. While confirming that these products are appropriate for the protection of public health, it underlined the need for years of scientific study and research to ensure that adult smokers aged 21 and over have access to innovative and potentially less harmful alternatives to traditional tobacco products.
The harm reduction approach in tobacco and the use of new generation tobacco products are becoming more and more widespread in the world and have been included in the public health policies of some countries such as the UK and New Zealand, which have been successful in the fight against smoking by reducing the prevalence. We think that the issue should be evaluated in the light of scientific research in our country where the prevalence is very high, and we share with you the articles published on it.
Rodgman, A. & Perfetti, Thomas. (2013). The Chemical Components of Tobacco and Tobacco Smoke, Second Edition.
https://www.researchgate.net/publication/294261056
Berg CJ, Bar-Zeev Y, Levine H. Informing iQOS Regulations in the United States: A Synthesis of What We Know. Sage Open. 2020 Jan-Mar;10(1):10.1177/2158244019898823. doi: 10.1177/2158244019898823. Epub 2020 Jan 9. PMID: 32719733; PMCID: PMC7384757.
https://pubmed.ncbi.nlm.nih.gov/32719733/