Americans love new technology, from reusable rockets to robotic microsurgery. So, why is there so much opposition to new technologies that can replace traditional cigarettes with a product far less harmful?
That was one of the questions at the recent Nicotine and Tobacco Science Conference at the Medical University of South Carolina in Charleston. The participants shared a wide range of views, from the benefits of transitioning smokers to alternatives like vaping and pouches and concerns over young people consuming smokeless tobacco products.
As the Food and Drug Administration continues wrestling with its policies on tobacco alternatives, researchers like Shannon Gravely, a research assistant professor with the International Tobacco Control Policy Evaluation Project at the University of Waterloo, say the benefits are clear.
“Many people are saying they’re vaping to help quit smoking,” she said at the conference. “Some say they vape to keep from relapsing to smoking. It needs to be part of health guidelines that vaping can help quit smoking.”
One frustration repeatedly expressed by presenters was that public health officials’ bias against nicotine kept them from looking objectively at the research regarding alternatives to traditional cigarettes.
Jonathan Foulds, a Penn State University Department of Public Health Sciences professor, recalled the reaction when he spoke at a World Health Organization meeting in the 1990s.
“The meeting went apoplectic when I said there was less harm from smokeless tobacco,” Foulds said.
Foulds has focused his career on helping people beat tobacco habits. He said products such as Snus, a Swedish product that is consumed by placing a pouch of powdered tobacco in the mouth, have fewer adverse health effects than regular cigarettes. He said that rates of oral and lung cancers are lower for Snus users.
He also pushed back on concerns expressed that alternatives to combustible cigarettes were a danger to teens.
“They deliver a meaningful amount of nicotine,” Foulds said of different products available to replace cigarettes. “They’re not causing a major use problem in young people.”
Nonetheless, the issue of young people taking up these products, particularly disposable vapes, remains contentious.
The rate of young people taking up products advertised as alternatives remains a concern to regulators and researchers, but comparisons among the various products remain elusive, according to David Ashley a research professor in the School of Public Health at Georgia State University. The companies constantly innovate and offer improvements, but the Food and Drug Administration has yet to say what constitutes a “substantial change,” Ashley said.
“New products should be improvements over the other products on the market, but what is innovation?” Ashely asked. “Industry tries to innovate to sell more products. Innovation should be a factor of public health and not a way to simply sell more products. (We should) require new products to show innovation is an improvement over what’s already available.”
He also said comparisons need to be made between related products, so heated tobacco products should be compared to vaping products and not traditional cigarettes.
While vaping products have created divisive ideas between public health officials, regulators and researchers, Waterloo researcher Gravely said there’s a balance between disincentivizing usage among minors and promoting the benefits for adults.
“E-cigarettes can help people quit,” said David Hammond, a professor in the School of Public Health Sciences at the University of Waterloo. “These products can play a role in ending tobacco addiction.”
Hammond presented research looking at the rates and patterns of 16- to 19-year-olds, which suggested that regular usage among that demographic is giving researchers better insight into perceptions of addiction and trends. While demand for nicotine among youth in Canada remains high, there is a growing interest in nicotine pouches and other smokeless products.
There are other ways to help smokers kick the habit, said Jed Rose, a leading smoking cessation expert who is running trials involving adaptive treatment algorithms and drug therapies.
“We want to have treatments that will be easily adopted by a lot of people,” Rose said. “While counseling and behavior therapy are efficacious, few smokers avail themselves of intensive behavioral treatment approaches. Therefore, our trials seek to test pharmacological treatments and harm reduction approaches that model real-world conditions, and which can be efficacious even when intensive behavioral treatment is not accessible.”
One thing the conference attendees agreed on: Cigarette smokers and public health professionals want smoking to stop. Hammond noted that data showing 90 percent of cigarette smokers say they regret having started.
“It’s about reach and getting more smokers to try better treatments and sooner,” Hammond said.
