The use of e-cigarettes and other smokeless nicotine products has probably reduced smoking among young people. This is according to Fabio Beatrice, a doctor and scientific director of the Italian organisation MOHRE. He is now joining other health scientists and doctors in calling for the implementation of a harm reduction strategy in the WHO Tobacco Convention and in the upcoming EU review of both nicotine taxes and frameworks.
Smokeless nicotine products are likely to come under scrutiny when WHO gathers to discuss future tobacco convention in November. And despite strong opposition from the anti-tobacco movement both inside and outside the WHO, a group of doctors and scientists hope that a broader perspective on harm reduction will gain greater support among member countries.
"Where alternatives to cigarettes are more available, smoking is declining. We have seen a dramatic reduction in cigarette smoking, not least among young people. Countries that have not demonised new products show the best results" says Fabio Beatrice, Scientific Director of the MOHRE Scientific Committee, at a conference on harm reduction organised by organised by the organisation in September.
"Young people are experimenting"
However, he points out that cigarette smoking is still prevalent in the younger age groups, taking Italy as an example.
"About one in three school students has tried cigarettes at least once. It is a phenomenon linked to the typical experimentation phase at this age, and this particular one is difficult to eliminate. However, data from the last thirty years show a clear decline: from 70 to 30 per cent in overall prevalence and from 20 to 8 per cent in terms of daily consumption." says Fabio Beatrice.
No increase in smoking - despite concerns
However, according to a high-profile report, there is a risk that the use of smokeless nicotine products may lead to more smoking later in life. The report received a lot of media attention. At the same time, the report has been criticised. Based on the data available today, it is not possible to draw any direct conclusions about this particular link. Most of the studies in the report did not look at causal relationships, but simply found that the same young people who try e-cigarettes (or snus) at some point also try smoking.
"The scientific debate is unfortunately full of bias and strong emotions on the nicotine issue. Unfortunately, this contributes to the confusion of smokers, who are not properly informed about the relative risks of harm between cigarette smoking and e-cigarettes, heated tobacco or other smoke-free alternatives." says Fabio Beatrice.
Sweden has become the centre of attention
In Sweden, the use of smokeless nicotine has increased dramatically since 2019. At the same time, overall nicotine consumption has remained static across generations in recent years, while smoking has declined. Sweden, together with United Kingdom, Japan and New Zealand, are often used as examples of countries where harm reduction in the nicotine market has had a positive impact.
Nevertheless, the youth issue has become central to the anti-tobacco movement's position. Within the EU, the debate on the appropriate regulation of both nicotine pouches and e-cigarettes is currently raging. In the future, this could mean banning key elements of the products to reduce their appeal to young people. Flavours and restrictions on availability are two key issues at the moment.
Flavours are important in smoking cessation
Kostantinos Farsalinos, physician and active in the Department of Public and Community Health, University of Western Attica, Greece, says the WHO and EU Commission health officials need to take a scientific approach to the situation.
"The debate on flavourings in harm reduction tobacco products is based solely on emotional arguments about young people, and ignores a significant body of evidence about their importance for smoking cessation and the effects of restrictions," says Kostantinos Farsalinos. "Future regulation of e-cigarettes should take into account their impact on smokers. Research highlights important data: the use of flavours NOT similar to tobacco and cigarette smoke has been consistently associated with a higher likelihood of quitting smoking. At the same time, severe restrictions or bans have led to the creation of a black market, both in developing and developed countries. Moreover, there is good evidence to suggest that they may even increase smoking."
Crucial role in harm minimisation
According to Konstantinos Farsalinos, who has been researching the health risks of e-cigarettes for almost 15 years, future legislation should aim to preserve flavours and also make it easier for smokers to find the products on the market.
"E-cigarettes play a crucial role in a harm reduction strategy to reduce smoking. Banning flavours would have unintended consequences, such as a return to traditional smoking. That would be disastrous" he tells magazine Sigmagazine.
