Reducing the prevalence of smoking through prevention

The Royal College of Nursing in the UK is currently running a campaign called ‘Prevention is better than cure’. It’s an expression learned early in life around the world: the wisdom passed down from our ancestors. We often spare ourselves the harmful effects of any action by avoiding such actions in the first place, rather than waiting to remedy the resulting consequences. This philosophy applies to all areas of life and the maintenance of assets. Prevention is a principle of modern primary health care systems and a major factor in the growing popularity of wellness programs around the world. In the field of health, where the concept is most popular, the logic is quite simple: go upstream to tackle the causes of ill health rather than waiting downstream to cure the resulting illnesses. As global health concerns increase regarding the impact of smoking on health, all scientifically proven measures that can reduce the prevalence of smoking should be encouraged and pursued. In recent months, various civil society organizations (CSOs) have increased calls for the placement of graphic health warnings alongside text on cigarette packs. The clamor is to be applauded for considering the potential harm of exposure to tobacco smoke to smokers and non-smokers in close proximity.

Tobacco harm reduction (THR) is a pragmatic approach to reducing the harm of combustible tobacco, based on scientific and empirical evidence that the risk of harm to smokers comes from the toxic effluents that result from the combustion of tobacco, that smokers inhale, not the nicotine they crave. Therefore, by providing alternative products that deliver nicotine or the smoking sensation but without the combustion of the tobacco, THR prevents nicotine users from exposing themselves to harmful tobacco smoke, which they would otherwise obtain from combustible tobacco. . As a public health strategy, THR advises and encourages smokers to switch from combustible tobacco to these alternative products, called reduced risk products (RRPs). RRPs include e-cigarettes; heated tobacco (HTP, which heats the tobacco without burning it), nicotine sachets; nicotine gum and the like.

While proponents of PTH recognize that abstinence remains the best way to prevent tobacco harm, experience over time has shown that abstinence is not always achievable. For users who are unable or unwilling to quit smoking, RRPs are for smokers who choose to continue enjoying nicotine, while enjoying the harms of tobacco smoke. Smoking prevention at any stage remains a more effective health and wellness strategy than quitting, therefore more proactive initiatives that result in earlier interventions tend to yield better results. This may be one of the reasons why the countries that pioneered the adoption of graphic health warnings on cigarette packs not only accepted the empirical evidence of the effectiveness of THR, but also put implement science-based regulations that provide guidance on the use of reduced-risk warnings. some products.

In a note published by the World Health Organization (WHO) in 2014, the WHO reported that citizens of countries such as Canada and the United Kingdom indicated that pictorial health warnings on cigarette packets were more likely to to quit smoking than text warnings. Recently, the Government of Canada, through Health Canada, released science-based statements such as “Replacing cigarettes completely with vaping will reduce your exposure to harmful chemicals” and “Vaping products and Electronic cigarettes release nicotine in a less harmful way than smoking. cigarettes” among several messages to adult smokers to steer them away from combustible tobacco products. Since graphic health warnings are mostly limited to cigarette packs, smokers tend to encounter them after deciding not only to smoke but also to proceed with the purchase of cigarettes. At this point, a decision has already been made to smoke and graphic images at point of sale or on cigarette packs may be less effective as a deterrent. On the other hand, THR messages continually and regularly instruct smokers to shift away from combustible cigarettes and switch to alternative products that prevent exposure to toxic tobacco smoke. This message does not depend on a smoker’s contact with cigarette packs. In addition to providing earlier warnings, THR also offers less risky alternatives, with the understanding that smokers really need nicotine, which is not toxic, and not the toxic smoke from burning tobacco.

The UK’s National Institute for Health and Care Excellence (NICE) has published guidelines on THR (or alternative tobacco products) and its effectiveness in reducing smoking rates. The guide recognizes that quitting smoking is still the best option for smokers, but supports the use of licensed nicotine-containing products (NCPs) to help smokers, who are currently unable to quit, transition to a less harmful option. A study by William G Shadel, Steven C Martino, Claude M Setodji, Michael Dunbarin et al, to assess the effectiveness of graphic health warnings in deterring tobacco smokers, was published by Oxford Academic in June 2019. The The result showed that graphic health warnings on the labels reduced the odds of cigarette purchase for smokers with low nicotine dependence, but had no effect on smokers with higher dependence.

This study is a landmark for many African countries that have only implemented graphic health warnings, to further adopt PTH as a scientifically established strategy with empirical evidence of success in reducing smoking rates and prevention of death and disease.

  • Adeoti writes from Lagos


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