The Science of Tobacco Harm Reduction – By: . .
In the 40 years since Professor Michael Russell, a South African scholar and specialist in the field of smoking behavior, pioneered the logic that smokers smoke nicotine but are killed by tar, the claim remained largely indisputable despite opposition from some quarters. This logic has served as the backbone of the concept of tobacco harm reduction (TRP) and the arguments in favor of it.
Over time, logic has spawned various innovations in tobacco consumption, ranging from vaping products to smokeless tobacco, which removes the combustible element and therefore the health risks of tobacco consumption.
A Public Health England review of e-cigarettes in January 2018 concluded that: “Based on current knowledge, stating that vaping is at least 95% less harmful than smoking remains a good way to unambiguously communicate the big difference relative risk so that more smokers are encouraged to switch from tobacco to vaping”.
Similarly, a recently developed scientific testing framework to assess the reduced risk potential of vapor products, particularly compared to conventional cigarettes, shows that vapor has very little or no biological impact on human cells. in the laboratory, compared to conventional cigarette smoke. , depending on the test used.
Notably, the past two decades have seen a proliferation of tobacco products that have the potential to serve as a means of reducing the health impact of tobacco use. These products are known as Reduced Risk Products (RRPs).
The concept of harm reduction is neither new nor unique to tobacco use. Its application can be found in several policy areas such as alcohol control, illicit drugs, car safety, child sex education, among others.
In the case of PTH, the underlying concept is that in addition to interventions aimed at preventing and promoting smoking cessation, it is a matter of providing reduced risk products (RRPs) to those who cannot not stop. While some experts believe RRPs will reduce the health impact of tobacco use, for those who switch completely; others warn that RRPs pose the risk of causing non-smokers to use and become addicted to nicotine and tobacco products. Nevertheless, science continues to prove the effectiveness of THR in reducing the harm inherent in combustible tobacco products.
In recent years, there have been policy and regulatory changes in several markets globally, as science continues to underscore the benefits of RRPs as a substitute for smoking. However, even though political actions and political will on THR have varied from country to country, some progressive nations have chosen to implement science-based policies for THR.
For example, the UK has a balanced regulatory regime in place that encourages adult smokers to migrate to RRPs while discouraging young people from enrolling. Instructively, his position is based on science and also supported by cross-party groups and in particular public health agencies such as Public Health England (PHE) and the Royal College of Physicians who have in recent years made discoveries interesting on the security of RRPs. and their efficacy in smoking cessation.
There are also success stories in countries like Sweden, Norway, Iceland, Japan and Korea that have adopted RRPs and made significant progress in reducing their smoking rates by encouraging smokers to switch to RRPs. products.
For most African countries, although there is legislation on conventional tobacco, there is a virtual absence or non-existence of legislation on RRP. Regulators still view tobacco use prevention as a unique approach to tobacco harm reduction, with little or no interest in the effectiveness of RPPS.
In Nigeria, for example, the National Tobacco Control Act 2015, which is the country’s legislative document on tobacco, does not adequately cover these reduced risk products. Evidence shows that countries that are successful in reducing smoking rates through THR have also established separate legislation or policies to guide the use, categorization and sale of RRPs. For PTH to work, effective and balanced regulation is needed that recognizes the lower-risk benefits that these alternative products can offer adult consumers who have made an informed choice to smoke.
Another challenge for Nigeria as well as many other developing economies is the level of consumer awareness of RRPs. In the United States, for example, a study by Brose et al., suggests that daily vaping of e-cigarettes enhances the user’s effort to quit or helps reduce the number of cigarettes smoked. The same cannot be said for Nigeria where the consumption of combustible cigarettes remains popular.
It is gratifying that more and more governments and regulators around the world are becoming increasingly aware of the effectiveness of safer alternatives, not only in reducing the impact of tobacco consumption on health , but also as an effective strategy to quit smoking. Therefore, it is hoped that the Nigerian government will embrace tobacco harm reduction as a public health strategy. According to experts, RRPs present a more realistic, pragmatic, consumer-driven and science-based approach to accelerating tobacco control and smoking cessation.
By Lanre Odusile, a public health communication specialist