With growing evidence on the case for tobacco harm reduction, we explore how smoke-free products are an alternative to cigarettes for adult smokers who would otherwise continue to smoke.

The reality for smokers today

Despite being aware of the evident health risks, many smokers continue to smoke cigarettes today. According to WHO, there are around one billion smokers worldwide, and it is estimated that this number will not change significantly in the coming years1.

Smoking causes a number of serious diseases (including cardiovascular, pulmonary diseases and cancer) and increases the risk of early death. With around eight million attributed deaths every year, cigarette smoking is a formidable public health challenge for governments, regulators and public health authorities worldwide2.

Quitting smoking is undoubtedly the right way to go. But how do we address those who would otherwise continue smoking? Harm reduction in the context of smoking continues to be a highly debated topic among public health officials. In some countries, the use of regulated tobacco and nicotine products to help smokers move away from cigarettes is encouraged by public health bodies. For instance, in England, the ‘Stoptober’ campaign encourages those who do not stop smoking to consider harm reduction alternatives3.

When a cigarette is lit, the tobacco combusts (burns) generating a smoke that contains thousands of chemicals, many of which are toxic or carcinogenic and known to be the primary cause of smoke-related diseases. Quitting smoking - or better yet, never starting - is without a doubt the best option to reduce the risk of smoke-related disease. However, for adult smokers who do not quit, the opportunity to switch to scientifically substantiated, less harmful alternatives has the potential to accelerate the decline in the number of people smoking cigarettes and reduce smoking-related harm. This is the principle of tobacco harm reduction.

Many believe that nicotine is the primary issue when it comes to smoking. Nicotine is addictive and not risk-free, but - contrary to what many believe - experts agree that nicotine itself is not the primary cause of smoking-related diseases4. Rather, it is the chronic exposure to the toxic chemicals in cigarette smoke that are generated when tobacco is burned that is the primary cause of smoking-related disease. On average, a cigarette burns tobacco at temperatures up to 800-900C and generates smoke containing over 6,000 chemicals. Smoke includes around 100 toxicants that have been identified as the primary cause of smoking-related diseases such as cancer and cardiovascular disease.

Burning tobacco has been the principal source of nicotine delivery for the last 100 years or so. However, advances in science and technology have enabled the development of smoke-free products that can deliver nicotine without burning tobacco and can be a better alternative to cigarettes for adult smokers who do not quit.

Closing the awareness gap

Smoke-free products can effectively help smokers move away from cigarettes. For example, in Japan, a substantial decrease in cigarette sales was observed since the introduction of heated tobacco products in the country5. The obstacles adult smokers face in adopting smoke-free alternatives lie in a number of critical areas: education, policy and regulation, and institutional support.

Proven across many industry and independent studies, smoke-free products, while not risk-free, have been shown to be better alternatives over continued smoking6. The challenge lies in educating adult smokers about the available scientific evidence behind smoke-free products. Raising awareness of smoke-free products that contribute to harm reduction practices requires a combined effort, not just from industry players but also from public health bodies that recognize its benefits and policies.

Tobacco control measures aimed at preventing smoking and supporting quitting play a key role in reducing the harm caused by smoking. In several countries around the world including the UK6 and New Zealand7, the use of regulated novel nicotine and tobacco products is seen as an appropriate alternative for smokers who do not quit, and their use is encouraged by public health bodies.

We at PMI are also playing our part by working closely with regulators to share data from the clinical disease reduction studies we have been conducting for many years now, as our organization works towards delivering a smoke-free future. These studies allow us and the relevant bodies to understand the benefits of quitting smoking on public health in greater depth8.

By integrating such studies with national health policies and, as a result, gaining institutional support, more people could be informed about smoke-free alternatives, making way for a smoke-free future. If enough adult smokers around the world using tobacco would switch to scientifically substantiated smoke-free alternatives, we can rapidly address the public health impact of smoking. This is what harm reduction is, and it is time to embrace this approach.

Sponsored by Philip Morris Management Services (Middle East) Limited

1https://www.who.int/news/item/19-12-2019-who-launches-new-report-on-global-tobacco-use-trends

2https://www.who.int/news-room/fact-sheets/detail/tobacco

3https://www.blf.org.uk/take-action/campaign-with-us/stoptober

4https://www.ncbi.nlm.nih.gov/books/NBK294310/#ch2.s6

5https://www.pmi.com/smoke-free-life/substantially-declining-cigarette-sales-in-japan

6https://www.gov.uk/government/news/e-cigarettes-could-be-prescribed-on-the-nhs-in-world-first

7https://www.hpa.org.nz/

8https://www.pmiscience.com/whats-new/why-we-carry-out-disease-risk-reduction-studies