Combating Combustible Tobacco Use

Fifty years ago the United States took a step forward to reduce the use of tobacco and eliminate its harms with the “Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service.”

Thanks to much concerted efforts, the number of tobacco users has seriously decreased since then. In 1965 when the report began, 43% of adults smoked, but by 2012 that has dropped to 18%. Despite this progress though, millions of Americans still expose themselves to harmful smoke and chemicals in traditional (combustible) tobacco products.

A new “Perspective” piece appeared in the January edition of the New England Journal of Medicine: Smoke, the Chief Killer — Strategies for Targeting Combustible Tobacco Use.

This is a landmark piece that recognizes “…combustibles as the chief tobacco killer calls for a progressive public health approach that focuses on the known, overwhelming risks of these products. Specifically, we believe that evidence-based, population-wide policies should be implemented that particularly target reducing combustible tobacco use.”

Despite the desire by many to reduce the numbers of people using combustible tobacco, many public health service groups have been unenthusiastic about various smoking alternatives available on the market today.

It’s important to note that it is the smoke, not the nicotine, which makes tobacco cigarettes so harmful. Alternatives like the electronic (smokeless) cigarette deliver the same taste, but without the smoke, tar and other harmful substances that affect not only the user, but those around them.

The article authors go on to acknowledge the great amount of research that clearly defines the overall harms of tobacco products. Furthermore, “…given that up to 98% of tobacco-related deaths are attributable to combustible products, the net harms of these products, including harms from secondhand smoke, dwarf those of other forms of tobacco use…”

Also, research shows “…all the noncombustible delivery vehicles are substantially less dangerous than combustible tobacco products….”

Furthermore, we need to communicate intelligently about harm reduction: not all nicotine-containing products are equal, and the public health focus should be on eliminating combustible tobacco products, even if some people who give up combustibles will continue using FDA-approved medications, e-cigarettes, or smokeless tobacco products indefinitely.

As the discussion  about tobacco harm reduction continues, it’s inevitable that many smokers will seek alternatives so they can continue to enjoy the “act” of smoking but not expose themselves and loved ones to dangerous substances.  E-cigarettes (http://www.eversmoke.com/e-cigarettes.html) are one type of non-combustible, alternative nicotine delivery device in which users can get a similar experience but without smoke, tar, etc.