Looking at various times in history, one can comment that tobacco consumption over the decades has had an interesting journey.
Just 50 to 60 years ago, no one would bat an eye at gaggles of gentlemen and their wispy dates smoking in fine dining restaurants. Corporate overlords decided the future of thousands of laborers in rooms laden with liquor and ashtrays. Cigarettes were once a striking symbol of decadence, vice and glamor in old-school cinema and advertisements.
But Father Time comes for all things, even cigarettes. Like other forms of practical technology—cellphones, personal computers, and cameras—cigarettes were eventually subjected to the inevitable forces of change and innovation.
As a slew of scientifically backed reports poured in linking smoking with disease, and with more smokers succumbing to illnesses like lung cancer and emphysema, cigarettes have tumbled out of public favor. Smoking and being a smoker has now become verboten.
Anyone who has smoked, or knows family and friends who are smokers, knows that quitting smoking is no joke. The road to quitting smoking is rarely linear. It is often rough and jagged, paved with roadblocks and pitfalls.
So difficult could be the quitting journey that the World Health Organization estimates that globally, there are still more than one billion smokers today.
Along comes a radical approach to reducing the prevalence of smoking—tobacco harm reduction (THR).
The idea behind THR is that for adult smokers looking to quit the smoking habit but finding it difficult to do so, they have the choice to switch to alternative nicotine or tobacco products that are scientifically substantiated to contain much lesser risks than cigarettes. In a nutshell, THR is a public health approach that aims to provide better alternatives to reduce harms caused by smoking.
E-cigarettes, heated tobacco products (HTPs), snus and its discreet close cousin, nicotine pouches, are some of the forms of THR available to adult smokers today.
Most prevalent in the market today, especially in the Philippines, are e-cigarettes, with HTPs close behind. How do they work and how are they helping adult smokers switch to “better alternatives”?
INHALING VAPOR INSTEAD OF SMOKE
The first commercial e-cigarette was launched in China in 2003. An e-cigarette is a lithium battery-powered device that heats a liquid (called an e-liquid) that typically contains nicotine, propylene glycol, vegetable glycerin, and flavorings. It converts the e-liquid into a mist or vapor that the user inhales. This is why using an e-cigarette is known as vaping.
E-cigarettes do not burn tobacco and do not produce tar or carbon monoxide, two of the most damaging elements in tobacco smoke. The UK National Health Service (NHS) has adopted vaping as part of their smoking cessation program.
The decision was based on an independent review by Public Health England (PHE), which concluded that e-cigarettes are around 95% less harmful to health than smoking tobacco and have the potential to help smokers quit smoking. Vaping is already estimated to contribute to an extra 50,000 to 70,000 smoking quits per year in England.
New Zealand’s Ministry of Health (MoH) was previously opposed to e-cigarettes. After taking the emerging scientific evidence into account, the agency changed its position.
The MoH stated that vaping products are significantly less harmful than smoking and that smokers switching to vaping products are highly likely to reduce their health risks and for those around them. The agency encourages smokers who want to use vaping products to quit smoking to seek the support of local stop smoking services.
A VIABLE ALTERNATIVE
HTPs heat the tobacco just enough to release a nicotine-containing tobacco aerosol but without burning the tobacco.
Because tobacco is heated and not burned, there is no smoke, and the levels of harmful and potentially harmful chemicals in the generated aerosols can be significantly reduced compared to cigarette smoke.
HTPs were first commercialized in the 1980s. However, the first HTP brands failed to offer a suitable and satisfying alternative for adult smokers.
But there was hope yet. Seeing the demand for smoke-free tobacco products, industry giant Philip Morris International (PMI) said it invested more than $10.5 billion, a decade of research, and enlisted a more than 1,500 scientists, engineers and technicians to develop its HTP line. This culminated in the 2014 launch in Japan and Italy of PMI’s HTP brand, IQOS.
Initial IQOS generations use blade heating technology which does not burn tobacco but rather only heats specially designed tobacco sticks called HEETS to produce an aerosol. As a result, it does not produce smoke or ash. Its latest iteration, the IQOS ILUMA, now uses bladeless technology and heats its tobacco sticks called TEREA through induction.
The use of HTPs has led to drastically reduced smoking rates in Japan, a country that for many years was heavily associated with conventional cigarette use. Japan now has the highest prevalence of HTP use in the world and is the country where HTPs have captured the highest share of the tobacco market.
Research has revealed that HTP uptake in Japan coincided with an accelerated decline in the sales of the predominant combustible tobacco categories, cigarettes and cigarillos in the country. Across all brands, HTPs reached almost one third of the total tobacco market in Japan by 2021.
The Japanese National Health and Nutrition Survey (NHNS) also found that a profound decline in adult cigarette smoking prevalence occurred following the introduction of HTPs. While 20% of adults reported smoking every day or some days in 2014 (prior to the introduction of HTPs), smoking prevalence dropped to 13% in 2019. The survey also showed that an overwhelming majority of HTP users, 76% in 2019, did not report any cigarette smoking.
And it’s not just Japan. HTPs as a legitimate harm reduction tool are backed by highly credible research and a roster of public health experts who threw their support behind these “better” alternatives.
London-based researchers from Queen Mary University stated in a study published by the journal Public Health Research that smoke-free products like HTPs and vapes may be accelerating the demise of smoking once and for all.
“The results of this study alleviate the concern that access to e-cigarettes and other low-risk nicotine products promote smoking. There is no sign of that, and there are some signs that they in fact compete against cigarettes, but more data over a longer time period are needed to determine the size of this effect,” said Prof. Peter Hajek, Director of Health and Lifestyle Research Unit at Wolfson Institute of Population Health in Queen Mary University of London.