Poll: HTPs/ENDS key to tobacco control

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Field research, laboratory testing, clinical validation/verification, peer review, collegial expert vetting, random population sample survey.

If a product or industrial process had gone through this exacting and rigorous routine and passed with flying colors, could there still be reasonable doubt as to its efficacy, integrity, reliability, and safety?

And what if the circuitous process is serially conducted and yields the same results?

Then, there should only be one conclusion, and one conclusion only – the product or  process works.       

The results of a first-of-its-kind survey in India highlight the potential of e-cigarettes as an additional option for tobacco control and how vaping can have a substantial impact on public health, according to a local vaping group. 

“This groundbreaking survey clearly shows vaping helps smokers quit or reduce smoking. Its results are particularly relevant to the Philippines because like India, our country has a large number of smokers and a low smoking cessation rate. The Department of Health and other local policymakers should look at the evidence for e-cigarettes with an open mind and start making science-based decisions to help reduce smoking in the country,” said Peter Paul Dator, president of The Vapers Philippines.

The Vapers Philippines is a consumer organization that advocates for vaping as much safer alternative to cigarette smoking and pushes policies that fairly regulate the use of smoke-free nicotine products such as e-cigarettes, heat-not-burn tobacco products and snus. The organization believes in the right to vape and promotes awareness about the health effects of using e-cigs.

Dator was referring to the interview-based survey involving 3,000 vapers aged 18 and older from eight of the largest metropolitan cities in India. The vast majority of respondents (71.3 percent) used e-cigs to quit (30 percent) or reduce (41.3 percent) smoking. Similar results were observed in smokeless tobacco users. 

Most (79 percent) believe that e-cigs are less harmful than combustible cigarettes. Survey participants reported minimal side effects (cough, headache, dry mouth/throat) and some health benefits (improved general health, breathing, smell and taste) after they started vaping. 

Around 81 percent of survey respondents were men and 19 percent women, with average age of 29 years. The majority (80 percent) were first exposed to nicotine through combustible cigarette smoking, SLT use, or both. Leading tobacco harm reduction expert Dr. Konstantinos E. Farsalinos and Indian researchers conducted the survey whose results were published on March 30, 2020 in Harm Reduction Journal.

Dator noted that India and the Philippines face similar smoking-related public health challenges. The World Health Organization  estimates that there are over 120 million smokers in India, accounting for almost 12 percent of the 1.1 billion smokers globally.

The 2016-2017 Global Adult Tobacco Survey  revealed that India has the second-lowest quit rate among GATS countries surveyed at the end of 2017. It also showed that India has the second-largest tobacco-consuming population in the world, estimated to be over 267 million, which includes at least 100 million tobacco smokers and over 199 million SLT users. 

According to Dr. Farsalinos and his co-authors, tobacco-related deaths in India are estimated to be over one million a year and are projected to rise to 1.5 million by 2020. They also pointed to the prevalence of smoking-related illnesses such as heart disease, lung cancer and chronic pulmonary obstructive disease in India. 

Dator cited DoH data, which show that almost 88,000 Filipinos die from smoking-related diseases every year. Healthcare expenditures and lost income due to smoking-related sickness and premature death cost the country P188 billion ($4 billion) yearly. These figures only cover four of more than 40 smoking-related diseases namely lung cancer, COPD, heart disease, and stroke. 

 GATS found that there are currently 16 million Filipino adult smokers.

“Like India, the Philippines has a very low smoking cessation rate of four percent. This dismal quit rate indicates the ineffectiveness of currently approved smoking cessation strategies in the country such as ‘quitting cold turkey’, counseling, and nicotine replacement therapy,” Dator said.

“We all know that the combustion in cigarettes is what is harmful to the health of smokers. The harm from smoking is caused primarily through the toxins produced by the burning or combustion of tobacco. By contrast, non-tobacco, non-smoked nicotine products such as e-cigarettes are considerably less harmful,” Dator explained.

He cited the widespread agreement among organizations such as Action on Smoking and Health, Public Health England, Cancer Research UK, the Royal College of Physicians and the Royal College of General Practitioners that, on the basis of current evidence, e-cigs or vapes represent a significantly less harmful alternative to tobacco cigarettes for smokers who are unable or unwilling to stop using nicotine. 

“The DoH should pay particular attention to how the study authors described India’s e-cigarette ban as a ‘missed opportunity’ and urged the Indian government to promote additional research and consider revising the regulatory framework if the evidence warrants it,” Dator noted.  

The Indian government banned the import, manufacture, sale, advertisement, storage and distribution of e-cigs in September 2019.

According to Dator, India's vaping ban is a tobacco control approach that other governments should not adopt.

“Such a retrogressive policy will be a major blow to smokers who have switched to vaping. It will likely push them to go back to smoking combustible cigarettes.”

To read the study in Harm Reduction Journal, please check this link: https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00362-7

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