Sunday, March 17, 2024

Medscape on Tobacco Harm Reduction: Part 1 – Nicotine

 

Most health professionals are familiar with Medscape, a free resource that describes itself as “the leading online global destination for physicians and healthcare professionals worldwide, offering the latest medical news and expert perspectives; essential point-of-care drug and disease information; and relevant professional education and [continuing medical education, CME].”

Recently, Medscape invited me to assist in developing a series of short CME programs on tobacco harm reduction, which evolved into an examination of nicotine and the differential risks of combusted versus smoke-free tobacco/nicotine products, among others.

The first program “Nicotine Misperceptions: What Does the Evidence Say,” professionally produced and based entirely on facts in the scientific literature, is now available online to everyone (here).  I encourage all health professionals and concerned members of the public to spend 30 minutes getting fresh insight into one of the most widely used drugs on the planet.

 

 

Thursday, March 14, 2024

The Japanese Tobacco Miracle the World is Overlooking


Smokers in Japan consumed 92.4 billion cigarettes in 2023 -- less than half as many as they did in 2014.  Since vapor products are illegal there, the impressive decline is likely due to the introduction of heat-not-burn tobacco products, which didn’t exist in 2014, but accounted for 38% of the Japanese tobacco market in 2023.  Notably, this progress occurred in an overall declining tobacco market. 

UK tobacco harm reduction advocate Clive Bates previously opined: “The only mystery is why the skies over Tokyo are not dark with chartered planes bringing officials from WHO, FDA, Truth Initiative, the Campaign for Tobacco-Free Kids, the European Commission and others on an emergency mission to learn about this most extraordinary shift.  What is the secret they would find? ‘Do nothing, stay out of the way....’  There was very little involvement from tobacco control – the demise of cigarettes in Japan has been driven by the market and consumer preference.”

Those officials should also be landing in Stockholm, the capital of the only country that has had comparatively minuscule smoking rates among men and is close to being officially smoke-free.

Instead, the WHO and its nicotine/tobacco prohibitionist allies persist in meddling with the natural demise of smoking that will result from the proliferation of vastly safer and satisfying cigarette substitutes.

One positive development to note: The U.S. FDA authorized the IQOS heat-not-burn system as a reduced exposure alternative to cigarettes on July 7, 2020, greenlighting these claims:

“AVAILABLE EVIDENCE TO DATE:

  • The IQOS system heats tobacco but does not burn it.
  • This significantly reduces the production of harmful and potentially harmful chemicals.
  • Scientific studies have shown that switching completely from conventional cigarettes to the IQOS system significantly reduces your body’s exposure to harmful or potentially harmful chemicals.

The FDA advised that its approval “is expected to benefit the health of the population as a whole.

Unfortunately, a patent dispute in 2021 blocked U.S. IQOS sales, but there is still hope for American smokers for re-introduction of the brand in 2024.

Back in 1995, I wrote (here), “It is not surprising to find that Swedish lung cancer mortality rates have been the lowest in Europe over the past 40 years.  These large scale vital statistics from Sweden…strongly support the suggestion that if tobacco is to be used, it should be in the form of [smokeless tobacco, ST] and not cigarettes. The population that uses ST in lieu of smoking is, in effect, protected from lung cancer and other major smoking-related diseases and suffers little or no increased risk of oral cancer.”  Seven years later I spent six months conducting research in Sweden and publishing a series of real-world tobacco harm reduction articles (here). 

The Japanese and Swedish miracles weren’t the result of government programs or anti-tobacco campaigns.  They arose organically, as tobacco users in those countries made rational choices to use smoke-free substitutes instead of cigarettes.

 

 

Wednesday, March 6, 2024

More Federal Data on Smoking & Vaping Rates Among American Adults

 

Recently I described how high school vaping rates reported in the National Survey on Drug Use and Health (NSDUH) are much lower than those reported in the CDC’s National Youth Tobacco Survey (NYTS) (here).  Today I review NSDUH adult vaping rates, compared to those in the National Health Interview Survey (NHIS), which is the CDC’s traditional source for adult smoking estimates.

The chart at left shows smoking and vaping rates among all American adults 18+ years.  In 2022, the NHIS estimate of current smokers was 11.6%, or about 29 million. 

Now let’s turn to vaping, keeping in mind that the “Dual Use” column segments count both current vaping and smoking.  In 2022, the NHIS estimate of current vapors was 6%, or nearly 15 million, including almost 4 million dual users.

As I demonstrated in a 2009 published analysis (here), NSDUH current smoking estimates are always higher than NHIS estimates.  Neither survey estimate is right or wrong; instead, taken together, they probably represent a reasonable range.  The 2022 NSDUH percentage of smokers was 15.9%, or about 39.5 million, while the NSDUH vaping prevalence for that year was 8.5% or 21 million, with 8.1 million dual users.

Turning to young adults 18-24 years old, in 2022 the NHIS estimate of current smokers in this group was 4.8% or about 1.4 million, but the vaping prevalence was even higher, at 15.1%, representing 4.3 million.  This means that vaping surpassed smoking among young adults.  The proportions are the same in NSDUH, even though the numbers are higher: the percentage of smokers is 10.6%, or about 3.7 million, figures that are swamped by the percentage of vapers, at 24.3%, or 6.9 million.

 

 

 

Why are NSDUH smoking and vaping estimates always higher than those in NHIS?  First, the surveys ask different questions to account for “current” use.  As we noted in our previous study, “NSDUH identifies almost twice as many some-day smokers as the NHIS, which is likely due to differences in the questions that subjects are asked.”  But we also discussed an even more important factor: “the respondents’ perceptions of smoking within the context of the two surveys. The NHIS is focused on the health status of participants, with more limited attention on behavioral risk factors. In this context, smoking may be perceived as one of the more undesirable behaviors that subjects are asked to report, which may lead to under-reporting.  In contrast, the NSDUH is devoted almost entirely to substance use, with questions about marijuana, cocaine and crack cocaine, hallucinogens, inhalants and non-medical use of prescription drugs. In the context that these substances are far more socially unacceptable than cigarettes, participants may be more comfortable acknowledging that they smoke.”

Fifteen years ago, we wrote, “It is surprising that estimates of national smoking prevalence have been derived from a single source, the NHIS, and that little research has been conducted to assess its accuracy over time… Further investigation of the NSDUH/NHIS discrepancy may lead to better surveys and an improved understanding of smoking trends in the USA.”

To date, nothing has been done to explain this discrepancy, so it is reasonable to consider the NHIS and NSDUH figures as low and high estimates for U.S. smoking and vaping.