Anti-Tobacco/Nicotine Activists Blame Smoke-Free Tobacco for the Dual Use They Promoted

 

Arielle Selya has published an excellent Substack commentary on the latest attack on tobacco harm reduction: Dual Use of Cigarettes and E-cigarettes.  Dr. Selya’s confirmation that the evidence for e-cigarettes as a quit-aid for smoking is unimpeachable should be read in conjunction with my documentation of the fact that the “teen vaping epidemic” has always been wildly exaggerated.

Dr. Selya explores dual use in detail, focusing on one-year follow-up results of an e-cigarette quit-smoking clinical trial by Britain’s Francesca Pesola and colleagues (here).  Compared with exclusive smokers, dual users were much more likely to quit at both the four-week and one-year timepoints in the trial.  This is solid evidence that dual use is not the deadly behavior that activists claim.  Ironically, the behavior itself is largely caused by activists.  Let me explain.

Some who use one tobacco product are inclined to try and/or use other combustible or smoke-free products.  Their preferences are influenced by a variety of factors, including family and social contexts, budget and concern about adverse health effects.

Today, nicotine and tobacco prohibitionists have made vapes nearly as expensive as cigarettes, and they regularly promote flawed research to associate vaping with a range of diseases.  This environment discourages smokers from switching, and creates an ambivalence that often leads to dual use.

I was keenly interested in dual use throughout my entire tobacco research career.  Twenty-three years ago I published with Swedish colleagues a prospective follow-up study of tobacco users in northern Sweden.  Using World Health Organization data following Swedish men for five to 13 years, we found that “Snus was the most stable form of tobacco use amongst men (75%); only 2% of users switched to cigarettes and 20% quit tobacco altogether.  Smoking was less stable (54%); 27% of smokers were tobacco-free and 12% used snus at follow-up. Combined use (smoking and snus) was the least stable (39%), as 43% switched to snus and 6% switched to cigarettes.”

I published additional observations in a 2011 letter to Nicotine & Tobacco Research, which answered the “concern” of the chair of the FDA Tobacco Products Scientific Advisory Committee.  I wrote, “The findings from Rodu et al. (2003) confirm and extend those from Frost-Pineda et al. (2010), and both studies address Dr. Samet’s concern about cessation. Although dual users are less likely than exclusive smokers to be completely tobacco abstinent at follow-up, they are much less likely to be smoking.” 

In conclusion, dual use is promoted by anti-tobacco/nicotine activists who falsely portray smoke-free products as being as dangerous as cigarettes.  Given the actual facts, smokers and dual users will complete the switch to and significantly benefit from less harmful smoke-free products.