on August 15, Brian King, director of the Center for Tobacco Products (CTP) of the U.S. Food and Drug Administration (FDA), published an article in the well-known American scientific journal WILEY titled “Commentary on Wackowski et al.” : Opportunities and Considerations for Addressing Misperceptions About the Relative Risks of Tobacco Products among Adult Smokers (Review of Wackowski et al. : Opportunities and considerations for addressing adult smokers’ misperceptions about the relative risks of tobacco products).
In a survey of adult cigarette smokers in the United States, Wackowski et al. found that only about 20% believed that e-cigarettes contained fewer harmful chemicals than cigarettes. Of those, half thought e-cigarettes were less harmful. Perception of fewer chemicals was positively correlated with e-cigarette use and interest.
According to King, there is an opportunity to educate adult cigarette users about the relative risks of related tobacco products, especially e-cigarettes.
At the same time, King presents three factors that need to be considered when developing and implementing strategies to educate adult smokers about the relative risks of tobacco products.
The following is the original translation:
The regulation of tobacco and nicotine products varies across countries around the world. In the United States, the Food and Drug Administration (FDA) has the authority to regulate the manufacturing, marketing, and distribution of tobacco products, including cigarettes and e-cigarettes, to protect public health.
There is no safe tobacco product . However, there is a continuum of risks associated with tobacco products, of which smoking products, such as cigarettes, pose the greatest risk . Substantial progress has been made in reducing tobacco use through integrated, evidence-based population-level strategies. Despite these advances, tobacco use still kills more than 8 million people worldwide each year.
Given that most adult cigarette users first started using them as teenagers, prevention strategies including price increases, smoke-free policies, and mass media campaigns are critical to reducing tobacco-related illness and death. In addition, among tobacco product users, accessible proven cessation strategies for populations, health systems, and individuals remain critical. As the tobacco product landscape continues to diversify, switching to less risky alternatives, such as e-cigarettes, is believed to reduce the risks associated with smoking. A 2018 National Academies of Sciences, Engineering, and Medicine report concluded that there is “solid evidence that replacing combustible tobacco cigarettes entirely with e-cigarettes reduces user exposure to the numerous toxic substances and carcinogens present in combustible tobacco cigarettes.”
Recently, Wackowski et al. conducted a representative survey of adult cigarette smokers in the United States and found that only about 20% believed that e-cigarettes contained fewer harmful chemicals than cigarettes; Of those, half thought e-cigarettes were less harmful. Perception of fewer chemicals was positively correlated with e-cigarette use and interest.
Wackowski et al. ‘s findings suggest that there is an opportunity to educate adult smokers about the relative risks of tobacco products, especially e-cigarettes. However, these educational efforts must be based on evidence. A data-driven approach should be adopted when formulating content, delivery, and audience. Of particular importance is the need to assess the benefits for the target population (i.e., adult smokers) and the risks for unexpected populations (e.g., adolescents).
Several factors need to be considered when developing and implementing strategies to educate adult smokers about the relative risks of tobacco products.
First, the use of tobacco products in any form, including e-cigarettes, is not safe among youth. Therefore, it is necessary to adopt strong strategies to prevent the use of tobacco products by young people. However, preventing young people from starting to use should not hinder efforts to promote cessation and educate about the relative risks of tobacco products among adult smokers.
Second, the preferred method of quitting for adult smokers should be products scientifically proven to be safe and effective, including FDA-approved drugs and devices. Behavioral counseling and medication are effective separately, and combining them increases the likelihood of quitting. No e-cigarettes are currently approved by the FDA for smoking cessation, which requires documentation of both safety and efficacy. A growing body of research shows that certain e-cigarettes can promote smoking cessation in adults; However, given the toxins in e-flue aerosol, further studies of high quality short – and long-term clinical outcomes, including lung effects, are still needed.
Third, for adult smokers who choose to use e-cigarettes, the FDA has authorized 23 tobacco-flavored e-cigarette products and devices. However, in order to get the full health benefits from these products, it is essential to switch completely from cigarettes to e-cigarettes. Biomarker assessments indicate that dual users who use both e-cigarettes and cigarettes generally exhibit high levels of toxic exposure similar to adults who smoke only. Many American adults double-use e-cigarettes; In 2021, 29.4% are current smokers, 40.3% were former smokers, and 30.3% have never smoked. Using cigarettes and e-cigarettes together can be a pathway to a complete shift to or continuation of addiction; In order to maximize the former, adult smokers must switch completely to e-cigarettes and not engage in prolonged dual use. Because no tobacco product is safe, the ultimate goal should be to wean ourselves off all tobacco product use, including e-cigarettes.
In conclusion, there is an opportunity to use evidence-based approaches to educate adult smokers about the relative risks of tobacco products, including e-cigarettes. However, these efforts should go hand in hand with efforts to prevent youth use of tobacco products, encourage the preferred use of FDA-approved smoking cessation therapies, and emphasize to adult smokers who use e-cigarettes the importance of a complete switch from cigarettes. These efforts can be implemented by both governmental and non-governmental stakeholders. For example, the FDA recently began formative studies on eliminating misperceptions about nicotine and potential messaging on the risk continuum for adult smokers. This is in addition to the FDA’s continued work to prevent youth use of tobacco products through “true cost” public education campaigns. At the same time, opportunities exist to continue to innovate new tobacco cessation therapies to further reduce tobacco-related illness and death.
【1】Commentary on Wackowski et al.: Opportunities and Considerations for Addressing Misperceptions About the Relative Risks of Tobacco Products among Adult Smokers