For those who do not know " Addiction“, It is the leading journal in the world in terms of clinical addiction and health policy around addictions. For its January 2017 issue, Addiction therefore focuses on electronic cigarettes, highlighting its evaluation framework for the impact of public health.
GRADUALLY REDUCE THE NICOTINE RATE IN CIGARETTES BY PROMOTING E-CIGARETTE
In the January 2017 issue of the journal Addiction, an editorial focuses on the necessary public health strategies for tobacco control over the next decade. The authors come from different research centers for tobacco control in the United States. They propose an original strategy to reduce or even eradicate (the word is written ...) the conventional cigarette.
One of the major public health strategies being considered today is a very gradual decline in nicotine levels in cigarettes. The idea is to encourage smokers to stop but especially to limit the development towards addiction among experimenters (most often teenagers). The authors cite research that has shown that a very slow decline in nicotine levels can prevent the occurrence of withdrawal symptoms in smokers, but especially is not accompanied by an increase in the number of cigarettes smoked . This strategy was recently mentioned by the WHO Study Group for the Regulation of Tobacco Products.
The authors of this editorial propose to insert the e-cigarette in the case. In their view, by promoting the e-cigarette, particularly by leaving higher levels of nicotine in electronic cigarettes while the maximum nicotine level is gradually lowered in conventional cigarettes, it would be possible to facilitate the gradual transition of smokers to smokers. electronic forms of nicotine consumption. The authors admit that such a strategy would not take place without controversy. The e-cigarette still raises many criticisms and questions, probably because of the lack of perspective on its long-term use.
WHAT EVALUATION FRAMEWORK FOR THE PUBLIC HEALTH IMPACT OF THE E-CIGARETTE?
In the January issue of 2017 of the journal Addiction, a special issue focuses on the evaluation framework to be built to properly evaluate the e-cigarette and its possible health impacts. The authors of the main article in the dossier are a group of international tobacco researchers. They recall that e-cigarettes and by-products are still very controversial, although it seems fairly clear that these products have substantially fewer toxicants than conventional cigarettes, and as such e-cigarettes must be seen as agents of damage reduction.
Despite growing evidence on the public health benefits of the e-cigarette, 55 countries on 123 have been investigated have banned or restricted the use of the e-cigarette, and 71 have laws that limit the minimum age of purchase, or advertising on these products. The authors believe that before promoting laws, it would be necessary to agree on scientific data through a framework of clear evaluation of the benefits and damages related to the use of these products. The authors propose objective criteria to consider.
1er criterion : the risk of mortality. The authors cite a recent study that estimated that the exclusive use of e-cigarettes was associated with a risk of mortality 20 times less important than the exclusive use of tobacco. They specify however that this figure could be modified with the progressive obtaining of data on the long term. For mixed use (tobacco and e-cigarette), the authors propose to reason in terms of reducing the amount and duration of tobacco use. They cite studies showing a reduced risk of lung cancer and chronic obstructive pulmonary disease, and deduce a reduced mortality risk.
2 criterion : the impact of the e-cigarette on teens who have never smoked traditional cigarettes. The fact that e-cigarette experimentation can promote the switch to smoking is one of the arguments most often put forward when talking about the risks of e-cigarettes. In practice, studies show that this phenomenon remains extremely limited for the moment (see the recent European survey published in Addiction also, and reported on Addict'Aides.). On the other hand, it is still difficult for tobacco experimentation to be induced by vaping, especially in adolescence, which is by definition a period of multiple experimentation. Finally, other studies show that most of the teenagers who experiment with e-cigarettes stop using them very quickly, while cigarette smokers who are vaping continue to use the devices for at least as long as smoking is used.
3e criterion : the impact of e-cigarettes on tobacco use. The authors cite several recent studies indicating that the more regular e-cigarette use, the more it is associated with being an ex-smoker or having reduced tobacco use. Good studies in this area need to compare this population with populations of smokers who do not vape. In clinical trials, however, the effectiveness of the e-cigarette in stopping smoking is not exceptional. It is at levels similar to those of patch substitution. But, in real life, it may not be the goal of all vapers to quit smoking immediately and completely. In addition, the authors emphasize that vapers are more frequently smokers who have already tried to quit in the past. Vapers are therefore unlikely to be “ordinary” smokers, and this factor should be considered in future studies.
4e criterion : the impact of e-cigarettes on former smokers. In other words, is it common for former smokers to resume nicotine use with an e-cigarette? Here again, the authors stress that the analysis of this criterion should be based on a comparison with subjects who directly resume smoking. This will highlight the benefit of reducing the risks of e-cigarettes. The rare studies that have explored this question seem to show a very low rate of tobacco resumption among ex-smokers who resume e-cigarette use (5 to 6%), and most often this tobacco use is not not daily.
5e criterion : the impact (good or bad) of health policies. The authors believe that health policies have a crucial role in the way e-cigarettes are presented and used by the population. Liberal regulation of these devices favors long-term use of the latter, as opposed to health policies aimed at presenting the e-cigarette primarily as an aid to quitting smoking. The states where there is a minimum age for purchasing vaping products are those with the lowest vaping rates among adolescents, and those with the highest tobacco consumption.
There are several comments to this princeps article. For example, Becky Freeman, from the Sydney Public Health Center (Australia), also believes that vaping products could be the “silver bullet” to put an end to the scourges of tobacco (cf. same issue of Addiction on this topic). However, the author stresses that while specialists are wondering how to evaluate the e-cigarette and its impact compared to that of tobacco, users do not wait for their conclusions and participate in the commercial success of these devices. . The author concludes that public health policies are certainly not the main factor explaining the success or failure of a level of device that may have a role in health.
Source : Addictaide.fr
