Smoking is a matter that has been on the coronary heart of public well being considerations for many years, with many efforts to limit tobacco gross sales, tax cigarettes and typically hard-hitting campaigns to get individuals to stop smoking. But when the tobacco management group has lengthy agreed on the harms of smoking, the place of decreasing, moderately than eliminating, hurt has been hotly contested. Merchandise containing nicotine have various related well being threat. Nicotine alternative merchandise like patches and gum fall on the safer finish of the dimensions; cigarettes, which ship nicotine by inhaled smoke particles, are on the lethal finish. Whereas there may be rising settlement that digital cigarettes fall towards the decrease finish of the chance scale, the function they need to play in hurt discount efforts has been the topic of appreciable debate.
In a brand new perspective article within the New England Journal of Drugs, Amy Fairchild, PhD, affiliate dean of educational affairs and professor within the Division of Well being Coverage and Administration on the Texas A&M College of Public Well being — along with Ju Sung Lee, a doctoral scholar at Texas A&M; Ronald Bayer, PhD, from Columbia College; and James Curran, MD, dean of the Rollins College of Public Well being at Emory College — underscore the significance of recognizing not only a continuum of threat relating to merchandise that ship nicotine, however a continuum of hurt discount methods. In 2017, the U.S. Meals and Drug Administration (FDA) introduced a brand new plan on tobacco and nicotine regulation, pushing the date for setting guidelines on digital cigarettes to August 2022 to offer researchers and policymakers time to totally think about the function e-cigarettes would possibly play.
Of their paper, Fairchild and colleagues discover that hurt discount proposals fall throughout a continuum between techniques that, whereas permitting for the sale and use of e-cigarettes, place strict limits on availability and insurance policies that give people who smoke simpler entry to digital cigarettes as an alternative choice to smoking. Extra restrictive insurance policies embody limiting entry solely to present people who smoke and limiting the sale of digital cigarettes to pharmacies. Such restrictions prioritize stopping younger individuals and non-smokers from utilizing digital cigarettes. On the alternative finish of the spectrum are insurance policies recognizing that some individuals utilizing nicotine won’t cease, and thus the purpose needs to be to attenuate well being dangers for present people who smoke. Many proposals — age restrictions, taxation and public consciousness campaigns in regards to the dangers of digital cigarettes — occupy the center floor. One of many keys for taxing digital cigarettes is to discover a taxation stage that’s excessive sufficient to place them out of the attain of younger individuals however low sufficient that, for people who smoke, they’re nonetheless less expensive than flamable merchandise.
Insurance policies relating to digital cigarettes will proceed to evolve with additional analysis, and the selections of organizations just like the FDA will play a vital function sooner or later. Fairchild and her colleagues state that many of those insurance policies maintain uncertainties, which might make it tough to resolve which path to take; nonetheless, given the character of the well being dangers concerned with smoking, policymakers might want to act even within the face of uncertainty. The important thing might be figuring out how a lot insurance policies scale back hurt and whether or not they discover the proper stability of restriction.
No matter how restrictive the strategy policymakers take relating to digital cigarettes, there might be a necessity for ongoing monitoring of well being and security, each for hurt discount and as a shopper safety problem.
“Policymakers will must be prepared to vary their approaches to make sure that they really scale back inhabitants hurt,” Fairchild mentioned. “This not solely signifies that a hurt discount measure would possibly must be rolled again if it hurts extra individuals than it helps, nevertheless it additionally signifies that simply because a tactic is by definition known as hurt discount, that it truly works to cut back hurt. An excessively restrictive strategy to hurt discount that leaves doubtlessly disruptive merchandise onerous to acquire and use could also be hurt discount in title solely.”
