The consumption of traditional tobacco is associated with serious ailments such as cancer, lung diseases and cardiovascular diseases and, therefore, with premature deaths. It is estimated that in the European Union it is the greatest avoidable risk to health. The combustion of tobacco causes more than 4,000 chemical substances, of which at least 250 are harmful and, of these, more than 50% cause cancer, mainly of the lung, according to the study Deaths attributable to tobacco use in Spain 2000-2014 published by the Ministry of Health. Up to 33% of tumors in the world and up to 22% of the mortality associated with them are caused by these substances derived from the combustion of tobacco, according to the study World Cancer Report 2014 of the World Health Organization (WHO).
Due to the damage caused by smoking, its control has become one of the highest priorities of the national authorities. It must also be taken into account that the health costs caused by diseases related to tobacco consumption could represent between 6% and 15% of health spending, according to data extracted from a report by Dr. Pilar Suárez -Bonel on the health value and absenteeism of smokers in an urban environment.
Deaths caused by smoking in Spain reach an average of 52,000 per year, according to the Ministry of Health, although other sources raise this average to 56,000. Traditional tobacco is one of the main causes of years of life lost due to disability (DALYs), about 1.15 million, mainly due to malignant tumors, cardiovascular diseases and associated chronic respiratory diseases, says the study Burden of disease in Spain: results of the Global Burden of Disease Study 2016.
The WHO Global Health Observatory highlights that three countries have managed to reduce the prevalence of the consumption of tobacco-related products the most in the period from 2005 to 2018: Sweden, Austria and the United Kingdom. This same body ensures that Spain occupies a moderate position in terms of the reduction in prevalence (19%) and has a behavior very similar to the average of the European Union, although it is far from the reduction achieved in the United Kingdom (39 %) or Sweden (35%). In both countries, the drop in prevalence has been accompanied by a migration of smokers to non-combustion nicotine products.
Strategies to quit smoking
Since in 2005, the World Health Organization (WHO), through a Framework Agreement signed by 168 countries, formalized a commitment to reduce tobacco consumption in the world, the authorities have adopted a variety of measures. Regulation of tobacco products, restriction of their advertising, implementation of smoke-free environments and implementation of anti-smoking campaigns are some of them. The WHO shows that Spain is at the forefront in the implementation of anti-smoking measures.
However, given the evolution of the real decrease in the prevalence of tobacco use, it is not foreseeable that the objective set by the WHO of reducing consumption worldwide by 30% will be achieved.
Therefore, in addition to continuing with traditional support measures to quit smoking, it would be interesting to promote complementary secondary strategies to reduce the damage caused by smoking in those who are not ready to quit smoking.
Reduction of damage in smokers
Nicotine Replacement Therapy (NRT) in the form of transdermal patches, lozenges, chewing gum, sublingual tablets, oral inhalers, and over-the-counter nasal sprays or prescription products, such as the drugs brupopion or varenicline, are considered effective measures for increase smoking cessation rates.
Additionally, a wide range of reduced risk (PRR) products have been introduced in recent years, such as electronic cigarettes or nicotine-capable devices, heated tobacco products (PTC), and non-tobacco types of oral nicotine pouches. .
It should not be forgotten that these products are not without risk and that they should always be aimed at smokers, never at those who do not have the habit of tobacco. Although the long-term impact on health and mortality of PRRPs is not yet known, the WHO Regional Office in Europe has recognized in your report Electronic Nicotine and Non-Nicotine Delivery Systems, May 2020, that smokers who switch to vaping systems can achieve a reduction in damage to their health, due to the reduction of the user’s exposure to many toxins and harmful substances present in the smoke of traditional cigarettes.
The potentially less harmful effect of these products is due to the fact that there is no combustion, so less emissions of tar and other toxic substances common in conventional tobacco are released, according to the findings of Public Health England and the United States Government Food and Drug Administration.
Dr. Fernando Fernández Bueno, spokesman for the Platform for the Reduction of Harm by Smoking, an initiative formed in Spain by doctors, professors, health workers and independent scientists committed to public health that does not receive funding from the tobacco industry or the electronic cigarette, says that “it is urgent to turn around smoking policies by introducing innovative formulas such as harm reduction to achieve a smoke-free Spain by 2030.” “To reject these formulas is to renounce the advances that countries such as the United Kingdom and France are already applying, where the consideration of less harmful products than cigarettes helps to reduce the damage caused by the toxic habit of smoking.”
The case of the United Kingdom
The United Kingdom is considered a country of reference by the WHO Global Health Observatory, given the drastic way in which it has managed to reduce the number of smokers using, among other measures, the promotion of PRRP.
In the seventh annual study by Public Health England published last February, it is noted that vaping products “continue to be the most widely used aid among smokers to quit smoking.” In 2017, more than 50,000 smokers quit using a vape. In 2020, 27.2% of smokers had used a vape as a method to quit smoking in the previous 12 months; 15% used nicotine replacement therapy; 4.4%, varenicline; and 2.2%, some prescription drug.
The study also reveals that the number of ex-smokers is increasing, while the number of those who still smoke is decreasing, indicating that “dual use” is decreasing.
Public Health England states in its 2021 report that “vaping products could play a crucial role in reducing the enormous healthcare cost caused by cigarette smoking.”
France is another prominent example in the White Paper on Reducing Harm from Smoking. Objective 2030: Spain free of smoke, prepared by the Spanish platform. The Ministry of Health has launched a web information campaign for The Month without Tobacco with the slogan I choose the electronic cigarette. Welcome to a life without tobacco with all the useful information on how to quit smoking with this product.
Disclaimer: Health authorities warn that tobacco seriously harms health.