Globally most smokers know or at least have a strong inkling their habit is bad idea. They may have lost family and friends to cancer or some form of lung disease. They themselves may now be easily out of breath where once they were active sportspeople. They tell researchers they want to quit. But millions don’t. Why?
There are many reasons; ritual, culture, accepted behaviour among peers, and maybe the power of advertising (although more diminished these days). But the primary reason must be that they enjoy the feeling they get from consuming nicotine. The reinforcing properties of nicotine mean that smokers can continue to feel the benefit from assistance in focussing on work or study and to decompress from stress – functions proven by clinical studies of the brain. Smokers may get sick from the effects of smoking, but they certainly don’t believe that smoking is and of itself a disease or that consequently they are sick.
Medical and public health authorities take a different view. Smoking is regarded as a disease with a worryingly high percentage of health professionals believing the primary culprit is nicotine. However, it is well demonstrated that nicotine is a relatively benign substance and certainly causes none of the damage inflicted by smoking. Therefore, a primary reason why people smoke is to consume a substance which does them little harm but tied to a delivery system proven to be highly dangerous.
What to do? The latest data indicates the number of smokers is rising now standing at 1.1 billion, yet the WHO admits that most of the world’s smokers have no access to stop smoking services. Moreover, the countries with some of the highest numbers of smokers like China and India have the smallest percentage of smokers who say they want to quit. Given all this evidence from WHO data sources, the most obvious solution is to take the nicotine out of the cigarette. Job done. Well, apparently not. Because a central part of the anti-tobacco harm reduction narrative is that the safer nicotine products don’t help people quit smoking. Actually they do, but that’s beside the point for this argument. The real public health tragedy is that smokers themselves believe there is no point in switching.
The e-cigarette was invented in China and the country supplies the world with devices and liquids. Yet there are only 3 million vapers in a country of nearly 300 million smokers who can choose from nearly 1000 brands from the country’s state tobacco company. So does that account for the low take-up of vaping? A new study suggests not.
The study titled, Reasons why Chinese smokers prefer not to use electronic cigarettes, gathered cross-sectional data from the Tobacco Questions for Surveys (TQS) conducted in four large Chinese cities (Chengdu, Wuhan, Xiamen, and Xi’an) between 2017 and 2018.
The study found that “The top three reasons that Chinese adult smokers reported for never having tried e-cigarettes were: ‘I do not want to quit smoking’ (35.35%), ‘I do not think they would help me quit or cut down’ (24.31%), and ‘I am not addicted to smoking and don’t need help to quit’ (14.93%). The researcher concluded that Chinese smokers associate e-cigarette use with smoking cessation and so find the products unappealing.
The narrative needs to change. The oft-repeated expression ‘e-cigarette smoking’ is dangerous nonsense and completely contrary to the interests of global public health. Those who perpetrate this misinformation need to take a hard look at themselves. Many smokers may well use the vaping off ramp as a way of quitting nicotine use entirely. That’s their choice. But the essence of tobacco harm reduction is enshrined in the idea of smoking cessation, quitting smoking and the stop-smoking services. Quite simply vaping is not smoking. So it makes perfect public health sense especially when global help for smokers is patently lacking, to encourage people to ‘stop smoking’ by switching to safer nicotine products - not push a bogus narrative that the only possible benefit from using safer nicotine products is to promote in effect nicotine cessation.