Are some people unable or unwilling to quit? A popular sociological belief has been that by making smoking uncool or difficult, it will become unpopular and people will quit, and only those unable to quit would remain. If so, products like e-cigarettes or smokeless tobacco make sense as alternatives.
Scholars at UC San Francisco, which has prided itself on being both against smoking and some smoking cessation tools, say just the opposite. They analyzed survey data spanning 18 years in the United States and 6 years in the European Union and found that, contrary to the prevailing assumptions, as the fraction of the population that smoked declined, the remaining smokers actually smoked less and were more likely to quit than to stick with it. The survey results affirm their agenda against nicotine-based e-cigarettes because, they say, anti-smoking public service announcements and smoking cessations tools controlled by pharmaceutical companies, such as nicotine-based gums and nicotine-based patches, are better.
If none of that makes sense to you - why smoking cessation based on one form of nicotine over another would be the target of a culture war by some academics - welcome to the dark side of academic funding, where it isn't about getting rid of cancer-causing smoking as much as it is advocating the cessation system promoted by certain corporations. Part of the e-cigarette market is owned by tobacco companies while all of the gums and patches are controlled by Big Pharma.
The concept of harm reduction, first proposed in the 1970s, was based on the theory that as smoking prevalence declines, the remaining "hard core" smokers will be less likely or able to quit smoking, a process called hardening. The analysis of surveys found that the population is actually softening.
"The fact that the smoking population is softening has important implications for public health policy," said senior author Stanton A. Glantz, PhD, the American Legacy Foundation Distinguished Professor of Tobacco Control at UCSF and director of the Center for Tobacco Control Research and Education, which receives federal government funding to promote gums and patches as cessation devices. "These results suggest that current tobacco control policies have been leading to softening of the smoking population without the need to promote new recreational nicotine products like e-cigarettes."
The survey results were that that for each 1 percent drop in the fraction of the population that smoked, the number of smokers who tried to quit increased by 0.6 percent in the United States and remained stable in Europe. They also showed that the percentage of U.S. smokers who quit increased by 1.13 percent, while daily cigarette consumption among remaining smokers dropped by 0.32 cigarettes in the United States and 0.22 cigarettes in Europe. Overall U.S. cigarette consumption levels dropped over time, while those associations remained stable in Europe.
The findings are significant, said Margarete C. Kulik, PhD, postdoctoral fellow at the Center and first author of the paper, because the group believes e-cigarettes with nicotine are not harmless, unlike nicotine gums and nicotine patches. UCSF did a review of hand-picked studies and reported that e-cigarette emissions trace amounts of formaldehyde and were not as likely to lead to quitting as the gums and patches UCSF endorses.
The takeaway, Kulik said, is that the current policies have been working, including anti-tobacco media funded by tobacco revenues, laws banning smoking in more places and increased tobacco taxes. They give credit to those for why smoking prevalence has declined - along with pharmaceutical alternatives but not e-cigarettes.
"We show that there is no real need to distribute e-cigarettes as part of a tobacco policy package because the smoking population is softening," she said. "Tobacco control policies should continue to move the population down these softening curves rather than changing policies to promote new forms of nicotine delivery, especially ones like e-cigarettes that are very appealing to children."
E-cigarettes are more appealing than chewing gum? If that statement gives you the impression that the agenda is to endorse one corporate segment and penalize another, you are not wrong.
Article: "The smoking population in the USA and the EU is softening not hardening," June 24, 2015, Tobacco Control. Supported by the National Cancer Institute (grants CA-113710 and CA-060121).