Beatrice F, J Community Med Public Health Care 2024, 11: 144

DOI: 10.24966/CMPH-1978/1000144

HSOA Journal of
Community Medicine and Public Health Care
Commentary Article

Meanwhile, in Great Britain, since some years, E-cigs had taken

Cigarettes in the Fight Against Lately, very significant and completely independent studies have
produced very convincing answers to this question.
Smoking? Already at the end of 2022, a systematic review by Cochrane Li-
brary examined 40 randomized studies with a total of 22,052 par-
Fabio Beatrice*
ticipants, concluding that there was high certainty evidence that
Scientific Director Of MOHRE (Mediterranean Observatory On Harm Reduc- E-cigs with nicotine increased cessation rates compared to nicotine
tion), Turin, Italy
dispensed in pharmacological way [11], and that has been confirmed
in the latest available update of such review [12].
Abstract
Nicotine is the most used drug in the world for managing the ad-
The most recently published data on the effectiveness of electronic diction of smokers trying to quit. Data from a US survey, showed that
cigarettes (E-cig) in the context of risk reduction proposals are re-
during a 2-year follow-up (the longest period measured so far), the
viewed. Such a proposal should be aimed at heavy smokers who
refuse or fail the cessation processes. Reducing the exposure to
use of E-cigs was substantially free of adverse events and there was
Harmful or Potentially Harmful Components (HPHCs) generated by no evidence of significant harm from nicotine taken via an electronic
the combustion of cigarettes, hence having the potential for a rela- device [13].
tive reduced risk of harm has the potential to save many lives and
should be used transparently as part of policies to help heavy smok- In February 2023, in their Commentary in Nature Medicine, War-
ers without being confused with policies to block initiation aimed at ner KE et al. pointed out that both in the United Kingdom and in the
adolescents and young adults. United States an increase in smoking cessation of 10-15% was associ-
ated with the use of E-cigs [14]. Those smokers who frequently used
E-cigs were significantly more likely to quit smoking than smokers
Commentary who did not vape [14]. Even the US Centers for Disease Control and
Harmful or Potentially Harmful Components (HPHCs) which are Prevention reported that smokers were more likely to use E-cigs in
generated by the tobacco combustion and are present in cigarettes their quit attempts than any other product, including Food and Drug
smoke are the main cause of smoking-related diseases whilst the nic- Administration (FDA)-approved smoking cessation medications [14].
otine addiction is the reason why people smoke but has a limited im- This paper also confirmed a 95% reduction in toxicants, usually pro-
pact on tobacco-related morbidity and mortality [1,2]. duced by combustion products, in electronic aerosol [14].

Tobacco harm is posed by about 70 certain caricinogenes and by In September 2023, a new systematic review by the Cochrane Li-
over 7000 toxicants that are present in cigarette smoking [3-8]. brary was published and showed that E-cigs and some drugs such as
varenicline and cytisine were more likely to help people quit smok-
Despite this certainty and despite the fact that 7 million people die ing. According to this review, for every 100 people, 10 to 19 were
every year in the world as a result of smoking, reducing the damage likely to stop smoking using E-cigs; 12 to 16 using varenicline; and
deriving from the burning of tobacco still remains a controversial top- 10 to 18 using cytisine [15].
ic.
Supporting the usefulness of nicotine consumption in the absence
About a year ago we asked ourselves whether it was still possible
of combustion, an in-depth review was recently published which
to go without risk reduction strategies and without the use of electron-
found that the health risks associated with the use of Snus, in which
ic cigarettes (E-cigs) in the fight against smoking [9].
nicotine is decoupled from tobacco smoke, are significantly lower
*Corresponding author: Fabio Beatrice, Scientific Director Of MOHRE (Med- than those associated with cigarette smoking. The use of Snus in Swe-
iterranean Observatory On Harm Reduction), Turin, Italy Tel: +393357112445; den has proven effective in reducing the incidence of lung cancer and
Email: [email protected] cardiovascular diseases: diseases for which combustion is the main
Citation: Beatrice F (2024) Which is the Role of Electronic Cigarettes in the Fight
culprit. This has led to calls for a review of the EU ban on the mar-
Against Smoking?. J Community Med Public Health Care 11: 144. keting and sale of Snus which represents a form of harm reduction in
heavy smokers with public health benefits [16].
Received: January 17, 2024; Accepted: January 25, 2024; Published: Febru-
ary 01, 2024 These concepts are supported by the opinion of authoritative In-
ternational experts who have recently reviewed the available evidence
Copyright: © 2024 Beatrice F. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestrict- in terms of Tobacco Harm Reduction (THR). Correct information for
ed use, distribution, and reproduction in any medium, provided the original author adult smokers on smoke-free products is hoped for, precisely in the
and source are credited. already quoted commentary published in Nature Medicine [14].
Citation: Beatrice F (2024) Which is the Role of Electronic Cigarettes in the Fight Against Smoking?. J Community Med Public Health Care 11: 144.

• Page 2 of 2 •

Further evidence on the fact that smoke-free systems can repre- 7. Beatrice F, Rossi Mason J, Massaro G (2020) Tobacco Harm Reduction: in
sent, for adult smokers, an effective application of the principle of pursuit of awareness and training for Health Care Professionals. J Com-
munity Med Public Health Care 7: 065.
harm reduction regards not only E-cigs but also Heated Tobacco
Products (HTPs) which appear to be equally efficient in guaranteeing 8. Food and Drug Administration (FDA) (2019) Harmful and Potentially
rates cessation rate of around 40%, at least in the short term [17]. Harmful Constituents (HPHCs).

We had already asked ourselves about the methods of using E-cigs 9. Beatrice F, Albera A, Rossi Mason J (2022) Can you do without Risk Re-
in a clinical setting in 2015 [18]. We showed that in a smoking ces- duction In the fight against smoking? J Community Med Public Health
sation setting it was possible to intervene to help heavy smokers re- Care 9: 119.
sistant to quitting using a E-cigs supported by specific counseling
according to the procedure called MB and protected but European 10. Office for Health Improvement and Disparities (OHID), UK. Nicotine va-
ping in England: 2022 evidence update.
trademark [18].

On the basis of such growing evidence, ignoring E-cigs and more 11. Hartmann-Boyce J, Lindon N, Butler AR, Bullen C, Begh R, et al. (2022)
Electronic Cigarettes for smoking cessation. Cochrane Database of Sys-
generally a risk reduction proposal in the context of policies to help tematic Reviews 4: CD010216.
heavy smokers is no longer possible both on a clinical and a scientific
level. 12. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.
pub8/full
It is believed that risk reduction proposals should be aimed at adult
smokers resistant to the cessation proposal and that they should not be 13. Kalkhoran S, Chang Y, Rigotti NA (2020) Electronic cigarette use and
confused with policies to block tobacco smoking initiation aimed at cigarette abstinence over 2 Years Among U.S. smokers in the Population
adolescents and young adults. Assessment of Tobacco and Health Study. Nicotine Tob Res 22: 728-733.

Conflicts of interest 14. Warner KE, Benowitz NL, McNeill A, Rigotti NA (2023) Nicotine e-ciga-
rettes as a tool for smoking cessation. Nat Med 29: 520-524.
I declare that I have no conflicts of interest.
15. Lindson N, Theodoulou A, Ordonez-Mena JM, Fanshawe TR, Sutton
References AJ, et al. (2023) Pharmacological and electronic cigarette interventions for
smoking in adults: component network meta-analyses. Cochrane Database
1. Food and Drug Administration (FDA) (2020) Chemicals in Tobacco prod- of Systematic Reviews 9: CD015226.
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2. UK Health Security Agency (2020) 8 things to know about e-cigarettes. 16. Clarke E, Thompson K, Weaver S, Thompson J, O’Connell G (2019) Snus:
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4. Pan B, Jin X, Jun L, Qiu S, Zheng Q, et al. (2019) The relationship between
Heated Tobacco Products and refillable Electronic Cigarettes for cigarette
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6. National Center for Chronic Disease Prevention and Health Promotion Successful nicotine intake in medical assisted use of E-Cigarettes: A pilot
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J Community Med Public Health Care ISSN: 2381-1978, Open Access Journal Volume 11 • Issue 1 • 100144
DOI: 10.24966/CMPH-1978/1000144
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