Smoking risks due to combustion – expert

To address the confusion over the difference between smoking and nicotine consumption, a London professor and smoking cessation expert said combustion or the process of burning tobacco, not nicotine, is what causes smoking-related diseases and death. 

“Practically all risks to health from smoking are due to combustion products that are released from burning tobacco,” Peter Hajek, professor of clinical psychology and director of the Wolfson Institute of Preventive Medicine’s Tobacco Dependence Research Unit at Queen Mary University of London.

Studies have found that tar and carcinogens found in tobacco smoke cause the death and disease associated with smoking, and not nicotine.  

“Outside pregnancy and some rare vascular diseases, using nicotine on its own does not pose much risks to physical health. If smokers switch from smoking to using nicotine on its own, they avoid practically all risks of smoking,” he said.

Hajek said by eliminating combustion from nicotine consumption, such as using products like e-cigarette, health risks will be significantly reduced. E-cigarettes or vapes, heated tobacco products and snus are among the non-combustible alternatives to smoking.

There is a mounting scientific evidence from around the world confirming that smoke-free nicotine products are significantly less harmful than traditional cigarettes.  Public Health England, an operationally autonomous executive agency of the UK Department of Health, said that e-cigarettes are at least 95-percent less harmful to humans than combustible tobacco. 

According to Hajek, nicotine is poorly understood globally including in the Philippines.  “Nicotine seems addictive when combined with other tobacco chemicals, but much less so when on its own. Adolescent non-smokers who try cigarettes have over 50-percent probability that they will progress to daily smoking, but adolescent non-smokers who try e-cigarettes very rarely progress to daily vaping,” he said.

"People do not get hooked on nicotine gum or patches. But while nicotine on its own seems unattractive to non-smokers, it can be rewarding to smokers who are already habituated to it. In this way, such products help smokers quit,” he said.

Hajek said the problem with smoking is not nicotine, but the smoke that causes cancer, heart disease and lung disease. 

“We have no problems with almost everyone drinking coffee, even if such use is daily, compulsive, and in many people could be labeled as ‘addictive’. In the same way, there is no issue with some smokers continuing to use nicotine, if health risks of such use are small,” he said.

To reduce the health risks from smoking, authorities in the Philippines and other countries should encourage smokers to switch to less harmful, smoke-free nicotine products such as e-cigarettes and snus, Hajek recommended.

“As long as cigarettes are freely available, Philippine legislators should try to make the less harmful nicotine products as attractive to smokers as possible, so that more smokers are encouraged to switch. Such products should be cheaper, more easily available, and accompanied by less restrictions and stigma,” he said. 

A February 2019 clinical trial by UK’s National Institute for Health Research found that e-cigarette was twice as effective as nicotine replacement treatments such as patches and gum at helping smokers quit.

Hajek said questions about the safety of e-cigarettes emerged last year with acute lung injuries reported among users of e-cigarettes in the USA. This however turned out to be due to contaminants in illegal marijuana products, and not related to nicotine vaping.


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