Smoking is still our most deadly addiction and the most significant public health crisis, but massive gains have been made.
Because it has been going on for so long, it’s almost as if we have become oblivious to the tragedy of preventable illness and deaths that cigarettes still represent.
Smoking tobacco is still the most significant cause of preventable disease and death. Up to two out of three lifelong smokers will die from smoking. You may have read some tabloid horror stories about vaping but put it into the context that 1200 people die daily in the USA from cigarette smoking.
What part of cigarettes is so harmful?
People talk about the many carcinogens in cigarettes, but most of them and the harmful substances are contained in the tar of cigarettes. As Russell stated in the BMJ (1) “People smoke cigarettes for the nicotine but die from the tar.”
Aren’t other addictions more harmful?
Smoking is the most deadly addiction for those of us with other addiction problems. It is so bad that, for example, twice as many alcoholics die from smoking as die from alcohol misuse:
“….. the death rate for alcoholics who seek treatment is 48.1% within 20 years compared with an 18.5% death rate for the general population. Of those deaths, more than half (50.9%) are attributed to smoking, and only 34.1% attributed to alcohol.”
Smoking constantly reducing
The good news is that there has been a long-running trend in the number who quit smoking, but as the number of smokers has become smaller, it seemes there were a few who were harder and harder to reach.
E-cigarettes have introduced a new push to reach even this group and give us further gains.
What about teenagers?
Of course, we see an alarming rise in vape pens and e-cigarette use, especially among the young, but it is essential to put this into perspective. As recently as 1996, the proportion of young people who had never smoked was 49%, so the majority had smoked cigarettes.
More and more people have been quitting smoking yearly and not even starting, so in 2018, not having ever smoked increased to 84%. (2) Compare this to the 9% who are currently reported to have tried using e-cigarettes, and you can see the significant gains being made.
Vaping ( electronic nicotine delivery systems ) has been a potent disruptor in smoking cessation. It has helped twice as many people stop smoking compared to other nicotine replacement therapy.
Sucking any smoke into your lungs is a harmful activity, but with vaping there are far fewer harmful chemicals than smoking, and the harms are estimated to be 1/20th ( Lancet 2019 ). Repeated scientific studies point out the significantly lower risk of e-cigarettes but it is poorly reported.
Even though using e-cigarettes is medically estimated to be 20 times less harmful than smoking, the most recent public survey ( Oct 22 ) revealed that when asked to compare the risks of e-cigarettes and cigarettes, only 19.4% correctly assessed it as less harmful to vape.
23.8% didn’t know, but 33.5% thought it was equally dangerous, and 23.4% thought vaping was actually more harmful! Something is seriously wrong with how this life-saving intervention is being communicated.
In every age group, we are witnessing an amazing win for public health; each age group is gradually quitting smoking even though the focus is mostly on young smokers/vapers.
Upward swing in teen vaping.
Although there has been a sharp upward trend in electronic cigarettes among teenagers, it is being matched by an equally sharp drop in cigarette smoking.
If we zoom in a bit on these last year or so, this is quite apparent:
Is Vaping a gateway?
There is a concern that vaping may be a gateway drug to smoking. However, a 2017 study showing that teens who start smoking e-cigarettes are more likely to start smoking cigarettes was refuted by later studies.
(4) Most recently, a UCL study in 2022 indicated little evidence for uptake in smoking from vaping (5) and the same was reported in a New Scientist March 2022 in an article titled “Vaping probably isn’t a gateway to smoking” (6).
We see a worrying upswing in e-cigarettes, especially amongst the young, but an equivalent downturn in cigarette smoking more than offsets this.
Given that vaping doesn’t seem to be a gateway to smoking and is 20 times less harmful than smoking, tremendous health gains are being made. Still, this message is not being communicated well.
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