“Stop the Swap”: A new hazard in tobacco control

Health professionals in the UK and New Zealand are engaging with non-therapeutic products for therapeutic purposes. High-quality independent reviews find high certainty evidence that vapes are as effective for smoking cessation as the most effective pharmacotherapies, with similarly low rates of adverse events, but with greater user acceptability. Unlike other approaches, they do not require high levels of motivation. Indeed, smokers who vape daily have much higher rates of smoking cessation regardless of intention to quit. Consequently, “swap to stop” programmes – programmes that provide priority groups of smokers directly with approved devices – offer a unique opportunity, especially for the most disadvantaged and dependent smokers.

However, the factors that drive use among adult smokers – affordability, accessibility and appeal – also drive use among youth and so are the growing target of public health policies. Around the world, many jurisdictions are adopting policies intended to “stop the start”, reducing uptake among youth.

When these policies also  “stop the swap”, they can undermine smoking cessation and increase smoking and its harms. Like it or not, policy makers must recognise and manage these trade-offs or risk worsening health outcomes and inequalities.