2022 - Session 1 Seminars

Substantially reducing the number of people smoking combusted tobacco products and minimizing the initiation of their use by non-smokers, especially youth, presents an objective that would have a profound impact on reducing the preventable disease and premature death from tobacco product use. Because their use mimics smoking, delivers substantial amounts of nicotine quickly, and delivers significantly less harmful and potentially harmful constituents during exclusive use compared to smoking, e-cigarettes are a tool that could make a major impact on overall population health. However, to date, e-cigarettes have not met their potential with too many adolescents starting their use and too many smokers either becoming dual users or rejecting e-cigarettes and relapsing to smoking.  This presentation will discuss some of the current approaches and propose some out-of-the-box ideas for consideration that are intended to encourage the conversation of how to maximize the potential benefits of e-cigarettes for reducing morbidity and mortality of tobacco smoking while minimizing the unintended consequences.

The continuum of risk is a cornerstone of a nicotine-based framework for public health proposed by the FDA in 2016. The idea is that products that deliver nicotine fall on a spectrum of risk based on toxicity and addictiveness. Combusted tobacco products such as cigarettes pose the highest risk, both in toxicity and addictiveness. An exception is the very low nicotine content cigarette, which is has high toxicity, but low addictiveness, and if mandated by regulation would be expected to promote smoking cessation or switching to less harmful nicotine products. Non-combusted nicotine products are less toxic, and if smokers cannot or do not want to quit smoking, switching to these products would benefit their health. This presentation will review the risks as well as potential benefits of nicotine delivered from sources other than combusted tobacco. It will also consider how risks of nicotine compare to other widely used drugs, such as alcohol and cannabis.

The close links between smoking and social disadvantage and poor mental health were traditionally considered to be primarily due to smoking having a stronger appeal for people whose lives are more stressful, but with the rise of vaping, claims increased that the association shows adverse effects of nicotine on the developing brain, either during pregnancy, or via smoking in adolescence. In animal studies, very large and stressful nicotine dosing of developing foetus and during early adolescence generated a range of pathological outcomes, but it is not clear whether this is relevant for nicotine self-administration in humans.

This presentation will review human studies that examine whether the associations between smoking and lower IQ and educational achievement, and between smoking and increased risk of ADHD, anti-social behaviour, autism and use of illegal drugs is due to smoking or due to genetic, familial and environmental factors. The talk will also consider the causality of the association between starting smoking at a younger age and higher cigarette dependence. It will then consider to what extent any adverse behavioural effects of smoking may apply to nicotine on its own, when not combined with other tobacco chemicals.

• The most recent Cochrane evidence on the effectiveness and safety of e-cigarettes for quitting smoking
• Findings from new analyses of longer term e-cigarette use, the role of flavours in cessation, and biomarkers of harm
• How we conceptualise, communicate, and address uncertainties in the evidence base

Cigarette smokers not planning to quit are often overlooked in population studies. This session will examine the methods and findings from a cohort study of 1600 adult daily cigarette smokers who did not initially use e-cigarettes and had no plans to ever quit smoking.  The main outcomes were discontinuation of cigarette smoking (i.e., no cigarette smoking) and discontinuation of daily cigarette smoking (i.e., no daily cigarette smoking) at follow-up interview. These findings call for consideration of smokers who are not planning to quit when evaluating the risk-benefit potential of e-cigarettes for smoking cessation in the population

• Has the US lost sight of the harm continuum, are we following the science
• Can the US still implement a comprehensive tobacco control plan?
• Is dual use a failure of public health, the product or both?
• Is the current strategy either protecting children or helping adults, is anyone happy?