Groundbreaking survey highlights vaping's role in tobacco control

A Filipino vaping group welcomed the results of a groundbreaking study in India which highlight the potential of e-cigarettes as an additional option for tobacco control and how vaping can have a substantial impact on public health.

“This groundbreaking survey clearly shows vaping helps smokers quit or reduce smoking. Its results are particularly relevant to the Philippines because like India, our country has a large number of smokers and a low smoking cessation rate. The Department of Health and other local policymakers should look at the evidence for e-cigarettes with an open mind and start making science-based decisions to help reduce smoking in the country,” said Peter Paul Dator, president of The Vapers Philippines.

Dator was referring to the interview-based survey involving 3,000 vapers aged 18 and older from eight of the largest metropolitan cities in India. The vast majority of respondents (71.3%) used e-cigarettes to quit (30%) or reduce (41.3%) smoking. Similar results were observed in smokeless tobacco (SLT) users. Most (79%) believe that e-cigarettes are less harmful than combustible cigarettes. Survey participants reported minimal side effects (cough, headache, dry mouth/throat) and some health benefits (improved general health, breathing, smell and taste) after they started vaping. 

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Around 81% of survey respondents were men and 19% women, with average age of 29 years. The majority (80%) were first exposed to nicotine through combustible cigarette smoking, SLT use, or both. Leading tobacco harm reduction expert Dr. Konstantinos E. Farsalinos and Indian researchers conducted the survey whose results were published on March 30, 2020 in Harm Reduction Journal.

High smoking prevalence, low quit rates

Dator noted that India and the Philippines face similar smoking-related public health challenges. The World Health Organization (WHO) estimates that there are over 120 million smokers in India, accounting for almost 12% of the 1.1 billion smokers globally. The 2016-2017 Global Adult Tobacco Survey (GATS) revealed that India has the second-lowest quit rate among GATS countries surveyed at the end of 2017. It also showed that India has the second-largest tobacco consuming population in the world, estimated to be over 267 million, which includes at least 100 million tobacco smokers and over 199 million SLT users. 

According to Dr. Farsalinos and his co-authors, tobacco-related deaths in India are estimated to be over 1 million a year and are projected to rise to 1.5 million by 2020. They also pointed to the prevalence of smoking-related illnesses such as heart disease, lung cancer and chronic pulmonary obstructive disease (COPD) in India. 

Dator cited DOH data, which show that almost 88,000 Filipinos die from smoking-related diseases every year. Healthcare expenditures and lost income due to smoking-related sickness and premature death cost the country Php 188 billion (US$ 4 billion) yearly. These figures only cover four of more than 40 smoking-related diseases namely lung cancer, chronic obstructive pulmonary disease (COPD), heart disease and stroke. 

GATS found that there are currently 16 million Filipino adult smokers. “Like India, the Philippines has a very low smoking cessation rate of 4%. This dismal quit rate indicates the ineffectiveness of currently approved smoking cessation strategies in the country such as ‘quitting cold turkey’, counseling, and nicotine replacement therapy,” Dator said.

Vaping ban a retrogressive policy

“We all know that the combustion in cigarettes is what is harmful to the health of smokers. The harm from smoking is caused primarily through the toxins produced by the burning or combustion of tobacco. By contrast, non-tobacco, non-smoked nicotine products such as e-cigarettes are considerably less harmful,” Dator explained.

He cited the widespread agreement among organizations such as Action on Smoking and Health, Public Health England, Cancer Research UK, the Royal College of Physicians and the Royal College of General Practitioners that, on the basis of current evidence, e-cigarettes or vapes represent a significantly less harmful alternative to tobacco cigarettes for smokers who are unable or unwilling to stop using nicotine. 

“The DOH should pay particular attention to how the study authors described India’s e-cigarette ban as a ‘missed opportunity’ and urged the Indian government to promote additional research and consider revising the regulatory framework if the evidence warrants it,” Dator noted.  

The Indian government banned the import, manufacture, sale, advertisement, storage and distribution of e-cigarettes in September 2019. According to Dator, India's vaping ban is a tobacco control approach that other governments should not adopt. “Such a retrogressive policy will be a major blow to smokers who have switched to vaping. It will likely push them to go back to smoking combustible cigarettes.”