Session 6: Tobacco harm reduction and public health Seminars

The American Lung Association lists as one of their legislative priorities to “raise the tax on e-cigarettes to parity with cigarettes.” In late 2019, the US House of Representatives passed such a tax, and in the current Congressional session legislators have introduced similar bills in both the House and the Senate. Meanwhile, 28 states have enacted e-cigarette taxes of varying magnitudes, with some actually exceeding the cigarette tax equivalency. In this presentation, I summarize the quasi-experimental research on e-cigarette taxes to date. These studies generally find across a variety of populations and data sets, that e-cigarette taxes sharply reduce e-cigarette use and sharply increase more dangerous cigarette use, suggesting that these taxes may overall harm public health. I suggest an alternative legislative priority instead of increasing taxes on alternative combustible tobacco products like cigars, whose taxes are in many cases overdue for raising.

Cigarette smoking is commonly viewed as a chronic, relapsing problem requiring long-term, repeated attention and multiple quit attempts. Yet the question of whether e-cigarettes may assist with cessation is often examined with a binary, single event, “all or nothing” lens. There may be advantages of using e-cigarettes within a relapse prevention/recovery of smoking abstinence framework when more adaptively used in targeted, individually tailored situations. This presentation will discuss potential approaches of how e-cigarettes can be used in sequential quit attempts to promote abstinence following smoking lapses; the potential role of transitions in self-identity away from being a “smoker”; and research designs to maximize more targeted and tailored approaches to help identify a role for e-cigarettes.

Successful public health campaigns rely on establishing and maintaining the public’s trust in the recommendations that are given.  This presentation highlights concerns that I have about the erosion of trust in tobacco control that appears to be happening because previously trusted public health officials are staking out policy positions that distort the truth about lower risk alternative nicotine products.

Human rights have been invoked strategically as motivation to oppose tobacco industry activities. Analysis of human rights can also be applied to tobacco harm reduction with, arguably, more support. This involves close examination and identification of the limits of public health paternalism, respect for human autonomy and agency, and advocacy for those who are marginalized in society. I will review current public health political dynamics that have placed THR in a subordinate role, and suggest some strategies to level the playing field.

The ways in which those who oppose tobacco harm reduction mimic the tactics of those who opposed reform of illicit drug policies is profoundly disturbing.  Politicians and public health officials ignore the voices and concerns of consumers and others who would most benefit from harm reduction policies.  Government and philanthropic funders focus almost entirely on potential harms and little if at all on benefits, or the role of pleasure, or personal agency, choice and human rights.  Powerful activist groups adapt the rhetoric and lies used by now discredited anti-marijuana groups.  Bans on harm reduction devices are justified in terms of protecting children notwithstanding evidence that they actually fail to protect young people while endangering adults.  Scant attention is given to the potential downsides and unintended consequences of overly restrictive regulations and prohibitions.  Medical associations and professionals accept and propagate claims that have no basis in scientific evidence.  None of this is consistent with responsible public health, good public policy or ethical standards of communication, public advocacy and serious political leadership.  Those who mimic the rhetoric, tactics and abuses of now discredited drug war proponents need to be called out and discredited.

• Have the socio-economic disparities in smoking been sacrificed for preventing youth uptake
• Has tobacco control become an anti-vaping movement?
• From flavor bans to increasing taxation – what are the intended and unintended consequences
  

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