48th Great American Smokeout Must Embrace Tobacco Harm Reduction

November 21 marks the 48th anniversary of the Great American Smokeout. This annual event, hosted by the American Cancer Society (ACS) on the third Thursday of November, provides an opportunity for adults who smoke “to commit to healthy, smoke-free lives.” The event aims to encourage the reduction of combustible cigarette use, but there is growing concern that groups like the ACS are conflating tobacco harm reduction products with more harmful combusted tobacco, potentially hindering public health efforts.

Despite widespread misinformation, e-cigarettes and other tobacco harm reduction products including heated tobacco and oral nicotine and tobacco products are significantly less harmful than combustible cigarettes. Further (and even better news), their use is associated with declines in combustible cigarette use.

A study published in the New England Journal of Medicine found e-cigarettes to be twice as effective as traditional nicotine replacement therapies like nicotine gums and patches in helping adults quit smoking. The widespread use of snus, an oral tobacco pouch, in Sweden is associated with some of Europe’s lowest lung cancer rates. The introduction of heated tobacco products in Korea directly correlates with significant declines in combustible cigarette use.

However, in America, strict regulations by federal agencies and misinformation spread by public health trade associations limit the options available to smokers seeking safer nicotine alternatives.

To date, the U.S. Food and Drug Administration (FDA) has authorized only 34 e-cigarette products, despite more than 20 million adults being current e-cigarette users in 2023. Contrastingly, since 2012, the agency has issued more than 16,000 orders for combusted and smokeless tobacco products – including more than 660 orders for combustible cigarette products in 2023.

Still clinging onto the “protect the children” narrative, the FDA and other groups including the ACS, continue to call upon policymakers to outright ban flavors in tobacco and vapor products, as well as impose draconian taxes, while simultaneously ignoring the fact that these products are safer than combustible cigarettes.

The FDA and groups like the ACS continue to advocate for banning flavored tobacco and vapor products and imposing harsh taxes, despite these products being safer than combustible cigarettes.

This week, the U.S. Surgeon General released an 800-page report on smoking that mentions “harm reduction” only three times. Further, this taxpayer-funded agency – the Department of Health and Human Services – is erroneously criticizing the tobacco industry, claiming that the industry is ‘appropriating the language of harm reduction,’ while muddying the debate within the broader research and public health community.” Yet, harm reduction isn’t a new concept, it is widely accepted among adults suffering substance abuse disorders, yet seems to not be applicable to tobacco products – despite more than a decade of research finding e-cigarettes (and other products) to be less harmful. Public Health England has maintained since 2015 that e-cigarettes are at least 95 percent less harmful than combustible cigarettes and continue to be a safer alternative for adults who cannot quit smoking. In America, there is population-based evidence that e-cigarette use correlates with significant declines in cigarette sales.

For the 2024 Great American Smokeout, policymakers should promote the use of safer smoking alternatives. With youth vaping rates stabilizing and declining, and adult e-cigarette use increasing among adults who are currently or formerly smoking, the focus should be on educating the over 30 million American adults who still smoke about safer alternatives rather than imposing steep taxes and strict bans.