Opportunities and Considerations for Addressing Misperceptions About Relative Risks of Tobacco Products among Adult Smokers

On August 15th, Brian King, Director of the Center for Tobacco Products (CTP) at the Food and Drug Administration (FDA), published an article in the prestigious scientific journal "WILEY" titled "Commentary on Wackowski et al.: Opportunities and Considerations for Addressing Misperceptions About the Relative Risks of Tobacco Products among Adult Smokers." This article discusses the chances and factors to be considered in tackling the misperceptions amongst adult smokers regarding the comparative risks of tobacco products.

In the article, Brian King mentions that Wackowski and colleagues conducted a survey on American adult cigarette smokers and found that only about 20% of them believe that e-cigarettes contain fewer harmful chemicals than traditional cigarettes. Among these individuals, half of them perceive e-cigarettes as less harmful. The awareness of reduced chemical content is positively associated with the use and interest in e-cigarettes.

Brian King suggests that incorrect perceptions about the relative risks of tobacco products, particularly e-cigarettes, among adult cigarette users can be corrected through education.

Meanwhile, Brian King mentioned in the article three factors that need to be considered when developing and implementing strategies for educating adult smokers about the relative risks of tobacco products.

The following is a translation of the original text: "The government announced today that it will be implementing a new policy to address the rising crime rates in the city. The policy includes increased funding for law enforcement agencies, the establishment of neighborhood watch programs, and stricter penalties for offenders. The government hopes that these measures will improve public safety and reduce crime rates. However, some critics argue that a more holistic approach is needed, including addressing the root causes of crime such as poverty and lack of social support. Only time will tell if the new policy will be successful in combating crime in the city.

Regulation of tobacco and nicotine products varies across different countries worldwide. In the United States, the Food and Drug Administration (FDA) is empowered to oversee the manufacturing, marketing, and distribution of tobacco products, including cigarettes and e-cigarettes, in order to safeguard public health.

There are no tobacco products that can be considered safe [1]. However, within the continuum of risk associated with tobacco products, smoking products such as cigarettes pose the greatest risks [1]. Substantial progress has been made in reducing tobacco consumption through evidence-based comprehensive population-level strategies. Despite these advancements, the global death toll from tobacco smoking still exceeds 8 million people annually.

Given that the majority of adult cigarette smokers initiate tobacco use during adolescence, prevention strategies, including price increases, smoke-free policies, and mass media campaigns, are crucial in reducing tobacco-related diseases and deaths. Furthermore, providing accessible, evidence-based cessation strategies for populations, healthcare systems, and individuals among tobacco product users remains essential. With the continually evolving landscape of tobacco products, shifting towards lower-risk alternatives, such as e-cigarettes, is thought to reduce the risks associated with smoking. The 2018 report from the National Academies of Sciences, Engineering, and Medicine in the United States concluded that there is "conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users' exposure to numerous toxicants and carcinogens found in combustible tobacco cigarettes.

Recently, a representative survey conducted by Wackowski et al. focused on American adult cigarette smokers. The study found that only about 20% of participants believed that e-cigarettes contained fewer harmful chemicals compared to traditional cigarettes. Among this group, half of the individuals perceived e-cigarettes as less harmful. The findings indicated a positive correlation between awareness of reduced chemical content and the use and interest in e-cigarettes.

The research conducted by Wackowski et al. suggests that there is an opportunity to educate adult smokers about the relative risks of tobacco products, particularly e-cigarettes. However, these educational efforts must be evidence-based. When developing content, delivery methods, and target audience, a data-driven approach should be employed. It is particularly important to assess the benefits for the target population (i.e. adult smokers) as well as the potential risks for unintended populations, such as adolescents.

When formulating and implementing strategies related to the relative risks of tobacco products for adult smokers, several factors need to be taken into consideration.

First and foremost, it is unsafe for adolescents to use tobacco products in any form, including e-cigarettes. Therefore, it is crucial to implement robust strategies to prevent youth from engaging in tobacco use. However, efforts to deter young individuals from starting should not impede endeavors to promote smoking cessation and educate adult smokers about the relative risks associated with tobacco products.

Furthermore, the preferred method for adult smokers to quit smoking should be scientifically proven safe and effective products, including FDA-approved medications and devices. Behavioral counseling and medications are both effective, and combining them increases the likelihood of quitting smoking. Currently, no e-cigarette has been approved by the FDA for smoking cessation, which requires evidence of both safety and efficacy. Increasingly, studies indicate that certain e-cigarettes may facilitate smoking cessation among adults; however, due to the toxins present in e-cigarette aerosol, further high-quality studies are still needed to examine short-term and long-term clinical outcomes, including pulmonary effects.

Thirdly, the FDA has authorized 23 tobacco-flavored e-cigarette products and devices for adult smokers who choose to use e-cigarettes. However, in order to fully reap the health benefits from these products, it is crucial for adult smokers to transition completely from traditional cigarettes to e-cigarettes. Biomarker assessments indicate that dual users who simultaneously use both e-cigarettes and traditional cigarettes typically exhibit high levels of toxic substance exposure similar to those seen in exclusive smokers. A significant number of American adults engage in dual use when using e-cigarettes; in 2021, 29.4% are current smokers, 40.3% were former smokers, and 30.3% have never smoked. Simultaneously using traditional cigarettes and e-cigarettes can either serve as a pathway to complete transition or maintain addiction. To maximize the likelihood of the former, adult smokers must fully switch to e-cigarettes and avoid prolonged dual use. Since no tobacco product is safe, the ultimate goal should be to quit using all tobacco products, including e-cigarettes.

In summary, there are opportunities to educate adult smokers about the relative risks of tobacco products, including e-cigarettes, using evidence-based methods. However, these efforts should go hand in hand with efforts to prevent youth from using tobacco products, encouraging the use of FDA-approved cessation therapies, and emphasizing the importance for adult smokers to completely switch from combustible cigarettes to e-cigarettes. These efforts can be implemented by both government and non-government stakeholders. For example, the FDA has recently initiated formative research on eliminating misconceptions about nicotine and communicating potential risks for adult smokers. This is in addition to the FDA's ongoing efforts to prevent youth tobacco use through its "Real Cost" public education campaign. Furthermore, there are also opportunities to continue innovating new tobacco cessation therapies to further reduce tobacco-related diseases and deaths.

References:

Analysis on Wackowski et al.'s study: Examining Ways to Correct Misconceptions About Tobacco Product Risks Among Adult Smokers