Response to “New tobacco products, a threat for tobacco control and public health of Mexico"

Riccardo Polosa Salvatore Urso Konstantinos E Farsalinos About the authors

Dear Editor: The position article by Reynales-Shigematsu and colleagues11. Reynales-Shigematsu LM, Barrientos-Gutiérez I, Zavala-Arciniega L, Arillo-Santillán E. Nuevos productos de tabaco, una amenaza para el control de tabaco y la salud pública en México. Salud Publica Mex. 2018;60(5):598-604. https:// doi.org/10.21149/9682
https://doi.org/10.21149/9682...
on the public health impact in Mexico of combustion-free electronic nicotine delivery systems (ENDS) fails to present a balanced overview of the risk-benefit ratio of these new technologies, grossly misrepresents the existing evidence, and ignores the broad consensus that these products are much less harmful than cigarettes.22. Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. London: RCP, 2016 [cited October 7, 2018]. Available from: Available from: http://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0
http://www.rcplondon.ac.uk/projects/outp...
,33. McNeill A, Brose LS, Calder R, Bauld L, Robson D. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England, 2018 [cited October 7, 2018]. Available from: Available from: https://www.gov.uk/government/ publications/e-cigarettes-and-heated-tobaccoproducts-evidence-review
https://www.gov.uk/government/ publicati...
,44. National Academies of Sciences, Engineering and Medicine. Public health consequences of e-cigarettes. Washington DC: The National Academies Press, 2018. https://doi.org/10.17226/24952
https://doi.org/10.17226/24952...

The work cited by the authors (references 8-21) on exposure risks from e-cigarette aerosol emissions report misleading results that do not reflect normal conditions of use.5 The authors claim that trial of e-cigarettes is propitiating tobacco initiation among Mexican adolescents, citing a longitudinal cohort study on Mexican high school students (reference 31) which actually disproves this claim, as it reported that the association between e-cigarette trial at baseline and past 30 day smoking at follow-up was not even statistically significant.55. Polosa R, Urso S, Farsalinos KE. Response to “New tobacco products, a threat for tobacco control and public health of Mexico” [internet]. Greece; c2015-2016 [updated 2019 Apr 26; cited 2018 Oct 7]. E-cigarrete research [about 7 screens]. Available from: Available from: http://www.ecigarette-research.org/research/index.php/ whats-new/2019/269-mexico-ecig
http://www.ecigarette-research.org/resea...
The authors dismiss the utility of ecigarettes in smoking cessation, but their cited references do not support this claim.5 Further, a recent high quality randomized controlled trial66 . Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers-Smith K, Bisal N, et al. A randomized trial of e-cigarettes versus nicotine replacement therapy. N Engl J Med. 2019;380:629-37. https:// doi.org/10.1056/NEJMoa1808779
https://doi.org/10.1056/NEJMoa1808779...
has shown e-cigarettes to be twice as effective in smoking cessation compared to nicotine replacement therapies. A detailed critique of the position article is available.55. Polosa R, Urso S, Farsalinos KE. Response to “New tobacco products, a threat for tobacco control and public health of Mexico” [internet]. Greece; c2015-2016 [updated 2019 Apr 26; cited 2018 Oct 7]. E-cigarrete research [about 7 screens]. Available from: Available from: http://www.ecigarette-research.org/research/index.php/ whats-new/2019/269-mexico-ecig
http://www.ecigarette-research.org/resea...

Following the authors, ENDS can only be part of a harm reduction strategy for Mexico if they immediately promote total smoking abstinence, as well as complete absence of dual usage and recruitment of non-smokers.77. Norma Oficial Mexicana NOM-028-SSA2-2009 Para la prevención, tratamiento y control de las adicciones. México: Conadic, 2009 [cited October 7, 2018]. Available from: Available from: http://www.conadic. salud.gob.mx/pdfs/norma_oficial_nom.pd
http://www.conadic. salud.gob.mx/pdfs/no...
However, these are maximalist and unrealistic conditions that no new harm reduction product can fulfill. A more realistic approach to harm reduction yields concrete benefits: the recreational usage of e-cigarettes, endorsed by health institutions in the United Kingdom under a consistent Tobacco Control strategy, has contributed to a significant decay of smoking prevalence with negligible usage by non-smokers of all ages.22. Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. London: RCP, 2016 [cited October 7, 2018]. Available from: Available from: http://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0
http://www.rcplondon.ac.uk/projects/outp...
,33. McNeill A, Brose LS, Calder R, Bauld L, Robson D. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England, 2018 [cited October 7, 2018]. Available from: Available from: https://www.gov.uk/government/ publications/e-cigarettes-and-heated-tobaccoproducts-evidence-review
https://www.gov.uk/government/ publicati...

By presenting ENDS as a threat to public health (consequently recommending their regulation as combustible tobacco products), Reynales- Shigematsu and colleagues are depriving 15 million Mexican smokers of key information on a plausible harm reduction alternative that can vastly improve their health. As an unintended consequence, this misinformation will keep them smoking.

References

  • 1
    Reynales-Shigematsu LM, Barrientos-Gutiérez I, Zavala-Arciniega L, Arillo-Santillán E. Nuevos productos de tabaco, una amenaza para el control de tabaco y la salud pública en México. Salud Publica Mex. 2018;60(5):598-604. https:// doi.org/10.21149/9682
    » https://doi.org/10.21149/9682
  • 2
    Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. London: RCP, 2016 [cited October 7, 2018]. Available from: Available from: http://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0
    » http://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0
  • 3
    McNeill A, Brose LS, Calder R, Bauld L, Robson D. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England, 2018 [cited October 7, 2018]. Available from: Available from: https://www.gov.uk/government/ publications/e-cigarettes-and-heated-tobaccoproducts-evidence-review
    » https://www.gov.uk/government/ publications/e-cigarettes-and-heated-tobaccoproducts-evidence-review
  • 4
    National Academies of Sciences, Engineering and Medicine. Public health consequences of e-cigarettes. Washington DC: The National Academies Press, 2018. https://doi.org/10.17226/24952
    » https://doi.org/10.17226/24952
  • 5
    Polosa R, Urso S, Farsalinos KE. Response to “New tobacco products, a threat for tobacco control and public health of Mexico” [internet]. Greece; c2015-2016 [updated 2019 Apr 26; cited 2018 Oct 7]. E-cigarrete research [about 7 screens]. Available from: Available from: http://www.ecigarette-research.org/research/index.php/ whats-new/2019/269-mexico-ecig
    » http://www. ecigarette-research.org/research/index.php/ whats-new/2019/269-mexico-ecig
  • 6
    Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers-Smith K, Bisal N, et al. A randomized trial of e-cigarettes versus nicotine replacement therapy. N Engl J Med. 2019;380:629-37. https:// doi.org/10.1056/NEJMoa1808779
    » https://doi.org/10.1056/NEJMoa1808779
  • 7
    Norma Oficial Mexicana NOM-028-SSA2-2009 Para la prevención, tratamiento y control de las adicciones. México: Conadic, 2009 [cited October 7, 2018]. Available from: Available from: http://www.conadic. salud.gob.mx/pdfs/norma_oficial_nom.pd
    » http://www.conadic. salud.gob.mx/pdfs/norma_oficial_nom.pd

Publication Dates

  • Publication in this collection
    22 Apr 2020
  • Date of issue
    Jul-Aug 2019
Instituto Nacional de Salud Pública Cuernavaca - Morelos - Mexico
E-mail: spm@insp3.insp.mx