E-cigarettes no silver bullet to quiting smoking
WHAT’S significant about South Africa’s pending tobacco control legislation?
There are five key areas of tobacco control that the new bill seeks to address: a smoke-free policy, plain or standardised cigarette packaging, regulating e-cigarettes, points of sale marketing, and removing cigarette vending machines.
Some are addressed in South Africa’s current tobacco control law. But the country still doesn’t fully comply with the standards set by the World Health Organisation’s Framework Convention on Tobacco Control. South Africa signed the convention in 2005.
Smoke-free public places are one example. The current law bans smoking in public places but allows for designated smoking areas in places like bars, taverns and restaurants provided that they do not take up more than 25% of the venue, but WHO’S convention calls for 100% smoke-free public places to protect non-smokers fully.
In line with this, the new bill calls for a 100% ban on smoking in public places. It will also ban the advertising of cigarettes and other products at tills or selling them in vending machines.
The health warnings on cigarette boxes and other tobacco product packages are another example. The current law allows for a text health warning on 20% of the package. But the convention calls for a minimum of 30% and encourages countries to have the more effective plain or standardised packaging with graphic and textual warnings.
So, the new law mandates standardised packaging with graphic health warnings to make tobacco packages less attractive to new smokers and to discourage old smokers from continuing to smoke.
The bill is also significant because it attempts to regulate e-cigarettes for the first time in South Africa. To date e-cigarettes have been freely marketed and sold to anyone, including children.
Is there evidence that the interventions will work?
There’s a great deal of evidence from the rest of the world.
Let’s start with smoke-free policies. In countries like South Korea and the US, where they are in place, research shows that they led to an overall improvement in health, particularly children’s health.
Incidents of smoking-related cancers went down and there was a reduction in childhood smoking. There was also an TO UNDERSTAND why e-cigarettes have such passionate advocates, you have to understand the libertarian ideology underpinning the devices.
To technophiles, they are not just a solution to the global smoking crisis but a beacon of free-market innovation.
While the tobacco industry is a perfect symbol of everything wrong with capitalism, and a clear illustration of the need for government regulation to protect consumers, many vaping defenders see their industry as a public health solution guided by the profit motive. It’s capitalism operating to save lives.
There is one problem: e-cigarettes, on their own, don’t appear to be very good at saving lives. If you really want to get smokers to quit, you need to build an incentive structure.
Consider a study published this week in the New England Journal of Medicine. Its authors took 6 000 smokers enrolled in tobacco-cessation programmes through their employers and randomly divided them into increase in the number of smokers saying they want to quit. When it comes to packaging, studies show that it encourages smokers to quit and discourages young people from wanting to start smoking.
E-cigarettes are still a five groups. The first received information about the health benefits of not smoking and motivational text messaging. The second received free cessation aids, such as nicotine patches or pharmacotherapy and, if those failed, free e-cigarettes.
The third received free e-cigarettes. And the final two received financial incentives – worth up to $600 (R7 500) – if they kept from smoking.
The result six months later? Those receiving financial incentives were up to three times more likely to quit than those given free e-cigarettes.
And while the quit rates for those given e-cigarettes were higher than other cessation aids or from the group that only received information and motivational texts, the authors note that the difference was not significant.
The researchers found similar results even when they focused on those who were motivated to quit when entering the programmes.
While about 5% of these smokers kept away from cigarettes for six relatively new factor. But research is already casting doubts on claims made about them. First introduced in China in 2004, they were initially mooted as an aid to quit smoking. But research shows that they, in fact, encourage young people to months with the help of vaping, almost 13% were able to do so when given financial incentives.
Vaping advocates might object and argue that even if e-cigarettes were relatively unsuccessful in making people quit smoking, they still may do some good by reducing the number of conventional cigarettes a smoker consumes.
However, experts warn otherwise. While e-cigarettes are considerably less harmful than combustibles, a recent start smoking cigarettes.
And studies have shown e-cigarettes do not reduce quit rates. Instead, the latest research shows they do the reverse – they reduce the quit rates of smokers intending to quit by about 66%.
There are 83 countries report by the National Academies of Sciences, Engineering and Medicine explained that e-cigarettes could only be helpful in improving short-term health if they result in the complete cessation of conventional smoking.
In other words, it’s all or nothing. You can’t improve your health by smoking part-time.
Scott Halpern, the lead author of the NEJM study and a professor of medicine at the Perelman School of Medicine at the University of that regulate e-cigarettes and about 27 that have completely banned their sale. These include Brazil, Singapore, Uruguay, Seychelles and Uganda.
The advertising, promotion and sponsorship of e-cigarettes is regulated or Pennsylvania, says the study provides some of the most robust data compiled on the ineffectiveness of e-cigarettes.
“All those groups offering these conventional cessation aids, what we find is that it’s not money well spent.”
Halpern and his team used the results of the study to calculate the cost of each intervention and found that financial rewards were far more costeffective than e-cigarettes alone.
While each successful cessation through e-cigarettes cost roughly $5 400, successful cessations through financial incentives cost only $3 400.
The lesson here is not to do away with e-cigarettes. They are, after all, a tool that can be used along with incentives. But it’s doubtful that e-cigarettes can be successful on their own. In fact, they may be doing harm by introducing teens who have never smoked cigarettes.
However, they should be part of a health campaign to specifically target smokers and offer them incentives to quit. – The Washington Post prohibited in 62 countries.
Why is it important to have a legislation like this?
Tobacco smoking is the single most preventable cause of death in the world. Smoking also worsens TB and HIV treatment outcomes. Yet 37% of South African men and 6.8% of South African women aged 15 years and older use tobacco.
Before the WHO convention, South Africa was a leader in tobacco control in Africa and across the world because of strong legislation it had put in place. But the laws weren’t updated according to current WHO standards and the country now lags behind some other African countries.
The new legislation will place South Africa on the right path. Apart from saving millions of lives, it will ensure that South Africa fulfils its obligation as a party to the WHO convention.
There are several benefits to having strong legislation.
Firstly, it will protect millions of South Africans who don’t smoke but take in second-hand smoke from those who do. They face the same health risks as active smokers.
Secondly, it will also help encourage people to quit and live healthier lives and discourage young people from starting.
And thirdly, the tobacco industry views young people as replacement smokers. Strong laws will prevent young people from being manipulated by the industry.
While e-cigarettes are unlikely to lead to one giving up smoking, they will help together with other incentives, researchers say
What are the next steps?
Once the bill becomes law, the health minister will have to draw up several regulations to guide its implementation.
These will ensure that the law is interpreted correctly and not manipulated by the tobacco industry, and that the potential gains of the legislation are not watered down.
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Egbe is a specialist scientist, Alcohol, Tobacco and Other Drug Research Unit, SA Medical Research Council.