Harm Reduction in Tobaccoism : What Does the Scientific Evidence Say?

Abstract

Smoking is considered a chronic disease caused by chemical dependence of nicotine. This is highly addicting, it in the brain system it influences our emotions, increases the feeling of pleasure/humor and reduces the anxiety. In a planet with about 8 billion people, around 1,36 billion are smokers. Cigarette smoking is the leading cause of preventable death in the world, around 8 million people die every year. A global public health problem, and those who smoke are vulnerable to 50 tobacco-related diseases, several kinds of cancer, lung diseases, cardiovascular disease, erectile dysfunction, female infertility and pregnancy complications. In 2020, according to data from the World Health Organization, 22,3% of the world population consumed tobacco, 36,7% of men and 7,8%of women. In Brazil, due to policies implemented to smoking control, we had a significant drop in the of period (1989 to 2019) from 34,8% of smokers to 12,6% and in 2021, the total percentage of smokers age 18 or over was 9.1%. All forms of tobacco consumption are harmful to health and there is no safe level. Cigarette smoke 4.720 different toxic substances such as nicotine, irritants, tar and carbon monoxide. In the last 15 years, new heated tobacco devices have arrived on the market with promises of less harm to health. In 78 countries this products are available, including Japan, The United States, Canada, Portugal, Australia, Italy and The United Kingdom. As they do not cause tobacco combustion, they created significantly lower levels of toxic substances, which is the strongest arguments made by defenders of those products. A systematic review of the literature in 2018 on heated tobacco products identified 31 studies randomly and blind over those devices, 11 independent and 20 funded by the products manufacturers, needing further long-term research. Another systematic review (relevant studies from 2015 to February 2021), both “in vitro” as alive has shown that the benefits of heated tobacco are controversial and more research is needed to the short-and-long term health effects. Another large concern is that availability of these smokeless products may encourage cigarette consumption, especially among young people and often with the combined use of traditional cigarettes and heated tobacco products.