Jeffrey A. Singer
Chapter 10 of Your Body, Your Health Care covers tobacco harm reduction by exploring various nicotine delivery systems that are safer than combustible tobacco, which causes the harmful chemicals linked to cancer, lung disease, and cardiovascular disease.
A study published this week in the Annals of Internal Medicine by researchers at the University of New South Wales found that nicotine e‑cigarettes are more effective than nicotine lozenges or gum in helping people quit smoking. This study reinforces earlier research, including a 2023 Cochrane comprehensive review and meta-analysis, as well as a 2021 systematic review of seven randomized controlled trials.
Today, an article in Filter highlights a study from Italy showing that people who quit smoking using nicotine e‑cigarettes or heated tobacco products experienced a significant increase in VO2max, the maximum amount of oxygen the body can use during intense exercise—a key measure of cardiovascular fitness and endurance. The 12-week randomized controlled trial found “quitters showed the greatest improvement in VO2max at both week 4 and week 12.” They observed no significant differences between those who used e‑cigarettes to quit and those who used heated tobacco products.
Heated tobacco devices, which resemble e‑cigarettes, deliver nicotine by heating tobacco to around 600°F—far lower than the 1300°F combustion temperature of cigarettes. Unlike e‑cigarettes, which vaporize liquid nicotine without tobacco, these devices create an aerosol with significantly fewer harmful chemicals than cigarette smoke. They offer a less toxic way to consume tobacco and nicotine, making them a valuable tool for harm reduction.
Although heated tobacco products are popular in Europe and Japan, the Food and Drug Administration has delayed their widespread availability in the US. Most users don’t turn to these products to quit smoking but to enjoy tobacco in a safer form. Evidence from Japan shows that they reduce cigarette sales and have limited appeal to youth. In 2022, the European Union banned flavored heated tobacco products. While the US hasn’t followed suit, as of early 2023, the FDA has only permitted adults to access a few heated tobacco products, all tobacco-flavored.
Yet as lawmakers and policymakers at the state and federal levels continue exploring ways to restrict nicotine delivery systems that don’t involve combustible tobacco, the evidence continues to grow that they offer adults a safer way to consume nicotine.