(Bloomberg) -- As rates of smoking decline worldwide, tobacco companies have found other ways to make money by satisfying people’s hankering for nicotine, the addictive stimulant found in tobacco. Sales of “smoke-free” nicotine products are eating into those of cigarettes and other combustibles. Yet health officials are divided as to whether they should condone these products. While less deadly than cigarettes, they can hook users just as easily and may also have harmful effects. The UK, for example, has long supported vaping as a means to help adults quit smoking. Now it plans to ban disposable e-cigarettes amid concerns over a surge in their use by children.
1. What are tobacco companies doing?
Two of the leading tobacco companies — Philip Morris International Inc. (PMI) and British American Tobacco Plc (BAT) — have pledged to phase down cigarette sales. “Cigarettes belong in museums,” Jacek Olczak, PMI’s chief executive officer, said in 2023. The company has set a goal of earning less than a third of its revenue from cigarettes by 2030. For its part, BAT committed in December to a “smokeless world” and an aim of earning half its revenue from non-combustibles by 2035. BAT also wrote down the value of some of its US cigarette brands by $31.5 billion to reflect their diminishing returns as smokers quit, trade down to cheaper brands or switch to non-cigarette alternatives. Anti-smoking campaigners accuse the companies of hypocrisy for promoting a smoke-free future while still selling billions of cigarettes annually.
2. How much has smoking declined?
Global rates of smoking were estimated at 33% among men and 7% among women in 2020, a decline of 27% for men and 38% for women since 1990. Most experts point to a 1964 report by the US surgeon general as a watershed moment marking the beginning of a growing understanding in the US and elsewhere that smoking is a serious health risk. According to the US National Library of Medicine, only 44% of Americans in 1958 believed smoking caused cancer, a figure that rose to almost 80% a decade later. Subsequent years brought an increasing awareness that second-hand smoke endangered non-smokers. That accelerated efforts to combat smoking across the world with the aim of improving public health.
3. Where are smoking rates highest and lowest?
Smoking rates tend to be elevated in low-to-middle-income countries, which are home to around 80% of the world’s tobacco users, according to the World Health Organization. The WHO estimates that tobacco use kills more than 8 million people a year. In China, just 2% of women smoke, but half of men do. Among the mostly wealthy countries belonging to the Organization for Economic Cooperation and Development, 16.5% of people age 15 and older smoked daily in 2019. The lowest rate is in Sweden, where 6% of adults smoked in 2021. Public health experts tend to credit government policies aimed at reducing smoking, with some saying the widespread adoption of the oral tobacco product snus as an alternative to cigarettes has contributed.
4. What have governments done to reduce smoking?
Laws limiting smoking in public spaces began to emerge in the US in the 1970s. Complete bans on smoking in indoor public places, workplaces and public transport were in place in 74 countries as of 2022, according to the WHO, up from 10 countries in 2007. Other policies governments have adopted include restricting cigarette advertising and promotion campaigns, requiring health warnings on cigarette packaging, and taxing cigarette sales in an effort to discourage purchases.
5. Has any country tried banning cigarette sales?
Yes. The Himalayan kingdom of Bhutan became the first, and only, country to completely ban the sale of tobacco products in 2004 under a law that allowed their importation for personal use. The move created a vibrant black market for cigarettes smuggled over the border from India, and the ban was lifted in 2021.
New Zealand enacted a law in early 2023 barring the sale of cigarettes to anyone born on or after Jan. 1, 2009 — only for a new government to repeal it the following year.
Unfazed by those setbacks, the previous UK Conservative government introduced a draft law in March that would gradually raise the legal age for buying cigarettes in an effort to create a “smoke-free generation.” Smoking has cost the country’s National Health Service £2.6 billion ($3.2 billion) a year, according to figures cited by the NHS. The legislation, which also sought to crack down on youth vaping, is being revived by the new Labour administration.
As Bhutan learned, however, cigarettes can also be an important source of tax revenue; in restoring sales, its government cited tax shortfalls as well as the smuggling problem. In China, which consumes roughly half of all cigarettes produced, the tobacco industry — the world’s biggest — is wholly owned and controlled by the government, and it generates about one 10th of all state revenue.
6. What are ‘smoke-free’ alternatives to cigarettes?
The tobacco industry has experimented with alternatives to cigarettes for decades.
- The first patent for a type of e-cigarette was granted in 1965. Today, e-cigarettes (or vapes) and heated tobacco products are the most widely known cigarette alternatives. The former gets its name from the process of heating and vaporizing a liquid solution containing nicotine mixed with the common food additive propylene glycol and, in many cases, flavoring. Heated tobacco products embed an inductive metal in small tobacco pods. Both vapes and heated tobacco products create a nicotine-containing vapor, avoiding some of the pollutants found in traditional cigarette smoke.
- People have been consuming tobacco orally for centuries, and in recent years the industry has developed an expanding array of oral products. Scandinavian Snus, pasteurized tobacco placed under the lip, has been used for centuries. It evolved more recently into a new generation of tobacco-free nicotine pouches — small sachets containing nicotine extract and, in most cases, flavoring. PMI agreed to pay $16 billion for the company Swedish Match in 2022, drawn to its snus and nicotine pouches. After PMI ramped up marketing for the Zyn brand of pouches, their sales rose 80% in the first quarter of 2024, causing shortages.
7. What’s the health argument against ‘smoke-free’ products?
The WHO has taken an aggressive stance against all forms of tobacco, calling both e-cigarettes and heated tobacco products “harmful to health” and not safe.
There is evidence that nicotine can harm brain development in adolescents, and some health authorities say smoke-free products are hooking a new generation on nicotine even as their effects remain unknown.
E-cigarettes and heated tobacco products are too new for scientific studies to have yielded conclusive evidence on the potential effects of the vapor they produce. But research suggests that emissions from heated tobacco products contain many of the harmful elements found in regular cigarette smoke as well as others. Some scientists argue that vapor from e-cigarettes risks damaging the user’s lungs. Studies have found evidence that snus increases the risk of cancer, heart disease, diabetes and birth defects.
Nicotine pouches, whose health impact has still to be fully studied, were the target of a US lawsuit in March, where the plaintiff alleged addiction and dental issues as a result of his Zyn use. The lawsuit said that the pouches deliver more nicotine than cigarettes and that PMI benefits from “Zynfluencers” who promote the brand on social media, with an estimated 30,000 TikTok accounts that use the hashtag #Zyn.
8. What’s the health argument for these products?
Other experts say that smoke-free products should be embraced as a way to get people to stop smoking. Health authorities in the UK, which is affected by high rates of smoking-related deaths, have taken this view. The UK National Health Service recommends smokers use vapes as a smoking “cessation aid.”
At the same time, medical experts in the UK and elsewhere are alarmed by the numbers of children who vape and might otherwise have never used tobacco. Disposable vapes have been a driver of teen use, according to UK authorities, who apart from banning the devices plan to restrict flavors marketed at children. In the US, vape manufacturer Juul Labs has settled multiple lawsuits accusing it of deliberately targeting its product to minors, and it faces still more.
(Michael R. Bloomberg, founder and majority owner of Bloomberg News parent Bloomberg LP, has been a longtime champion of tobacco control efforts and has campaigned and given money in support of a US ban on flavored e-cigarettes and tobacco.)
--With assistance from Andy Hoffman and Tiffany Kary.
©2024 Bloomberg L.P.
