Lancet Study Highlights Need To Explore Safer Nicotine Alternatives

Experts have highlighted the need to explore safer nicotine alternatives alongside the existing tobacco-control measures, citing a recent Lancet Regional Health Western Pacific study that found New Zealand recording a sharp decline in smoking rates after regulated lower-risk nicotine products were incorporated into its smoking cessation strategy. According to the study, daily smoking in New Zealand, which had already been declining under conventional tobacco-control measures, fell below 7 per cent by 2022-23 after safer nicotine alternatives, including regulated vaping products, were formally recognised as cessation aids in 2018-19.

Researchers used joinpoint regression analysis, a statistical technique, to assess smoking trends and reported that the annual rate of decline accelerated from 3.5 per cent to 17.9 per cent after the policy shift, indicating a nearly five-fold increase in the pace of reduction.

The findings have relevance for India, which has an estimated 13.5 crore smokers and records around 13.5 lakh tobacco-related deaths annually, the experts said.

Dr Saurabh Tomar, interventional pulmonologist at Aakash Healthcare, Dwarka, said the study suggests that conventional tobacco-control interventions, while effective, may eventually reach a plateau in reducing smoking prevalence.

"Despite New Zealand implementing measures such as plain packaging, graphic health warnings and repeated tax increases, smoking declined only gradually. The sharper fall came after regulated, substantially less harmful nicotine alternatives were recognised as cessation tools and made available to adults," he said.

According to Tomar, scientific evidence differentiates the health risks posed by tobacco combustion from those associated with nicotine itself.

"It is the combustion of tobacco that generates thousands of toxic chemicals responsible for lung cancer, chronic obstructive pulmonary disease and cardiovascular disease. Public policy should recognise this distinction while strengthening smoking cessation efforts," he said.

The study also noted that New Zealand strengthened safeguards for young people by enforcing age restrictions, limiting flavours, banning disposable vaping devices and capping nicotine concentrations.

According to the researchers, youth smoking among 14-15-year-olds continued to decline to historically low levels during the same period, even as youth vaping prevalence increased.

Dr Satish Kumar, senior consultant of internal medicine at Pacific One Health Hospital, Delhi, said although India and New Zealand differ significantly in demographics and healthcare systems, tobacco dependence follows similar biological principles.

"The study indicates that conventional demand-reduction measures remain necessary but may not be sufficient to produce rapid declines in smoking, particularly among socio-economically disadvantaged populations.

"Regulated access to substantially less harmful nicotine alternatives complemented traditional tobacco-control measures and accelerated progress," he said.

The experts also pointed to the distinction between tobacco harm reduction and nicotine elimination, arguing that the two objectives require different policy approaches.

They noted that the World Health Organization has included nicotine replacement therapies in its Essential Medicines List since 2009, while India's Drugs Technical Advisory Board has exempted 2 mg nicotine gum under Schedule K, recognising its role in smoking cessation.

The experts said India continues to face low unassisted quit rates among smokers and limited access to structured tobacco-cessation services. They suggested that evidence from New Zealand could inform future discussions on strengthening smoking cessation strategies while maintaining strict safeguards against youth uptake and nicotine initiation.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)