Communication challenges of a tobacco addictiveness reduction policy

Abstract

Published by European Publishing. © 2021 Bialous S. and Freeman B. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License. (https://creativecommons.org/licenses/by/4.0/) Tob. Induc. Dis. 2021;19(May):38 https://doi.org/10.18332/tid/134747 While nicotine has long been identified as the primary addictive substance in tobacco products, globally there has been minimal policy action to regulate nicotine levels within tobacco products. Current maximum limits on nicotine content in tobacco products have yet to result in any public health gains, as nicotine is still maintained at an addictive level. Initial ideas for a nicotine reduction strategy involved gradually reducing the allowable level of nicotine in cigarettes to non-addicting levels, both as a way to prevent youth from becoming addicted and to help existing smokers to quit. A growing body of small experimental studies suggests that removing nicotine from cigarettes may assist smokers to successfully quit, but no large-scale interventions, under real-world conditions, have yet been conducted. Nonetheless, there is some interest in exploring possible policy solutions to reducing the addictiveness of tobacco products, especially given the current proliferation of novel and alternative nicotine and tobacco products. In 2016, at the seventh session of the Conference of the Parties of the WHO Framework Convention on Tobacco Control (FCTC), Parties decided to hold a meeting to explore the positive and negative aspects of tobacco addictiveness reduction policies. One of the key issues identified as part of this meeting was how such a policy, if implemented, could be effectively and proactively communicated to the public. This echoes a 2015 recommendation from the WHO Study Group on Tobacco Product Regulation (TobReg) that an ‘immediate reduction in nicotine, preceded by health communication strategies and public education’ be pursued as the most promising way of reducing the addictive potential of tobacco products. TobReg defined a policy to reduce the addictiveness of tobacco by ‘setting a maximum allowable limit on the nicotine content of all cigarettes and potentially other forms of tobacco (both combusted and non-combusted) that are available for sale, with the intention of minimizing the development and/or maintenance of nicotine addiction’. Currently, there is a lack of consensus as to whether a tobacco addictiveness reduction policy would reduce tobacco use. Some of the assumed benefits of such a policy include making it easier for smokers to quit using tobacco and encouraging smokers to use alternative forms of nicotine delivery, including medicinal nicotine replacement products. For non-tobacco users that experiment with tobacco use, such a policy could make it less likely that they progress to regular tobacco use. However, it is also possible that smokers will readily obtain tobacco products containing nicotine through illicit or cross-border channels, and that non-users may mistakenly believe that tobacco products are now ‘safer’ to use if they no longer contain nicotine. The aim of our commentary is to provide a preliminary exploration of the communication challenges if a policy to reduce the addictiveness of tobacco products were to be adopted. The complex communication needs suggest substantial planning and resources would be required to help ensure the desired AFFILIATION 1 Social and Behavioral Sciences Department, School of Nursing, University of California, San Francisco, United States 2 Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia +Co-first authors