In 2010, artificial intelligence still seemed like something out of science fiction, you had to kick the ground to propel yourself on a scooter and large cities did not consider restricting access by private vehicle to the center. That year the last major regulatory change affecting tobacco was approved. It was a time when sniffing from a brightly colored plastic tube was still far from being a fashion. The Ministry of Health wants to resume the comprehensive plan against smoking and adapting that strategy to new habits and addictions means getting involved in the growing division of the industry: vapers. The goal: “Achieve the first smoke-free generation.”
At the beginning of December, Minister Mónica García announced her intention to “take the comprehensive anti-smoking plan out of the drawer.” The public health strategy was going to be one of the spearheads of her in the Government. “We cannot turn our backs on the fact that more years of life can be expected for the population,” she explained while pointing to the terraces of bars and restaurants as the next smoke-free zones. The measures that would affect the vapersfor which he guaranteed “specific regulation.”
Barely two months later, Health is outlining what its intentions are for electronic cigarettes. “We want to equate them to normal tobacco, especially those that include nicotine,” explains the new general director of Public Health and Equity, Pedro Gullón. The measure is an old request from the National Committee for the Prevention of Smoking (CNPT). In the Madrid 2018 declaration, after the International Conference for Tobacco Control, it was already claimed to “apply the current regulation on smoke-free spaces to all related products.” However, the resistance of the industry, which has found in these products a source of consumption in a market that was going down, is many and strong. Faced with them, the Ministry insists: “Our intention is to equalize them.” “There is always pressure but we don’t care, we are clear about the plan against tobacco,” Gullón said in a recent interview in elDiario.es.
In 2021, the Ministry promoted a plan that included a ban on smoking in the car, more taxes, and regulating the use, sale, and promotion of electronic cigarettes. The strategy was buried in a drawer and the then head of Health, Carolina Darias, headed for the mayor’s office of Las Palmas de Gran Canaria. The islands are the main tobacco producers in Spain, with around 540 million cigars and cigarettes in the first half of 2023, according to Treasury data.
“We know that there are families who live off tobacco, but it is not about annoying anyone, but about changing the lifestyle we have. In Extremadura you can plant more cherry, olive or carob trees and in the Canary Islands you can plant tropical fruits,” explains the president of the CNPT, Francisco Pascual. This medical doctor points out that the comprehensive plan is already three years late, so this “clear route with a schedule” should be immediately promoted from scratch. “Since 2021 there has been new data: we have a small decrease and changes in the consumer profile,” he indicates.
More than half of the students have used electronic cigarettes
Tobacco continues to be the second most prevalent psychoactive substance among students aged 14 to 18. According to Survey on drug use in secondary education in Spain 2023 (Estudes), 33.4% of students between those ages have smoked tobacco at some point in their lives, 27.7% did so in the last year and 7.5% do so daily. The latter is the lowest figure in the historical series and represents 1.5 percentage points less than in the previous edition, in 2021. However, the report provides another worrying fact: more than half of the students admit to having consumed cigarettes electronics, 23% more than two years ago. But not only that, 19.3% of boys and 26.4% of girls have used these devices with nicotine and/or cannabis.
At the end of the year, the Government Delegation for the National Drug Plan published the results of a pilot study on possible behavioral addictions in children under 12 and 13 years of age. The work, which expands the Estudes data, indicated that 8.5% of the students acknowledged having smoked tobacco at some point in their lives, 6.5% in the last year and 4.1% in the last month. . In the case of electronic cigarettes the rates were 25.2%, 21% and 11.2%, respectively. After knowing these data, Minister García assured in her X account that “vapers look like toys and have sweet flavors, but they are harmful and represent the prelude to smoking.”
“It is true that some vapes do not contain nicotine, so you are not addicted to that substance, but they are not exempt from having a health risk, especially related to lung problems. And, if we talk about children, we are creating a habit. We were very clear about it a few years ago, when chocolate cigarettes were banned (with the anti-smoking law of 2005) because they could promote this smoking habit,” explains Pascual, who points out that “the consumption of vapers is the gateway to other substances.”
Harm reduction, without solid evidence
E-cigarette advocates have been cultivating the idea of “tobacco harm reduction” (THR) for years. The theory of this strategy, often wrapped in a supposed scientific veneer, is that these devices are safer than tobacco and that they also help people abandon traditional cigarettes. In practice, the main study that supports this theory was responded to by several experts who defined it as “methodologically weak” and with conflicts of interest that raised “serious doubts about the conclusions.”
According to a report from the World Health Organization, children who use these devices are up to three times more likely to use tobacco in the future than those who do not. In 2020, the Ministry of Health and the autonomous communities approved a report in which they highlighted that there is no solid evidence on the hypothesis that they are useful as a tool to quit smoking. In addition, it warned of the risks of cigarette aerosol, which would contain carcinogenic substances, and the short-term health effects, with lung injuries associated with vaping. A year earlier, the United States Centers for Disease Control and Prevention (CDC) monitored an outbreak of lung injuries associated with these products, which caused 2,668 hospitalizations and 57 deaths.
The harm reduction strategy is a false solution, as it represents a commercial strategy of the tobacco industry to increase its sales by making it difficult to control smoking.
Spanish Society of Pulmonology
The Spanish Society of Pulmonology and Thoracic Surgery (Separ) has clearly positioned itself against these harm reduction strategies. “It is a false solution, as it represents a commercial strategy of the tobacco industry to increase its sales by making it difficult to control smoking, since it retains smokers in tobacco consumption and prevents them from making serious attempts to quit,” they indicated in a statement. positioning document. In the same text they indicated that “these products are a gateway for adolescents to use tobacco.”
“Ladies and gentlemen, I am especially concerned about the so-called ‘harm reduction’ associated with new forms of smoking,” García acknowledged in the Congressional Health Commission, who noted that it was “especially dangerous for the young population, for whom it facilitates access.” to nicotine to fruity flavors and visually attractive formats.”
Disposable vapes, in the spotlight
Beyond the announcements, the Ministry has taken some firm steps against smoking. A couple of weeks ago, the Council of Ministers approved the transposition of a European directive that requires the lifting of the exceptions enjoyed by heated tobacco. Although it does not include vapes, by mid-April these non-combustible processed tobacco products will no longer be able to contain flavorings and must include a clear warning about health risks, as is the case with conventional packs.
Regarding electronic cigarettes, García assured that not only health matters, but also “the ecological part that has to do with disposable vapes.” This is the line in which some surrounding countries are advancing. France announced that it would ban them, in a package of measures that includes declaring beaches, parks and school environments smoke-free, as well as raising the price of a pack from 10 to 13 euros. The United Kingdom will do the same with the vapers not rechargeable. Those that are will have neutral packaging and limits on flavors.
The president of Mexico, Manuel López Obrador, has gone further. At the end of January he announced a constitutional reform to prohibit them: “Just like the consumption of chemical drugs such as fentanyl, we are also going to request the prohibition of vaping devices and also other things that I do not want to advance now, but they are going to be considered.” because it is a mercantilist and corrupt criterion.” According to WHO data, there are 2 billion people in the world who are not protected by any regulatory restrictions on electronic cigarettes with nicotine.
The tax part is also in the focus of Health. It will equate traditional and electronic cigarettes. “We are going to work on it, taking into account that we are going to increase the price of tobacco, because it is one of the most effective strategies for reducing consumption, which is goal number 1 of the comprehensive plan against smoking and is, perhaps, where Spain is a little further away,” explains Gullón.
9,000 million euros are collected from tobacco, but we spend three times as much due to the health consequences it generates
— President of the CNPT
“9 billion euros are collected from tobacco, but we spend three times as much due to the health consequences it generates,” Pascual defends. According to data from the Spanish Epidemiology Society, around 63,000 people die in Spain every year due to tobacco, of which 21% are under 65 years of age. From this society, they called for updating policies, with “strategies aimed at preventing the initiation and cessation of consumption, both of conventional tobacco and of new forms of consumption.”
On the occasion of the last World No Tobacco Day, which is celebrated in May, the General Council of Dentists warned in a statement that the “still scarce” studies on vaping devices “show evidence that they also have consequences for oral health.” And he quotes: “a possible increased risk of oral cancer and a clear impact on periodontal diseases.”
Despite the evidence on the health benefits of reducing smoking, the fact that the old plan has never been applied and has been in hibernation for years suggests that the path for Health will not be easy. Asked if he fears pressure from the industry so that this strategy falls on deaf ears, the director general of Public Health was clear: “I suppose there will be pressure, but we are going to go with health first.”