Nicotine and tobacco control in LMIC

The level of adolescent tobacco use ranges from around 2% to over 30% worldwide, depending on region and on the form of tobacco. As the leading cause of preventable death globally, most of the global mortality burden of tobacco use lies predominantly in ‘low to middle’ income countries (LMICs).

Overall, about a fifth of young teenagers (13–15 years) around the world are smokers. High-income countries may lower levels of adolescent tobacco use. Low and middle-income countries have contrastingly high rates of adolescent smoking, where rates in some countries can reach as high as 46% and reflect high rates of all-age smoking. Adult smoking rates generally appear to reflect adolescent smoking rates

With this fear in mind, policymakers in LMICs have made “tobacco control” a priority to mitigate effects of tobacco related morbidity and mortality, by harnessing cessation interventions techniques from high-income countries. In reality, we are only seeing an increasing number of smokers in LMIC, questioning the effectiveness of the ‘total cessation’ policy. This session reviews reasons for this failed attempt of ‘total cessation’ in LMICs, and the possible risks it possesses. One evident phenomenon is the creation of ‘hidden populations’ of smokers, who continue their smoking habit against regulations and isolate from health providers, in fear of litigation.

Is there a role for ‘tobacco harm reduction’ in the form of e-cigarettes or alternate non-combustible products over ‘total cessation’ policies? Despite evidence of its less harmful effects compared to conventional cigarettes, there has been lots of restrictions and hesitations towards ‘tobacco harm reduction’. In driving their agenda, international policies have also neglected special populations, individuals living with mental health problems, where even nicotine replacement has shown modest results.

This talk stands firm on the fundamental understand that ‘harm reduction’ initiatives respect the rights, health and safety of smokers, without compromising on ‘the right of all people to the highest standard of health’, as per WHO’s Framework Convention on Tobacco Control.