In this episode of GFN News, Pritika Kumar discusses a recent study looking at how THR and safer products are viewed by frontline health and social care workers, and how a revolution in THR training amongst frontline professionals could be a crucial step in reducing smoking rates in at-risk groups.
Chapters:
0:00 - Intro with Joanna Junak 0:45 - Pritika Kumar discusses a recent study examining the health burden of combustible products 2:55 - Barriers to THR acceptance amongst health professionals 4:56 - High levels of awareness of the continuum of risk of nicotine products amongst frontline professionals 6:11 - Frustrations amongst health professionals 11:22 - Prohibition takes its toll 12:49 - Closing remarksTranscription:
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Joanna Junak: Hello and welcome. I'm Joanna Junak and this is GFN News on GFN.TV. To reduce the health burden of combustible tobacco products, science-based policies should be implemented that acknowledge the risks as well as the benefits of different nicotine products. Joining us today to discuss the health burden of combustible tobacco products is Pritika Kumar, a social and behavioral scientist and former resident senior fellow in integrated harm reduction policy at the R Street Institute. Hello, Pritika. First, can you briefly summarize the study and the objective of the study? Yes.
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Pritika Kumar: Thank you so much for giving me this platform to share the findings of this really important study that we did. I, up until very recently, was a senior policy fellow at R Street Institute, which is a free market think tank based out of DC. So the results that I'll be sharing today are really not the opinions or views of R Street, but really are coming from the key stakeholders who we interviewed for this study. So as we know, that you know, smoking rates have dropped drastically to about 12.5 in the United States from what they used to be. And so, but unfortunately, the use of combustible tobacco products is now concentrated in communities suffering from the greatest economic health and social disparities. So while my study is based, was based out in the United States, we must not forget that 80% of combustible tobacco users in the world are concentrated in the low and middle income countries. And also the success rates of quitting are anywhere less than 10%, whatever studies you may refer to, with a very high relapse rate to smoking. So while another thing that is really unfortunate is that despite mounting evidence that show the efficacy of reduced risk nicotine products in reducing the negative effects of combustible tobacco products, the use of vapes and other reduced risk nicotine products has really been met with a lot of resistance at various levels. So that really was, that's what triggered the start of this policy study was to understand what are the key factors that influence the decision of stakeholders in the support or opposition of promoting tobacco harm reduction measures for the populations that they serve.
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Joanna Junak: Which groups participated in the research and what methodology did you use?
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Pritika Kumar: Yes, as a public health, social and behavioral scientist, I understand the importance of data. But often when we do large scale quantitative studies, we miss out on the stories of some key stakeholders whose voices are missing at the table. And when it comes to advocacy, we know that the voices that are loudest in tobacco control are academic public health and other agencies, but we don't really hear the voices of certain other stakeholders who probably interface with people who smoke way more. So this is the reason we decided to explore the barriers to acceptance of tobacco harm reduction from a qualitative lens. I interviewed 17 stakeholders working in diverse areas related to harm reduction. And they included staff from harm reduction coalitions, staff from not-for-profit policy or service organizations, serving people with substance use issues, HIV, AIDS, or serious mental illness. I also interviewed primary care or addiction medicine physicians and other healthcare staff, social workers, nurses, and academic researchers within the area of public health or harm reduction. And I used a semi-structured interview guide organized by constructs such as the, I tapped into the areas of perceived commitment of leadership, both inside and outside of the organization of the stakeholder. looking at the challenges at local, state, or national levels, and also their recommendations to overcome the tobacco harm reduction related barriers. And this study, we also took it through the Institutional Review Board, and it was approved by the board.
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Joanna Junak: Different tobacco products have different levels of harm associated with their use. What results did you achieve from stakeholders who were interviewed for this study?
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Pritika Kumar: The stakeholders in this study were mostly aware of the concept of tobacco harm reduction. Most of the interviewees, even if they were not directly working in the tobacco space, they seemed aware of the difference between combustible tobacco products and alternative nicotine products. such as gums and chews, oral pouches and vapes. All of the interviewees were aware of nicotine replacement therapies, such as gums and chews, and they saw them as a measure to help lessen the habit of smoking. While all the participants knew about vapes, only about half knew the types of products that are FDA approved as reduced risk products. And nearly half of all the interviewees were unaware of the evidence that exists in supporting non-combustible tobacco, nicotine-containing products as less harmful alternatives to cigarettes, or the difference between the different classes of products, such as e-cigarettes and heat-not-burn devices.
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Joanna Junak: And what barriers do you see to adopting THR as a possible public health strategy of harm reduction?
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Pritika Kumar: I'm going to share the barriers that the stakeholders really talked about in this study. And in my conversation with these interviewees, they shed light on the key barriers at system level, at product level, and policy levels. So briefly, at a system level, there seems to be a massive debate among leading health authorities on the existence and or credibility of the evidence to qualify e-cigarettes as tobacco cessation tools. Several participants in this study, they were frustrated with the zero-sum approach of some of their public health colleagues. To quote one participant who noted that there is a large population of people who smoke and are dealing with comorbid mental health or substance use conditions. But despite this, they noted that there are some who are dogmatically and unalterably opposed to even talking in any positive way about the use of alternative products. So within the healthcare system, some of the barriers that stakeholders with a healthcare background pointed were A, the need of nurses who specialize in smoking cessation counseling, just like it's been done in diabetes education and treatment. In fact, you know, it was interesting, I recently found out that in a Gallup survey, nurses were ranked as the most trusted healthcare professionals. And the stakeholders in the study pointed out that nurses are severely underleveraged in the tobacco cessation and harm reduction space. So from a patient or a client perspective in the healthcare system, several stakeholders shared that people living with HIV have higher smoking and lower quick trades due to factors such as history of or coexistence of substance use and psychiatric diagnosis and other socioeconomic challenges. So these stakeholders, they emphasized the value of offering varying degrees of reduced harm solutions, whether it comes from dual use of smoking and e-cigarettes or completely switching to reduced risk nicotine products, allowing these adults to choose a healthier lifestyle overall based on where they are in their journey. What we also see in the study is that within the healthcare system, there remains a lot of ignorance, a lack of knowledge and acceptance of reduced risk nicotine products. And then some of the physicians in the study, they expressed their hesitation in discussing tobacco use with their clients, not just because of lack of time, which is a significant factor, but also the lack of confidence and training in talking about this topic. And they didn't want to risk the positive physician-client relationship that they had established. And then lastly, health insurance companies in the US, they limit their number of quit attempts that they will provide treatment coverage for. So the physicians noted that it's even more crucial that healthcare providers have the knowledge of other reduced risk products for that reason. In the product level barriers, some of the stakeholders shared their concern about youth use. but a handful were skeptical about e-cigarettes because of how they could have implications of being marketed to youth. And some of the stakeholders in the addiction medicine or harm reduction coalitions, they pointed out that some of their clients may not find smoking as a pressing issue, considering some of the other pressing addictions or issues that they are currently dealing with. So in that context, they noted that having the availability, accessibility, of a diverse range of affordable and authorized reduced risk nicotine products would be crucial in such contexts. And then at a policy level, the discussions that we had were mostly around the role of law enforcement and FDA. One participant in this study with a law enforcement background shared that it would be more efficient if tobacco control agencies such as the FDA proactively collaborated with law enforcement when they're passing laws such as the menthol ban announcement or the flavor ban announcement on state levels. And they also noted that too often, law enforcement involvement is an afterthought. They shared the unintended consequences of such you know, prohibition-based regulatory measures have often led to a proliferation of illicit markets as consumers want to find a way to access their products. So I think those were some of the key barriers that were highlighted within the study by the stakeholders we interviewed.
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Joanna Junak: Smoking rates, according to the paper, are different in different communities. Can you explain to us what factors affect this and where we can observe higher smoking prevalence?
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Pritika Kumar: It's unfortunate. In the United States, current tobacco policies are designed and implemented with the aim of permanently reducing smoking rates. but unfortunately by deploying punitive and prohibitory bans and sometimes alarmist public service messaging. Integrating a harm reduction lens would mean recognizing that reduced risk and alternative nicotine products offer value to those who want to continue using nicotine or are unable to quit the use of nicotine through smoking. I strongly believe that the role of FDA is key in terms of determining how smoking harm reduction is equitable. It is embraced at a population level, including in terms of what reduced risk nicotine products are available, how they're accessed by people who need it the most to fully achieve a smoke-free United States. So the agency really needs to align its strategy to other developed nations that have fully adopted e-cigarettes as a tobacco cessation tool.
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Joanna Junak: Thank you, Pritika. That's all for today. Tune in next time here on GFN TV or on our podcast. You can also find the transcriptions of each episode on the GFN.TV website. Thanks for watching or listening. See you next time.