世界卫生组织关于烟草控制和减少危害的立场

Tobacco and nicotine product companies, and associated front groups, are increasinglypromoting a range of tobacco, nicotine and related products. They claim these productspose lower risks to health than conventional cigarettes and can be part of a ‘harmreduction’ approach to tobacco control. These products frequently include electroniccigarettes (e-cigarettes), nicotine pouches, heated tobacco products (HTPs) and smokelesstobacco products. However, tobacco companies have a long history of dishonestly downplaying the harmscaused by their products(1). This includes use of misleading descriptors for cigarettevariants like ‘light’ and ‘mild’, use of filters to suggest reduced harm, and knowinglyengineering products to fool machine-based testing(2).And this is not all in thepast, as they continue to mislead consumers and authorities about the risks posedby their products(3).This forms part of a profit-driven strategy to grow and sustaintobacco company businesses by expanding their customer base or market share, whileundermining tobacco control policies by arguing for a largely unregulated or lightlyregulated commercial market. The industry engages in mass marketing of harmful products to the public at large, whilecloaking that conduct in the public health language of harm reduction. This conductcan be contrasted with genuine harm reduction programmes in other areas of publichealth, which see health actors and agencies pursuing health objectives by implementingevidence-based strategies and interventions that are tightly controlled and monitored. All tobacco, nicotine and related products pose health risks, including risk of addiction(4). Wide variation in product characteristics (including within product categories), andhow products can be manipulated and used by consumers, limit our ability to generalizeabout the health risks posed by entire product categories. In reality, the true level ofrisks of these products will only become clearer over time and through a sustainedcommitment to impartial assessment. How harmful these products are in real life also depends on how people use them, howwidely they are used, who is using them, and how they are marketed and regulated.Flavoured e-cigarettes, for example, are aggressively marketed, including on youth-frequented social media platforms, using imagery appealing to children, adolescentsand young people and often have nicotine levels exceeding conventional cigarettes(5).The high and rising levels of e-cigarette use among young people is alarming. RecentWHO trends data(6)shows that over 15 million children aged 13–15 now use e-cigarettesand that children aged 13–15 are, on average, nine times more likely than adults to usee-cigarettes(6).The industry also packages and retails HTPs and nicotine pouches asappealing consumer products, increasing the risks of uptake, sustaining addiction, andincreasing overall harm to population health(7). Governments can best protect health by fullyimplementing comprehensive tobaccocontrol measures that reduce demand and supply for all tobacco, nicotine and relatedproducts. This includes: •Where countries ban manufacturing, distribution and sale of specific product categories,enforcing those prohibitions should rigorously against commercial actors. •Where countries permit commercialization, ensuring tobacco, nicotine and relatedproducts are strictly regulated, by implementing the measures in the WHO FrameworkConvention on Tobacco Control (WHO FCTC)(8)and its implementation Guidelines forall tobacco, nicotine and related products. In addition to measures such as prohibitingsale to minors, requiring health warnings, taxing products and comprehensivelyprohibiting advertising, promotion and sponsorship, implementing product specificmeasures, such as: –banning flavouring agents, attractive product features and colours that increaseappeal; and –limiting the concentration of nicotine and prohibiting additives that have or generatechemicals with carcinogenic, mutagenic and reprotoxic properties. •Educating the public and offering help to quit through proven cessation methods,such as nicotine replacement therapies and toll-free quit lines, which have beenevaluated by national authorities and proven to be safe, efficacious, and effective. •Prohibiting sale of harmful products via remote means, including digital platformsfrequented by children and young people, to control the supply chain.•Protecting public health policies from commercial and other vested interests ofindustry, including by implementing Article 5.3 of the WHO FCTC and its Guidelines. Based on the totality of the current evidence, WHO recommends that where bans arenot in place and countries permit commercialization, all tobacco, nicotine and relatedproducts should be subject to these measures. All tobacco, nicotine and related products pose risks to health. If you do not use theseproducts, don’t start. If you currently use these products: •Choose proven cessation methods