Kenneth E. Warner is among a group of prominent tobacco control experts who warn that focusing too much on nicotine’s potential risks for youth has resulted in an “unbalanced” debate that overlooks the potential benefits of tobacco harm reduction.

Warner, from the University of Michigan’s School of Public Health, is among 15 past presidents of the Society for Research on Nicotine and Tobacco who express their concerns in a jointly-authored paper published recently in the American Journal of Public Health.

The paper provides a comprehensive review of the risks of e-cigarettes with a focus on the United States. However, many of the arguments are relevant to other lower-risk nicotine products such as Swedish snus and nicotine pouches.

“All nicotine and tobacco products should be regulated on the basis of their relative risk,” Warner tells Snusforumet.

Too much focus on potential youth risks

As US and European regulators grapple with how to regulate new nicotine products like e-cigarettes and nicotine pouches, Warner and his colleagues are frustrated by what he calls an “unbalanced” debate about tobacco harm reduction.

“Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths,” the authors write.

Alarming headlines about a youth vaping “epidemic” in the US and unfounded claims in Sweden that snus and nicotine pouches are a gateway to cigarette smoking contribute to a misperception among policymakers and the public about the relative risks of such products.

As a result, says Warner, there is “little consideration given to the potential benefits for adult smokers” of alternative nicotine products.

“We hope to get the attention of the public health community, the media, and legislators to consider the evidence we present in the paper,” he tells Snusforumet.

Warner has a long history in tobacco control in the United States and globally. In addition to being a past president of the Society for Research on Nicotine and Tobacco, he also represented the World Bank at the first WHO Framework Convention on Tobacco Control (FCTC) negotiations. 

He was a founding member of the Board of Directors of the Truth Initiative, a nonprofit public health organization committed to ending tobacco use among young people. It was founded as part of the 1998 Master Settlement Agreement between 46 US states and the four largest US tobacco companies.

‘Short-sighted’ to regulate snus like cigarettes

In the paper, Warner and his co-authors also present a number of policy options designed to strike a more sensible balance between the “valid concerns” about risks to youth and the smoking cessation benefits of non-combustible nicotine products.

Among their proposals is a call for more “nuanced, targeted communications” from governments and health organizations that include language about the potential benefits to adult smokers of “less-risky (but not risk-free)” alternatives.

In addition, the authors call for heavier taxes on cigarettes and other combustible tobacco products.

While Warner believes “all nicotine and tobacco products” should be regulated, it would be “shortsighted” to introduce tougher regulations on snus and nicotine pouches.

“Lower-risk products like snus and e-cigarettes should be taxed relatively lightly, reflecting the fact that they are substantially less dangerous than smoking,” he tells Snusforumet.

He points to Sweden as evidence that the availability of less harmful products can help lower smoking rates and rates for tobacco-related diseases, particularly among males.

“Swedish males have clearly substituted snus for cigarettes,” says Warner.