In the 50 years since the twentieth century's smoking epidemic began to decline from the beginning of the 1960s, hundreds of millions of smokers around the world have stopped smoking permanently. Overwhelmingly, most stopped without any formal assistance in the form of medication or professional assistance, including many millions of former heavy smokers. Nascent discussion about national and global tobacco endgame scenarios is dominated by an assumption that transitioning from cigarettes to alternative forms of potent, consumer-acceptable forms of nicotine will be essential to the success of endgames. This appears to uncritically assume (1) the hardening hypothesis: that as smoking prevalence moves toward and below 10%, the remaining smokers will be mostly deeply addicted, and will be largely unable to stop smoking unless they are able to move to other forms of 'clean' nicotine addiction such as e-cigarettes and more potent forms of nicotine replacement; and (2) an overly medicalised view of smoking cessation that sees unassisted cessation as both inefficient and inhumane. In this paper, we question these assumptions. We also note that some vanguard nations which continue to experience declining smoking prevalence have long banned smokeless tobacco and non-therapeutic forms of nicotine delivery. We argue that there are potentially risky consequences of unravelling such bans when history suggests that large-scale cessation is demonstrably possible.

译文

:自20世纪20年代的吸烟流行从1960年代初开始下降以来的50年中,世界各地成千上万的吸烟者已永久性戒烟。绝大多数人在没有任何形式的药物或专业协助的情况下就停止了活动,其中包括数百万前重度吸烟者。在关于国家和全球烟草残局情景的初学者讨论中,以以下假设为主导:从香烟过渡到替代形式的有效的,消费者可接受的尼古丁形式,对于残局的成功至关重要。这似乎是不加批判地假设(1)强化的假设:随着吸烟率接近或低于10%,其余的吸烟者将成瘾,并且除非他们能够转向其他形式的吸烟者,否则他们将基本上无法戒烟。 “干净”的尼古丁成瘾,例如电子烟和更有效的尼古丁替代形式; (2)过度医学化的戒烟观念,认为无助戒烟既无效率又不人道。在本文中,我们质疑这些假设。我们还注意到,一些吸烟率持续下降的先锋国家长期以来禁止无烟烟草和非治疗性的尼古丁传递。我们认为,如果历史表明大规模停止是有可能的,则取消此类禁令会带来潜在的风险后果。

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