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Journal: Salud publica de Mexico


Dear Editor


The position article by

Reynales-Shigematsu and collea



on the public health impact in

Mexico of combustion-free electronic

nicotine delivery systems (ENDS)

fails to present a balanced overview

of the risk-benefit ratio of these new

technologies, grossly misrepresents

the existing evidence, and ignores

the broad consensus that these pro

ducts are much less harmful than



The work cited by the authors

(references 8-21) on exposure risks

from e-cigarette aerosol emissions

report misleading results that do not

reflect normal conditions of use.



authors claim that trial of e-cigarettes

is propitiating tobacco initiation

among Mexican adolescents, citing a

longitudinal cohort study on Mexican

high school students (reference 31)

which actually disproves this claim,

as it reported that the association

between e-cigarette trial at baseline

and past 30 day smoking at follow-up

was not even statistically significant.


The authors dismiss the utility of e-

cigarettes in smoking cessation, but

their cited references

do not support

this claim.


Further, a recent high

quality randomized controlled trial


has shown e-cigarettes to be twice

as effective in smoking cessation

compared to nicotine replacement

therapies. A detailed critique of the

position article is available.


Following the authors, ENDS

can only be part of a harm reduction

strategy for Mexico if they imme

diately promote total smoking abs

tinence, as well as complete absence

of dual usage and recruitment of



However, these are

maximalist and unrealistic conditions

that no new harm reduction product

can fulfill. A more realistic approach

to harm reduction yields concrete

benefits: the recreational usage of

e-cigarettes, endorsed by health insti

tutions in the United Kingdom under

a consistent Tobacco Control strate

gy, has contributed to a significant

decay of smoking prevalence with

negligible usage by non-smokers of

all ages.


By presenting ENDS as a threat

to public health (consequently re

commending their regulation as

combustible tobacco products), Rey

nales-Shigematsu and colleagues


depriving 15 million Mexican smokers

of key information on a plausible

harm reduction alternative that can

vastly improve their health. As an

unintended consequence, this misin

formation will keep them smoking.