Tobacco harm reduction

Tobacco harm reduction describes actions taken to lower the health risks associated with using tobacco or nicotine. These measures include:

1. Switching to Western smokeless tobacco
2. Switching to non-tobacco sources of nicotine
3. Smoking safer or fewer cigarettes
4. Eliminating nicotine use with or without the use of pharmaceutical products.

Some alternatives such as smoking safer or few cigarettes lower the health risk a little while substituting nonsmoking forms of tobacco, nicotine replacement therapies and non-nicotine pharmaceuticals reduce the risk a great deal. Abstention confers the greatest lowering of risk.

Given the varying legal, moral and historical status of tobacco, and the different types of tobacco and tobacco use, in different cultures around the world, debates on tobacco harm reduction tend to be geographically defined arguments. For instance, in the United States, tobacco use tends to mean cigarette smoking with a smaller number of users availing themselves of cigars, pipes, and smokeless tobacco. The political climate over the last few decades has led to both restrictions in the sale and use of tobacco and a widespread knowledge of the negative health effects of tobacco use. Despite this, tobacco, in all its forms, has remained a legal product.

In other countries, the pharmaceutical options might not exist, smokeless tobacco might not be a common form of use, the smokeless tobacco in use is too similar in health risks to smoking, or the target society may not consider any form of tobacco use a problem. In Sweden, there is a tradition of smokeless tobacco use as the dominant form of use among men and there is little controversy regarding using smokeless tobacco as an alternative to smoking. In the United Kingdom, most forms of smokeless tobacco are illegal, with only the more damaging ethnic forms being available so this option is less likely to be pursued.

Proponents of tobacco harm reduction argue that lessening the health risk for the individual user is worthwhile in itself and manifests itself over the population in fewer tobacco related deaths and illnesses.

Opponents argue that some aspects of harm reduction interfere with the possibility of abstention and might increase the number of people beginning to use tobacco in the first place.

References

• Tobacco harm reduction: an alternative cessation strategies for inveterate smokers. Rodu B & Godshall WT. 2006. Harm Reduction Journal 3:37. [1]
• Modified tobacco use and lifestyle change in risk-reducing beliefs about smoking. Haddock CK et al. Am J Prev Med 2004;27(1).

• Sumner W. Permissive nicotine regulation as a complement to traditional tobacco control. BMC Public Health 2005 5:18. [2]

• Russell MAH. 1974. Realistic goals for smoking and health: a case for safer smoking. Lancet 1:254-258.

• Rigotti NA & Tindle HA. The fallacy of light cigarettes. BMJ 2004 (328) 278-279. [3]