Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives

Abstract

Inhalation of the toxic smoke produced by combusting tobacco products, primarily cigarettes, is the overwhelming cause of tobacco-related disease and death in the United States and globally. A diverse class of alternative nicotine delivery systems (ANDS) has recently been developed that do not combust tobacco and are substantially less harmful than cigarettes. ANDS have the potential to disrupt the 120-year dominance of the cigarette and challenge the field on how the tobacco pandemic could be reversed if nicotine is decoupled from lethal inhaled smoke. ANDS may provide a means to compete with, and even replace, combusted cigarette use, saving more lives more rapidly than previously possible. On the basis of the scientific evidence on ANDS, we explore benefits and harms to public health to guide practice, policy, and regulation. A reframing of societal nicotine use through the lens of harm minimization is an extraordinary opportunity to enhance the impact of tobacco control efforts.

Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient‐provider communication

“…Consistent with our participants' perceptions, a recent report from the National Academies of Sciences, Engineering, and Medicine concluded that ECIGS are far less harmful than cigarettes . A recent meta‐analysis found that ECIGS may indeed increase smoking cessation and is consistent with national survey findings, yet the National Academies report concluded that there was “insufficient evidence” from randomized controlled trials that e‐cigarettes can help people quit smoking. Of note, approximately half of our sample successfully quit smoking using ECIGS.…”

Socioeconomic patterning of vaping by smoking status among UK adults and youth

“…While health consequences of long-term ecigarette use (or vaping) are largely unknown [1][2][3][4], expert opinion regards vaping as substantially less harmful than smoking [1,5]. Mounting evidence supports this view [2,[6][7][8] and that vaping may aid smoking cessation [2,[9][10][11]. Nevertheless, concerns remain [3,12], particularly around risks of vaping introducing youth to nicotine and cigarette use [13][14][15][16], though so far regular (at least weekly) vaping by youth in the UK has been rare [17,18].…”

“…Perhaps most importantly, management of nicotine addiction with e-cigarettes only (i.e. vaping among exsmokers) is likely to be substantially less harmful than with smoking [1,2,6,7], and vaping by ex-smokers may often represent intentional replacement of cigarettes with e-cigarettes for health reasons [32]. There could also be other reasons for switching such as relative price, preference, or differences in regulation as to where the behaviour is allowed.…”

Reply to ‘Smoke free, but dependent on nicotine’ (Karam‐Hage 2019)

“…In the context of defining smoking behaviour and abstinence, where e‐cigarette use falls is an issue that continues to attract debate . In our study of the real‐world effectiveness of popular smoking cessation aids , we defined our outcome as abstinence from smoking, rather than abstinence from nicotine.…”