Public Health Implications of Smokeless Tobacco Use as a Harm Reduction Strategy

Abstract

Harm reduction strategies involve promoting a product that has adverse health consequences as a substitute for one that has more severe adverse health consequences. Smokeless tobacco low in nitrosamine content offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the potential for such products to serve as a gateway to more harmful tobacco products, public misinterpretation of "less harmful" as "safe," distraction from the public health goal of tobacco elimination, and ethical issues involved in advising those marketing these harmful products. We offer a research agenda to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.

Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

“…122 There also is concern that marketing one tobacco product as a substitute for others will divert attention from the smoking cessation message. 143 Given that smokers who are concerned about their health and who may have medical illness are often more interested in trying PREPs, the fear that these tobacco users may be derailed from quitting altogether is of special concern. 5 Furthermore, some fear that exsmokers may relapse to tobacco use by choosing these PREPs as a safe alternative to cigarettes and an alternative to be used in environments where smoking is prohibited.…”

Similar Exposure to a Tobacco-Specific Carcinogen in Smokeless Tobacco Users and Cigarette Smokers

“…Smokeless tobacco use is generally considered to be less toxic and carcinogenic than cigarette smoking because smokeless tobacco lacks or has considerably lower concentrations of many of the toxicants and carcinogens formed during combustion. Thus, responsible members of the tobacco control community have suggested that switching to ''low nitrosamine'' smokeless tobacco may be an effective harm reduction strategy for smokers who cannot stop using tobacco products (4,5). Yet there are only scattered data in the literature on exposure to the strong carcinogen NNK in smokeless tobacco users.…”

Receptivity to Taboka and Camel Snus in a U.S. test market

“…At the same time, growing attention to methods of harm reduction has increased interest in lower nitrosamine smokeless tobacco as a product that, if taken up by smokers in lieu of smoking, could result in greatly reduced morbidity and mortality. There is substantial agreement in the public health community that the low-nitrosamine smokeless products are much less harmful than cigarettes ( Levy et al, 2004 ;Luo et al, 2007 ;Savitz, Meyer, Tanzer, Mirvish, & Lewin, 2006 ). Nevertheless, there is a great deal of controversy about whether to disseminate information about the harm-reduction potential of switching from smoking to low-nitrosamine smokeless tobacco use.…”