Reducing harm from tobacco use

Abstract

If current trends in smoking prevalence continue, even with the implementation of enhanced tobacco control measures, millions of smokers will continue to fall ill and die as a direct result of their smoking. Many of these will be from the most deprived groups in society - smoking continues to be one of the strongest drivers of health inequalities. The personal costs of this morbidity and mortality, as well as costs to business and the economy, are unequalled and will therefore remain high for several decades to come. However, there is an addition to the tobacco control armoury that could have a marked impact on public health, but it requires radical action to be taken. This would be to embrace harm reduction, but this approach is as controversial in the case of tobacco as it is in the case of illicit drugs from where it derives. However, harm reduction remains the Cinderella of the three major strategies for reducing smoking-related harm, the others being prevention and cessation. Here we make the case that harm reduction has an important role to play in reducing the health burden of tobacco use.

Magnitudes of biomarker reductions in response to controlled reductions in cigarettes smoked per day: A one-week clinical confinement study

“…Department of Health and Human Services, 1990), and they may also be able to reduce risk, albeit to a much lesser extent (Hatsukami et al, 2006b), by reducing their cigarette per day (CPD) consumption (Lee, 2013). Other options include switching to lower risk products as part of a harm reduction approach (Fagerström and Bridgman, 2014;McNeill and Munafo, 2013). Long-term cessation/abstinence is generally accepted as being the most effective intervention (U.S. Department of Health and Human Services, 2010).…”

Are waterpipe users tobacco-dependent?

“…In our opinion, efforts to tackle the increase in waterpipe tobacco smoking globally will be best served by representing accurately the potential harms of this form of tobacco use, and placing these into the wider context of harms associated with other forms of tobacco use [2]. Indeed, tobacco harm reduction relies on an accurate understanding of the relative harms of different forms of tobacco use, so that the least harmful can be promoted over the most harmful [3]. In our opinion, harm reduction strategies are likely to result in better health outcomes than only encouraging people to abstain entirely.…”

“…Maynard et al highlight that, while harms pertaining to cigarette use are currently driven by dependence, this is not as strongly patterned among waterpipe tobacco users. Indeed, most waterpipe tobacco users do not show signs of nicotine dependence unless smoking greater than several times each week [3]; and in a recent study among young people in London, most smoked intermittently [4].…”

“…However, waterpipe dependence may be constructed differently to cigarette dependence as traditional cigarette measures, including time from waking to first smoke, are invalid predictors of waterpipe dependence [3]. What is more, WTS is in its very early stages of use compared to cigarette smoking [5].…”

Tobacco harm reduction in the real world: has the availability of snus in Norway increased smoking cessation?

“…Given a medical consensus that snus is approximately 90-95% less harmful than smoking (Levy et al, 2004), the overall effect from snus on public health will come down to the balance between its beneficial effect on smoking prevalence and its adverse effects on overall prevalence of tobacco use (see Benowitz, 2011;Lund, 2009;Le Houezec et al, 2011;McNeill & Munafó, 2012, SCENIHR 2008 for a discussion). Norway and Sweden, with its long tradition of snus use, constitutes a natural laboratory in which we can study how snus competes for market share with cigarettes.…”