The Strategic Dialogue on Tobacco Harm Reduction: a vision and blueprint for action in the US

Abstract

The issues related to tobacco harm reduction continue to challenge the tobacco control research and policy communities. The potential for combusting tobacco products to reduce exposure and risk remains largely unknown, but this has not stopped manufacturers from offering such products making these claims. The role of oral tobacco products in a harm reduction regimen has also been a source of dialogue and debate. Within the last few years, major cigarette manufacturing companies have begun selling smokeless products for the first time, claiming to target current cigarette smokers. Other cigarette manufacturers are also offering smokeless products in markets around the world. The harm reduction debate has at times been divisive. There has been no unifying set of principles or goals articulated to guide tobacco control efforts. In particular, the research needs are extraordinarily high in order to drive evidence-based policy in this area and avoid the mistakes made with “light” cigarettes. This paper discusses recommendations from a strategic dialogue held with key, mostly US-based tobacco control researchers and policy makers to develop a strategic vision and blueprint for research, policy and communications to reduce the harm from tobacco for the US. Short-term and long-term objectives are described.

Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?

“…23 Electronic cigarettes are designed to mitigate tobacco-related disease by reducing cigarette consumption and smoking rates. The evidence reviewed in this article suggests that electronic cigarettes are a much safer alternative to tobacco cigarettes.…”

“…In addition, a product that reduces harm to the individual may attract new, nonsmoking users, and thus undermine efforts to prevent tobacco use. 23 …”

“…25 Alternatives promoted as safer may prove more dangerous, or they may be equally dangerous, leading to false or unsupported claims and to the misleading of the public Experience with potentially reduced exposure products in the past has revealed that products promoted by the tobacco industry as potentially safer have ended up either not being safer or resulted in increased toxicant exposures. 23 In particular, a broad consensus within the public health community holds that 'light' cigarettes misled consumers into thinking that they were being exposed to lower levels of toxic chemicals. 26 Smokers ended up compensating for the reduced nicotine in 'lights' by smoking with greater frequency and intensity, resulting in higher exposures than originally reported.…”

“…It is impossible to assess the risks of a new product using machine measured delivery of smoke constituents, because there is no good way to simulate actual smoking behavior. 23 We cannot, moreover, easily infer human risk from chemical measurements because no reliable toxicity indices exist. 24 A widespread school of thought in tobacco control holds that the very nature of tobacco combustion precludes safer cigarettes, and therefore attempts to develop them should be abandoned.…”

“…26 Smokers ended up compensating for the reduced nicotine in 'lights' by smoking with greater frequency and intensity, resulting in higher exposures than originally reported. 23 NRT has not been effective, meaning that harm reduction equals harm maintenance…”