Wikipedia Entry
Following is our submission to Wikipedia before imposed changes (we think this version is both less dry and more expansive).
Tobacco Harm Reduction (Original Version)
Tobacco harm reduction refers to any behaviors that lower the health risks associated with using tobacco or nicotine. These include switching to Western smokeless tobacco (1), to non tobacco sources of nicotine, to smoking safer or fewer cigarettes, and to 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.
Since the harm reduction approach tends to be associated with drugs or behaviors that are circumscribed to varying degrees, the debate is rarely confined to the evidence. 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 of tobacco harm reduction tend to be geographically defined arguments.
For instance, in the United States, tobacco use tends to mean cigarette smoking with a lesser number of users availing themselves of cigars, pipes, and smokeless tobacco. The political climate over the last few decades has been anti-tobacco leading 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.
Specific legislation regarding tobacco demands product labeling indicating the potential harm but not allowing any statements of comparative risk with other tobacco products. Though the general public is aware that using tobacco is unhealthy, they are in general uninformed as to the magnitudes of risk associated with any forms of tobacco (2).
The nation is divided on the proper role of the government in determining the acceptable behaviors of individuals. The most effective driver of American tobacco use policy has been the evidence of harm to the users which can lead to arguments surrounding the concept of the cost of tobacco use to society in general. The second most effective driver of tobacco use policy has been the focus on environmental smoke. While it is somewhat contentious to argue the rights of an individual to act, it is more straightforward to argue for the rights of an individual to not be unfairly acted upon. A third strong influence on both tobacco use policy and actions relating to tobacco harm reduction arises from the demonization of the tobacco industry. Despite maintaining the legitimacy of the industry, it is argued that given the history of the industry’s manipulation of public opinion regarding the health risks of tobacco use, no statements by, or research by, or product developments by tobacco companies are of value. The recent history of the tobacco industry within the context of American society seems to be an exception to both the general corporate friendly and laissez faire stance.
In the United States, the only widely accepted version of tobacco harm reduction is abstention with or without the use of pharmaceuticals. This is fully consistent with a culture that embraces prohibition and abstention as the most reasonable responses to non pharmaceutical drug use. This is also fully consistent with a health system which emphasizes surgical or pharmaceutical interventions for disease.
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 Britain, 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.
Though there is scientific acceptance of the dose response relationship in smoking, there is still a rejection of smoking fewer or less toxic cigarettes as a proper means of harm reduction (5). It has been found that smokers adjust their smoking (compensatory smoking) to get the required amount of nicotine so that safer cigarettes do not end up being as safe as preliminary tests usually indicate. The evidence also indicates that the bulk of the harm in tobacco consumption comes from consuming it in a combusted form. It has been suggested that higher levels of nicotine would be beneficial to the smoker in that they would smoke less to get the required levels, and thereby the reduction in smoke inhalation would reduce their health risk (4). It has been argued that the increasing safety of cigarettes over the decades has kept people smoking and that if cigarettes had remained high tar and filterless that fewer people would have started, and more would have quit.
As in the case of safer cigarette variations, smokeless tobacco is rejected as a reasonable alternative on the basis of it being tobacco and on the basis of it being a product manufactured by the tobacco industry (3). These alternatives are also dismissed not on the basis of being safer, but on the basis of not being perfectly safe.
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. While it is evident that these alternatives reduce the risk, some critics suggest that to promote any alternative with a proven level of risk runs counter to public health ethics. As well, the prospect of continued addiction has been presented as a counterargument to some of the alternatives despite that addiction in itself is not a risk to health.
- Tobacco harm reduction: an alternative cessation strategies for inveterate smokers. Rodu B & Godshall WT. 2006. Harm Reduction Journal 3:37.
- 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.
- 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.
See the existing version at Wikipedia: Tobacco Harm Reduction.