Interpretation of Risks of Novel Tobacco Products, Including Harm Reduction Theory

The concept of tobacco harm reduction (THR) is a speculative and controversial topic in the context of the international battle against the use of all types of tobacco. This concept involves providing tobacco users who are unable or unwilling to quit smoking or using other types of tobacco (snuff, chewing), with modified risk tobacco product (MRTP) for continued use. Skepticism about THR is huge and is associated with the negative experience of tobacco companies to produce cigarettes with a low content of tobacco tar/nicotine, which should have had significantly lower health risks than conventional cigarettes. Paradoxically, such an experience served as a springboard to an increase in the number of tobacco products that potentially have the properties of MRTP. Moreover, some members of the anti-smoking coalition, including WHO, consider the transition of tobacco smokers to MRTP as a strategy with great potential. However, the European Group of Experts believes that the MRTP strategy does not work and will lead to another generation of young people getting used to tobacco. In this article, we have critically analyzed the history of the past and present of tobacco products, myths and contradictions around them. We have tried to evaluate the modern concept of S THR as objectively as possible, which has a high potential for a real reduction in the number of deaths associated with smoking.

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Electronic cigarette communications between patients and physicians in the United States

10.1101/2021.11.01.21265609 ◽

2021 ◽

Author(s):

Cristine Delnevo ◽

Michelle Jeong ◽

Arjun Teotia ◽

Michelle T Bover Manderski ◽

Binu Singh ◽

...

Keyword(s):

Harm Reduction ◽

Strong Predictor ◽

The United States ◽

Physician Education ◽

Heavy Smoker ◽

Primary Role ◽

Cross Sectional Survey ◽

Tobacco Products ◽

The Past ◽

Clinical Scenarios

Importance: Physicians play a primary role in smoking cessation, and their communication regarding e-cigarettes needs to be understood. Objective: To examine physician-patient communication regarding e-cigarettes. Design: A national, repeated cross-sectional survey in 2018 and 2019 was conducted. Setting: Participants were invited by mail; surveys were completed online. Participants: Response rates were 51.8% (2018) and 59.1% (2019), resulting in 2,058 board-certified physicians from family medicine, internal medicine, obstetrics/gynecology, cardiology, pulmonary/critical care, and hematology/oncology. Exposures: Physician demographics, tobacco use, medical specialty, and harm-reduction beliefs (i.e., not all tobacco products equally harmful); two hypothetical clinical scenarios. Main outcomes and measures: Physicians' self-reported e-cigarette communication behaviors (being asked about e-cigarettes by patients and recommending e-cigarettes to patients), and hypothetical e-cigarette communication in two clinical scenarios. Results: Among 2,058 physicians, the mean age was 51.6 years and 41.5% were female. Over 60% of physicians believed all tobacco products are equally harmful. Overall, 69.8% of physicians reported ever being asked about e-cigarettes by their patients (35.9% in the past 30 days), while 21.7% reported ever recommending e-cigarettes to a patient (9.8% in the past 30 days). Pulmonologists (adjusted odds ratio [AOR], 2.14, 95% CI, 1.10-4.16) and cardiologists (AOR, 2.04; 95% CI, 1.03-4.05), as well as physicians who implemented the US Public Health Service Clinical Practice Guidelines (AOR, 1.77; 95% CI, 1.12-2.80) had greater odds of recommending e-cigarettes to patients. Physicians who endorsed a harm-reduction perspective (AOR, 3.04, 95% CI, 2.15-4.31) and had ever smoked cigarettes (AOR, 1.98; 95% CI, 1.27-3.08) were significantly more likely to recommend e-cigarettes. Being asked about e-cigarettes by patients was a strong predictor of physicians' recommending (AOR,16.6; 95% CI, 10.3-26.7). In clinical scenarios, physicians were overall more likely to recommend e-cigarettes for cessation to an older, heavy smoker with multiple unsuccessful quit attempts than a younger, light smoker with no prior cessation treatments (49.3% vs. 15.2%, p<.001). Conclusions and relevance: Findings suggest physicians may recommend e-cigarettes for cessation under certain circumstances. Given the role of e-cigarettes in FDA's comprehensive nicotine policy, there is need for continued physician education regarding e-cigarette efficacy, particularly correcting misperceptions regarding harm reduction.

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Redukcja szkód związana z przyjmowaniem substancji psychoaktywnych

Medycyna Rodzinna ◽

10.25121/mr.2018.21.1.73 ◽

2018 ◽

Vol 21 (1) ◽

Author(s):

Adam Prokopowicz

Keyword(s):

Harm Reduction ◽

Electronic Cigarettes ◽

The Body ◽

Economic Consequences ◽

Toxic Substances ◽

Psychoactive Substance ◽

Substitution Therapy ◽

Tobacco Products ◽

Substance Addiction ◽

Addiction Therapy

Psychoactive substance addiction is difficult to treat, brings huge damage to the body and has negative social and economic consequences for the addicted, their families and society. Rehabilitation therapy is often long and has a high failure rate. For this reason, there is a need for extensive action to minimise the negative effects of psychoactive substance use. Substitution therapy is one of the programmes included in the harm reduction strategy. It involves the replacement of an illicit drug with a legal substance with similar or identical pharmacological effects and is applied in drug addiction therapy. In the case of nicotine addiction, substitution therapy involves taking the same psychoactive substance (nicotine) in a form which is devoid of the majority of other toxic substances that are found in tobacco smoke. The introduction of alternative forms of nicotine supply (electronic cigarettes, non-smoking tobacco products) have renewed the controversy around the topic of efficacy of harm reduction involving the replacement of traditional tobacco products with those with reduced emission of toxic substances, but which still deliver nicotine. According to the opponents of substitution therapy, it prevents one from achieving abstinence that allows for full elimination of harm generated by psychoactive substances. Finding a common platform between the proponents of harm reduction and advocates of complete abstinence-based therapy would be of benefit to the addicted individuals.

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Heated tobacco products: another tobacco industry global strategy to slow progress in tobacco control

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054340 ◽

2018 ◽

Vol 27 (Suppl 1) ◽

pp. s111-s117 ◽

Cited By ~ 19

Author(s):

Stella A Bialous ◽

Stanton A Glantz

Keyword(s):

Harm Reduction ◽

Tobacco Control ◽

Tobacco Consumption ◽

Tobacco Product ◽

Global Strategy ◽

Tobacco Products ◽

Control Policies ◽

Tobacco Control Policies ◽

Tobacco Epidemic ◽

Slow Progress

There has been a global decline in tobacco consumption that, if continued, will negatively impact the tobacco industry’s profits. This decline led the industry to invent and market new products, including heated tobacco products (HTP). HTP are an extension of the industry’s strategies to undermine government’s tobacco regulatory efforts as they are being promoted as part of the solution for the tobacco epidemic. Under the moniker of ‘harm reduction’, the tobacco companies are attempting to rehabilitate their reputation so they can more effectively influence governments to roll back existing tobacco control policies or create exemptions for their HTP. Rolling back tobacco control policies will make it easier for the companies to renormalise tobacco use to increase social acceptability for all their products. When regulations are absent or when loopholes exist in classifying HTP as a tobacco product (thus subject to all tobacco control regulations), the industry’s marketing of HTP is making these products more visible to the public and more accessible. Governments need to ensure that HTP are regulated as tobacco products or drugs and reject partnerships with the tobacco companies to promote ‘harm reduction’. The tobacco companies remain the vector of the tobacco-caused epidemic and cannot be part of the global tobacco control solution.

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