How to Think—Not Feel—about Tobacco Harm Reduction

2018 ◽  
Vol 21 (10) ◽  
pp. 1299-1309 ◽  
Author(s):  
Kenneth E Warner
Keyword(s):  
Public Health ◽  
Smoking Cessation ◽  
Harm Reduction ◽  
Tobacco Control ◽  
National Survey ◽  
Objective Assessment ◽  
Positive Contribution ◽  
Youth Smoking ◽  
Tobacco Harm Reduction ◽  
Reduced Risk

Abstract Introduction The debate over tobacco harm reduction (THR) has divided the tobacco control community into two camps, one expressing serious reservations about THR whereas the other believes that reduced-risk products like e-cigarettes will disrupt the cigarette market. The often emotional debate would benefit from dispassionate data-based evaluation of evidence. Methods After briefly discussing harm reduction in public health and specifically in tobacco control, this paper identifies major issues concerning e-cigarettes and reviews relevant evidence. Issues include: e-cigarettes’ risks compared to cigarette smoking; the effect of vaping on youth smoking; vaping’s impact on adult smoking cessation; the net long-term public health implications of vaping; and differences in views on policy issues. The intent is to provide a broad overview of issues and evidence, directing readers to more detailed reviews of specific issues. Findings Principal findings include the following: (1) while longitudinal studies suggest that vaping increases never-smoking young people’s odds of trying smoking, national survey data indicate that adolescents’ 30-day smoking prevalence decreased at an unprecedented rate precisely whereas vaping increased. Use of all other tobacco products also declined. (2) Recent population-level studies add evidence that vaping is increasing adult smoking cessation. (3) Vaping is likely to make a positive contribution to public health. Conclusions THR can be a complement to, not a substitute for, evidenced-based tobacco control interventions. Tobacco control professionals need to focus on objective assessment of and discussion about the potential costs and benefits of THR. Implications Participants on both sides of the divisive THR debate need to examine the complicated issues and evidence more objectively. This entails considering both the potential benefits and costs associated with reduced-risk products like e-cigarettes. Furthermore, it requires examining different kinds of evidence when considering specific issues. For example, those concerned by longitudinal study findings that vaping increases students’ trial of cigarettes should consider US national survey evidence that youth smoking has decreased at an unprecedented rate. A review of the major issues suggests that the potential of vaping to assist adult smokers to quit outweighs the potential negatives.

scholarly journals Origins of tobacco harm reduction in the UK: the ‘Product Modification Programme' (1972–1991)

2018 ◽  
Vol 27 (e1) ◽  
pp. e12-e18 ◽  
Author(s):  
Jesse Elias ◽  
Pamela M Ling
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Tobacco Control ◽  
Tobacco Industry ◽  
Policy Implications ◽  
British Government ◽  
Tobacco Harm Reduction ◽  
Parliamentary Debate ◽  
Product Modification ◽  
The Uk

ObjectiveTo better understand the current embrace of long-term nicotine maintenance by British governmental agencies and tobacco harm reduction by several leading British public health organisations, describe the context and deliberations of the UK’s first formal tobacco risk reduction programme: ‘Product Modification’.MethodsAnalysis of previously secret tobacco industry documents, news archives and Parliamentary debate records.ResultsFrom 1972 to 1991, the British government sought to investigate safer smoking through the ‘product modification programme'. The Independent Scientific Committee on Smoking and Health (ISCSH) advised the British government on these efforts and collaborated with the tobacco industry, with which government then negotiated to determine policy. The ISCSH operated from four industry-backed premises, which contributed to the ISCSH’s support of safer smoking: (1) reduced toxicity indicates reduced risk; (2) collaboration with the tobacco industry will not undermine tobacco control; (3) nicotine addiction is unavoidable; (4) to curtail cigarette use, solutions must be consumer-approved (ie, profitable). These premises often undermined tobacco control efforts and placed the ISCSH at odds with broader currents in public health. The product modification programme was abandoned in 1991 as the European Community began requiring members to adopt upper tar limits, rendering the ISCSH redundant.Policy implicationsEndorsements of reduced harm tobacco products share the same four premises that supported the product modification programme. Current tobacco harm reduction premises and policies supported by the British government and leading British public health organisations may reflect the historical influence of the tobacco industry.

scholarly journals The Ethics of Tobacco Harm Reduction: An Analysis of E-Cigarette Availability From the Perspectives of Utilitarianism, Bioethics, and Public Health Ethics

2020 ◽  
Author(s):  
Rebecca Thomas ◽  
Lisa S Parker ◽  
Saul Shiffman
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Biomedical Ethics ◽  
Public Health Ethics ◽  
Individual Autonomy ◽  
Tobacco Harm Reduction ◽  
Reduction Strategy ◽  
Ethics Framework ◽  
Health Ethics ◽  
Harm Reduction Strategy

Abstract Much evidence suggests e-cigarettes are substantially less harmful than combustible cigarettes. Assuming this is true, we analyze the ethical case for a policy of e-cigarette availability (ECA) as a tobacco harm reduction strategy. ECA involves making e-cigarettes available to allow smokers to switch to them, and informing smokers of the lower risks of e-cigarettes vis-à-vis smoking. After suggesting that utilitarian/consequentialist considerations do not provide an adequate ethical analysis, we analyze ECA using two other ethical frameworks. First, ECA is supported by a public health ethics framework. ECA is a population-level intervention consistent with respecting individual autonomy by using the least restrictive means to accomplish public health goals, and it supports equity and justice. Second, ECA is supported by four principles that form a biomedical ethics framework. By reducing smokers’ health risks and not harming them, ECA fulfills principles of beneficence and non-maleficence. Because ECA allows smokers to make informed health decisions for themselves, it fulfills the principle requiring respect for persons and their autonomy. Here, we consider whether nicotine addiction and thus ECA undermine autonomy, and also discuss the ethical warrant for special protections for youth. Finally, ECA can also advance justice by providing a harm reduction alternative for disadvantaged groups that disproportionately bear the devastating consequences of smoking. Policies of differential taxation of cigarettes and e-cigarettes can facilitate adoption of less harmful alternatives by those economically disadvantaged. We conclude that public health and biomedical ethics frameworks are mutually reinforcing and supportive of ECA as a tobacco harm reduction strategy. Implications Making e-cigarettes and information about them available is supported as ethical from multiple ethical perspectives.

scholarly journals Assessing the Knowledge, Attitude, and Practices of Cigarette Smokers and Use of Alternative Nicotine Delivery Systems in Pakistan: A Cross-Sectional Study

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Abdul Hameed ◽  
Daud Malik
Keyword(s):  
Smoking Cessation ◽  
Harm Reduction ◽  
Large Scale ◽  
Weak Link ◽  
Principal Component ◽  
Delivery Systems ◽  
Tobacco Harm Reduction ◽  
Cross Sectional ◽  
Quit Smoking ◽  
Nicotine Delivery

Background. This research has been conducted to assess smokers’ knowledge and behavior vis-à-vis combustible smoking cessation, prevalence, and risk, and the use of alternative nicotine delivery systems to quit smoking. Methods. A mixed-method approach utilizing cross section primary survey data and comprising descriptive and s-KAP index analysis has been adopted to ascertain the relationship between dependent and independent s-KAP variables; the principal component analysis methodology has been used to determine the use of alternative nicotine delivery systems. Results. Most of the smokers were aged between 15 and 35 years. A predominant 69.8% of the smokers came from middle-class background. Moreover, 71.3% were unaware of any alternative Tobacco Harm Reduction product. A majority of the respondents (68.2%) were keen to quit smoking. However, when asked why they had not succeeded, 52.9% reported addiction to nicotine as the main impediment. In Pakistan, lack of smoking cessation services is the weak link in the fight against the tobacco epidemic. Smokers are generally unaware of the Tobacco Harm Reduction products available in Pakistan; moreover, only 10.9% of the respondents were willing to spend more than Rs. 4000 per month on Tobacco Harm Reduction products. The average s-KAP score for young adults below the age of 20 was much lower than the national average but improved with the level of education. Interestingly, the score of smokers who had ever tried to quit smoking was slightly higher than that of those who had never tried to quit. Conclusion. There is intent to quit combustible smoking but the policy and infrastructure necessary for successful quitting are missing. Pakistan needs to concentrate on two fronts: a large scale awareness campaign against the use and harms of combustible smoking and simultaneously providing affordable and accessible smoking services across the country. Pakistan should look at the use and regulation of safer nicotine products in the UK. The country should carefully weigh the options of ensuring how to incorporate the use of safer nicotine delivery systems in its tobacco control efforts.

scholarly journals Toxicology of Ngirimbo Samples across Chitipa District

2021 ◽  
Author(s):  
Vita Mithi ◽  
John F. Kamanula ◽  
Ashok Pandey ◽  
Rebecca S. Dewey
Keyword(s):  
Smoking Cessation ◽  
Harm Reduction ◽  
Smokeless Tobacco ◽  
Atomic Absorption Spectrophotometry ◽  
Gas Chromatography Mass Spectrometry ◽  
Toxic Heavy Metals ◽  
Tobacco Harm Reduction ◽  
Nicotine Content ◽  
Toxicological Studies ◽  
Clinical Consequences

Abstract Introduction: Smokeless tobacco describes a wide variety of tobacco products that do not require combustion, and is typically used either orally or nasally. Ngirimbo is a form of oral smokeless tobacco used by smokers in Malawi for tobacco harm reduction. The aim of this study was to determine the acidity (pH), nicotine content, mineral content (iron, zinc, calcium, magnesium and copper), heavy metal content (lead, chromium and cadmium), and presence of other volatile compounds in ngirimbo across Chitipa District in Malawi . Methods: Atomic absorption spectrophotometry and gas chromatography-mass spectrometry were used to estimate nicotine content, concentration of toxic heavy metals, minerals of potential toxicity and other harmful chemicals in the samples. Results: Samples were found to contain harmful chemicals, high pH and nicotine [2-(1-methyl-2-pyrolidinyl)-pyridine, (S)- and (S)-3-(1-methyl-2-pyrolidinyl)-pyridine] levels. Mineral concentrations were found to be much higher than typical safety limits. Conversely, samples were not found to contain lead, and had low concentrations of chromium and cadmium. Conclusions: These findings suggest that prolonged use of ngirimbo is a significant health risk to people with chronic diseases. Nonetheless, ngirimbo provides a valid method of tobacco harm reduction and a potential smoking cessation tool. Therefore, further analytical toxicological studies are needed to fully characterize variations in the quality of the product. Implications : Consumers of ngirimbo are susceptible to acute toxic effects of oral and dermal exposure to the product, as well as addiction. Some individuals would suffer from convulsions or seizures following ngirimbo use, and other clinical consequences depending on the amount ingested. However, understanding the amount of nicotine, and other volatile constituents, consumed through ngirimbo use will help to generate recommendations for quantity and frequency of use. Further, establishing the threshold of harm for nicotine consumption will contribute to the extraction, isolation, and use of nicotine as a smoking-cessation agent, and for treating psychiatric disorders such as schizophrenia and neurodegenerative diseases such as Alzheimer’s.

scholarly journals New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?

CNS Drugs ◽  
2016 ◽  
Vol 30 (10) ◽  
pp. 951-983 ◽  
Author(s):  
Emma Beard ◽  
Lion Shahab ◽  
Damian M. Cummings ◽  
Susan Michie ◽  
Robert West
Keyword(s):  
Smoking Cessation ◽  
Harm Reduction ◽  
Tobacco Harm Reduction ◽  
Pharmacological Agents

scholarly journals Vaping Restrictions: Is Priority to the Young Justified?

2020 ◽  
Author(s):  
Monica Magalhaes
Keyword(s):  
Public Health ◽  
United States ◽  
At Risk ◽  
Young People ◽  
Harm Reduction ◽  
Ethical Dilemma ◽  
The United States ◽  
Youth Smoking ◽  
Health Authorities ◽  
Public Health Authorities

Abstract The vast majority of smokers become dependent on nicotine in youth. Preventing dependence has therefore been crucial to the recent decline in youth smoking. The advent of vaping creates an opportunity for harm reduction to existing smokers (mostly adults) but simultaneously also undermines prevention efforts by becoming a new vehicle for young people to become dependent on nicotine, creating an ethical dilemma. Restrictions to access to some vaping products enacted in response to the increase in vaping among youth observed in the United States since 2018 have arguably prioritized prevention of new cases of dependence—protecting the young—over harm reduction to already dependent adults. Can this prioritization of the young be justified? This article surveys the main bioethical arguments for prioritizing giving health benefits to the young and finds that none can justify prioritizing dependence prevention over harm reduction: any reasons for prioritizing the current cohort of young people at risk from vaping will equally apply to current adult smokers, who are overwhelmingly likely to have become nicotine-dependent in their own youth. Public health authorities’ current tendency to prioritize the young, therefore, does not seem to be ethically justified. Implications This article argues that commonsense reasons for prioritizing the young do not apply to the ethical dilemma surrounding restricting access to vaping products.

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