The US tobacco control community's view of the future of tobacco harm reduction

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.

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Tobacco harm reduction: Past history, current controversies and a proposed approach for the future

Preventive Medicine ◽

10.1016/j.ypmed.2020.106099 ◽

2020 ◽

Vol 140 ◽

pp. 106099 ◽

Cited By ~ 2

Author(s):

Dorothy K. Hatsukami ◽

Dana M. Carroll

Keyword(s):

Harm Reduction ◽

Past History ◽

Tobacco Harm Reduction ◽

The Future

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Migration to the US among rural Puerto Ricans who inject drugs: influential factors, sources of support, and challenges for harm reduction interventions

BMC Public Health ◽

10.1186/s12889-019-8032-2 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

R. Abadie ◽

P. Habecker ◽

C. Gelpi-Acosta ◽

K. Dombrowski

Keyword(s):

Puerto Rico ◽

Harm Reduction ◽

Puerto Rican ◽

Service Providers ◽

Influential Factors ◽

Care Needs ◽

Migration Patterns ◽

The Us ◽

The Future ◽

Hcv Transmission

Abstract Background While PWID of Puerto Rican origin have been migrating to the US for decades, the range of factors influencing their migration to the US and the resources they draw on to do so are not well understood. This is particularly true for rural Puerto Rican PWID, and the present study is the first empirical research to document migration patterns among this population. The specificities of their migration raise important challenges that need to be documented in order to implement more effective harm reduction policies at home (Puerto Rico) and abroad (US). Methods This paper draws from data obtained employing a modified NHBS survey which was administered to (N =296) PWID in four rural municipalities of Puerto Rico with participants 18 years or older. The primary dependent variables for this paper are the number of times a person has lived in the continental US, and if they are planning on moving to the continental US in the future. Results Findings suggest that 65% of the sample reported ever lived in the US and that 49% are planning on moving in the future. The number of times living in the US is associated with higher education and older age, but not with self-reported positive HIV or HCV statuses. Planning to move to the US is associated with knowing PWID who have moved or plan to move, negatively associated with age, and is not associated with HIV or HCV status. Around one third of those that lived in the US reported having some sort of support, with the majority receiving support from family sources. No participant received help to enter HIV/HCV treatment. Conclusions A multi-region approach to prevention is required to make a dent in curbing HIV/HCV transmission in this population. Understanding PWID migration patterns, risk behaviors, and health care needs in the US is now more important than ever as natural disasters prompted by human-made climate change will only increase in the future, raising demands not only for service providers but also harm reduction policies to cope with an increasing influx of “climate refugees” as PWID move across national borders.

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Tobacco Harm Reduction as a Path to Restore Trust in Tobacco Control

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115560 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5560

Author(s):

Tamar M. J. Antin ◽

Geoffrey Hunt ◽

Rachelle Annechino

Keyword(s):

Harm Reduction ◽

Tobacco Control ◽

Significant Proportion ◽

The United States ◽

Tobacco Prevention ◽

Tobacco Harm Reduction ◽

The People ◽

Reduction Strategies ◽

Control And Prevention ◽

And Control

The controversy of tobacco harm reduction in the United States persists despite evidence that an important audience of tobacco prevention and control, i.e., the people who use or are likely to use nicotine and tobacco products, are engaging in practices that may be considered harm reduction. Despite this, a significant proportion of the US tobacco control and prevention field continues to be guided by a precept that there is “no safe tobacco,” therefore failing to acknowledge practices that may be used to reduce the harms associated with consuming combustible forms of nicotine and tobacco. In this commentary, we argue that ignoring the potential benefits of harm reduction strategies may unintentionally lead to an erosion of trust in tobacco control among some members of the public. Trust in tobacco control as an institution is crucial for the success of tobacco control efforts. To ensure trust, we must return to our basic principles of doing no harm, developing programs that are responsive to people’s experiences, and providing resources in assisting people to reduce the harms that may be associated with practices, such as smoking, which adversely affect health. Only by respecting an individual’s priorities can we cultivate trust and develop tobacco prevention efforts that are grounded in the realities of people’s lives and responsive to their needs.

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How to Think—Not Feel—about Tobacco Harm Reduction

Nicotine & Tobacco Research ◽

10.1093/ntr/nty084 ◽

2018 ◽

Vol 21 (10) ◽

pp. 1299-1309 ◽

Cited By ~ 34

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.

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