Executive Summary
(See also: our brochure-sized condensation of this report.)
According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders, and pulmonary diseases.
Many smokers are unable – or at least unwilling – to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit or die.
A third alternative, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products.
This report provides a description of traditional and modern smokeless tobacco products. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about smokeless tobacco products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations.
The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist consumers in distinguishing real health threats from spurious health claims. As this report documents, there is a strong scientific and medical foundation for tobacco harm reduction, which shows great potential as a public health strategy to help millions of smokers.
Introduction
Even though people have known for more than 40 years that cigarettes are deadly, cigarette smoking remains the number one preventable cause of death in the United States, accounting for more than 400,000 deaths per year.
Efforts to reduce the number of people who smoke have had mixed results. On the plus side, it is less common for people to start smoking now than it was in the past. On the minus side, smokers’ efforts to kick the cigarette habit usually fail. Statistics show that 70% of smokers want to quit and that 40% make a serious attempt to quit each year; however, each year fewer than 5% succeed in quitting permanently. Because nicotine is addictive, most people who want to quit smoking find themselves unable or unwilling to quit when they try.
A new approach to reducing the number of deaths and illnesses caused by cigarette smoking has recently been suggested: encouraging smokers to switch from cigarettes to less harmful smokeless tobacco products so that they can reduce their risk of tobacco-related illness and death without having to break their addiction to nicotine. Some health experts and antismoking advocates have welcomed this idea, but others have strongly criticized it.
In this report, the American Council on Science and Health (ACSH) evaluates the prospect for the use of smokeless tobacco as a harm reduction alternative for smokers, discusses the reasons why this approach is controversial, and recommends some policy changes that may reduce the risk of tobacco-related illness and death among cigarette smokers. This report is based on a peer-reviewed ACSH report entitled "Tobacco Harm Reduction: An Alternate Cessation Strategy for Inveterate Smokers," by Dr. Brad Rodu and William T. Godshall, M.P.H., from the Dec. 21, 2006 issue (Vol. 3, issue 1) of Harm Reduction Journal.
