A Comprehensive Review of Tobacco Harm Reduction

Tobacco harm reduction: an alternative cessation strategy for inveterate smokers. Published in Harm Reduction Journal (2006), by Brad Rodu and William T. Godshall.

This review article was endorsed as the official position of the American Council on Science and Health. The abstract follows, but you can download the complete article in pdf format from the Harm Reduction Journal website here. (U of L)

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 approach to smoking cessation, 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, and of
the prevalence of their use in the United States and Sweden. 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 ST 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, and it shows great potential as a public health strategy to help millions of smokers.