Rodu B, Cole P.  Impact of the American anti-smoking campaign on lung cancer mortality.  International Journal of Cancer 2002; 97: 804-806.

“Our study indicates that the American anti-smoking campaign has reduced significant smoking in younger smokers.  However, the campaign now should more directly address inveterate smokers over age 40, of whom 420,000 die annually from smoking-related diseases… Innovation is overdue, and the implementation of harm reduction may serve to lower the appallingly high number of deaths among inveterate smokers.” (p. 806) 


Accortt NA, Waterbor JW, Beall C, Howard G. Chronic disease mortality in a cohort of
smokeless tobacco users. American Journal of Epidemiology 2002; 156: 730-737.

“Overall, we found no increased mortality for subjects who reported ever smokeless
tobacco use when compared with subjects who reported no tobacco use. The few
increases in mortality that we discovered, although likely due to chance, should be
investigated further. Evidence from this study shows that smokeless tobacco use is a
safer alternative than continued cigarette smoking. Mortality for exclusive smokeless
tobacco users is considerably less than mortality for exclusive smokers for all cancer
(especially lung cancer) and for ischemic heart disease.” (p. 736).


Ault RW, Ekelund RB. The personal economics of smoking cessation. Journal of Family and Consumer Sciences 2002; 94: 41-49.

“As noted in this study, smokeless tobacco shows a high quit rate (bested only by Zyban
in Table 2) and a high net benefit vis-à-vis other techniques both in the short and in
longer runs. For heavily addicted smokers, moreover, it is not clear that further
progress will be made with more standard techniques. For these and other smokers,
smokeless tobacco should clearly be considered as a viable alternative. The failure to
present smokeless tobacco and long-term use of nicotine replacement therapies as
alternatives to smoking comes from a fear of recommending any therapy that has any
harmful health consequences. However, there is no logic for arguing against a therapy
that results in a net reduction in harm and economic costs.” (p. 48).


Cummings KM. Can capitalism advance the goals of tobacco control? Addiction 2002; 97:

“Competition to produce more consumer-acceptable medicinal nicotine products would
be helped by educating consumers about what factors in tobacco products really
contribute to disease risk. Ironically, many smokers do not perceive much difference in
health risk between smokeless tobacco products, nicotine medications and cigarettes.
Yet if all nicotine products were put on a risk continuum the actual difference between
smokeless and nicotine medications would be seen as fairly minor compared to the
difference in disease risk between smoked and smokeless products (Stratton et al.
2001). Until smokers are given enough information to allow them to choose products
because of lower health risks, then the status quo will remain. Capitalism, and not
government regulation, has the greatest potential to alter the world-wide epidemic of
tobacco-related disease.” (p. 957).


  Rodu B, Stegmayr B, Nasic S, Asplund K.  Impact of smokeless tobacco use on smoking in Northern Sweden.  Journal of Internal Medicine 2002; 252: 398-404.

“The major finding in this study is that the prevalence of smoking amongst men in northern Sweden was very low, falling from 23% in 1986 to 14% in 1999.” (p. 401)

“Recent epidemiologic studies have shown that Swedish snus is not associated with oral cancer or other smoking-related cancers.  Furthermore, snus does not appear to be a strong risk factor for cardiovascular diseases.  Thus, the balance of tobacco use in northern Sweden amongst men – and perhaps incipiently amongst women – may confer substantial health advantages compared with smoking-dominated societies.” (p. 403)


Kozlowski LT. Harm reduction, public health, and human rights: smokers have a right to be informed of significant harm reduction options. Nicotine and Tobacco Research 2002; 4 Suppl 2: S55-60.

“Snus reduces tobacco harm dramatically in comparison to cigarettes . . . . Since about
half of cigarette deaths arise from lung cancer and respiratory disease . . . and since
smokeless products are not otherwise more dangerous than cigarettes, smokeless
tobacco products can be estimated to reduce mortality by at least half, because they do
not cause lung cancer or respiratory disease. Snus is lower than other moist snuffs in
known toxins (N-nitrosamines and polynuclear aromatic hydrocarbons) . . . There has
been concern about smokeless tobacco and oral cancer. Noting the high rate of snus use
in Sweden and citing five studies, the Institute of Medicine report stated, ‘[T]he use of
snus in Sweden has generally not been associated with oral cavity cancer’ (p. 428). . . .
There also are no secondhand smoke or fire risks from snus. The findings are mixed on
whether snus contributes to cardiovascular disease . . . Snus is not safe, but, on the basis
of toxicological principles (no smoke toxins from smoke exposure to the lungs) and
current epidemiological knowledge, snus is significantly less dangerous to individual
users than cigarettes.” (p. S56).

“Cigarettes kill about half of those who smoke them . . . . It is urgent to inform smokers
about options they have to reduce risk. This needs to be done in ways that inform
smokers as fully as possible that never starting and complete quitting as soon as
possible are the best choices to promote health, while also indicating that snus or
medicinal nicotine (the latter more than the former) would be preferable to continued
smoking. Also, complete substitution of these products should be encouraged over
mixing them with continued smoking. The harm reduction message will be complex.
There will be many ways to give it. Some will misinterpret even the most artfully
framed message. Notwithstanding, public health policy in this instance lacks
compelling justification to override the human rights of the individual. Individuals have
the right to such health relevant information.” (Citations omitted, p. S59).


Tobacco Advisory Group of the Royal College of Physicians. Protecting smokers saving lives. A case for tobacco and nicotine regulatory authority. Royal College of Physicians of London. December

“As a way of using nicotine, the consumption of non-combustible tobacco is of the
order of 10-1,000 times less hazardous than smoking, depending on the product. Some
manufacturers want to market smokeless tobacco as a ‘harm reduction’ option for
nicotine users, and they may find support for that in the public health community.” (p.


  Rodu B, Cole P.  Smokeless tobacco use and cancer of the upper respiratory tract.  Oral Surgery 2002; 93: 511-515.

“Although [initiation and prevalence of SLT use] are genuine health concerns, the abundance of data now available indicates that commonly used SLT products increase the risk of oral and upper respiratory tract cancers only minimally.” (p. 514)

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