Levy DT, Mumford EA, Cummings KM et al.  The potential impact of a low-nitrosamine smokeless tobacco product on cigarette smoking in the United States: estimates of a panel of experts.  Addictive Behaviors 31: 1190-1200, 2006.

“…the introduction of a new LN-SLT product introduced to the US market under strict regulations but with relevant health claims would not impede the decline in overall smoking prevalence.  Indeed, all Panel members indicated that the new policy would likely accelerate the decline in smoking prevalence.  Estimates of the decreases in predicted smoking prevalence compared to the current product/policy scenario range from 1.3% to 3.1% percentage points.”

From an accompanying press release:

“About 4 million fewer Americans would smoke cigarettes with the proper marketing of a low-carcinogen smokeless tobacco that's popular in Europe… This research… was funded by the National Cancer Institute in the National Institutes of Health.  ‘The results show that cigarette users would switch to low-carcinogen smokeless tobacco with little change in overall tobacco use,’ said David Levy, Ph.D., a PIRE senior research scientist and author of the study. ‘A substantial reduction in health risks would result in lower mortality.’”


Phillips CV, Guenzel B, Bergen P. Deconstructing anti-harm-reduction metaphors; mortality risk from falls and other traumatic injuries compared to smokeless tobacco use. Harm Reduction Journal 2006; 3: 15.

“Certain health advocates believe it is acceptable to mislead people into making choices they would not otherwise make; presumably they rationalize this based on the absurd premise that delaying mortality is the only thing that matters. Trying to change people's behavior through risk communication is an ethical and very legitimate health promotion activity, assuming it is based on giving people accurate information for making their own choices. . . . Through the use of various tactics, advocates who oppose the use of ST [smokeless tobacco] as a harm reduction tool have managed to convince most people that the health risk from ST is several orders of magnitude greater than it really is. The primary tactic they use is making false or misleading scientific claims that suggest that all tobacco use is the same. . . . Apparently motivated by their hatred of all things tobacco, they are trying to convince people to not switch from an extremely unhealthy behavior to an alternative behavior that eliminates almost all of their risk.” (p. 8).


Foulds J, Ramstrom L. Causal effects of smokeless tobacco on mortality in CPS-I and CPS-II? [Letter to the editor]. Cancer Causes and Control 2006; 17: 227-8.

“[W]e agree that the health risks from use of smokeless tobacco products are markedly smaller than those from smoking tobacco products. We believe it would be helpful for health professionals and the public to be provided with best estimates of the relative risks of death from all causes and specific diseases, comparing exclusive smokeless tobacco users with exclusive smokers.” (p. 228).


Haukkala A, Vartiainen E, de Vries H. Progression of oral snuff use among Finnish 13–16-year-old students and its relation to smoking behaviour. Addiction 2006; 101: 581-9.

“Although snuff use has adverse health consequences, these are clearly smaller than with cigarette smoking.” (p. 581).


McNeill A, Bedi R, Islam S, Alkhatib MN, West R. Levels of toxins in oral tobacco products in the UK. Tobacco Control 2006; 15: 64-7.

“[S]mokeless tobacco users should also be informed about the much greater health risks of cigarette smoking to prevent them switching to this more dangerous form of nicotine delivery.” (p. 67).


Thompson F, Fagerstrom K. Current trends in international tobacco control. Clinical Occupational and Environmental Medicine 2006; 5: 101-16.

“However one interprets the Swedish experience, it is clear that Swedish snus is substantially less hazardous than cigarettes, because users are not exposed to the many dangerous compounds that are created by combustion. If people insist on using nicotine, it is preferable they use snus (and more preferable still if they can switch to nicotine gum or patches).”

“Any regulatory system that tries to deal solely with the issue of cigarette toxicity inevitably will be challenged by some harm reduction advocates. Why spend time and regulatory effort reducing cigarette toxicity by 10% when you can reduce the risk of tobacco-caused death by 90% by shifting a smoker to the right kind of smokeless tobacco and the toxicity of smokeless tobacco is much easier to regulate?” (p. 112).

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