Global InformationTobacco harm reduction information
Tobacco harm reduction (THR) is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the use of drugs. Tobacco smoking is widely acknowledged as a leading cause of illness and death,[1] and reducing smoking is vital to public health.[2][3][4][5][6]
Tobacco use if not stopped can be the cause of death in 50% of its users according to WHO report. [7] The benefits of tobacco cessation starts within minutes as heart rate and blood pressure starts falling.
The consumption of tobacco products and its harmful effects affect both smokers and non-smokers,[8] and is a major risk factor for six of the eight leading causes of deaths in the world, including respiratory diseases, cardiovascular diseases, cerebrovascular diseases, periodontal diseases, teeth decay and loss, over 20 different types or subtypes of cancers, strokes, several debilitating health conditions, and malignant diseases.[2][3][4][5][6][9][10] In high income countries, smoking rates have been reduced mostly by reducing the uptake of smoking among younger people rather than improving the rates of quitting among established smokers. It is, however, mostly current smokers who will face disease and death from smoking.[11][12]
Nicotine itself, however, is addictive but not otherwise very harmful, as shown by the long history of people safely using nicotine replacement therapy products (e.g., nicotine gum, nicotine patch).[13] Nicotine increases heart rate and blood pressure and has a range of local irritant effects but does not cause cancer.[14] None of the three main causes of death from smoking—lung cancer, chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis), and cardiovascular diseases—is caused primarily by nicotine; the main reason smoking is deadly is the toxic mix of chemicals in smoke from combustion (burning) of tobacco. Products that can effectively and acceptably deliver nicotine without smoke have the potential to be less harmful than smoked tobacco. THR measures have been focused on reducing or eliminating the use of combustible tobacco by switching to other nicotine products, including:
- Cutting down (either long-term or before quitting smoking)
- Temporary abstinence
- Switching to non-tobacco nicotine containing products, such as pharmaceutical nicotine replacement therapies or currently (generally) unlicensed products such as electronic cigarettes
- Switching to smokeless tobacco products such as Swedish snus
- Switching to non-combustible tobacco products
Quitting all tobacco products definitively reduces risk the most. However, quitting is difficult, and even approved smoking cessation methods have a low success rate.[1] In addition, some smokers may be unable or unwilling to achieve abstinence.[15] Harm reduction is likely of substantial benefit to these smokers and public health.[1][13] Providing reduced-harm alternatives to smokers is likely to result in lower total population risk than pursuing abstinence-only policies.[16]
The strategy is controversial: supporters of tobacco harm reduction assert that lessening the health risk for the individual user is worthwhile and manifests over the population in fewer tobacco-related illnesses and deaths.[15][17] Opponents have argued that some aspects of harm reduction interfere with cessation and abstinence and might increase initiation.[18][19] However, surveys carried from 2013 to 2015 in the UK[20] and France [21] suggest that on the contrary, the availability of safer alternatives to smoking is associated with decreased smoking prevalence and increased smoking cessation. In Japan the sales of cigarettes have decreased by 32% since the introduction of heated tobacco products.[22]
- ^ a b c Nitzkin, J (June 2014). "The Case in Favor of E-Cigarettes for Tobacco Harm Reduction". International Journal of Environmental Research and Public Health. 11 (6). MDPI: 6459–71. doi:10.3390/ijerph110606459. PMC 4078589. PMID 25003176. S2CID 19155518.
A carefully structured Tobacco Harm Reduction (THR) initiative, with e-cigarettes as a prominent THR modality, added to current tobacco control programming, is the most feasible policy option likely to substantially reduce tobacco-attributable illness and death in the United States over the next 20 years.
- ^ a b Rodu B, Plurphanswat N (January 2021). "Mortality among male cigar and cigarette smokers in the USA". Harm Reduction Journal. 18 (7). BioMed Central: 7. doi:10.1186/s12954-020-00446-4. ISSN 1477-7517. LCCN 2004243422. PMC 7789747. PMID 33413424. S2CID 230800394.
- ^ a b Chang CM, Corey CG, Rostron BL, Apelberg BJ (December 2015). "Systematic review of cigar smoking and all cause and smoking related mortality". BMC Public Health. 15 (1): 390. doi:10.1186/s12889-015-1617-5. PMC 4408600. PMID 25907101. S2CID 16482278.
- ^ a b Laniado-Laborín R (January 2009). "Smoking and Chronic Obstructive Pulmonary Disease (COPD). Parallel Epidemics of the 21st Century". International Journal of Environmental Research and Public Health. 6 (1: Smoking and Tobacco Control). MDPI: 209–224. doi:10.3390/ijerph6010209. PMC 2672326. PMID 19440278. S2CID 19615031.
- ^ a b "Health topics: Tobacco". www.who.int. World Health Organization. 2021. Archived from the original on 13 August 2021. Retrieved 18 August 2021.
- ^ a b Albandar JM, Adensaya MR, Streckfus CF, Winn DM (December 2000). "Cigar, Pipe, and Cigarette Smoking as Risk Factors for Periodontal Disease and Tooth Loss". Journal of Periodontology. 71 (12). American Academy of Periodontology: 1874–1881. doi:10.1902/jop.2000.71.12.1874. PMID 11156044. S2CID 11598500.
- ^ "Tobacco". www.who.int. Retrieved 2024-02-24.
- ^ Skipina TM, Upadhya B, Soliman EZ (July 2021). Munafò M (ed.). "Secondhand Smoke Exposure is Associated with Prevalent Heart Failure: Longitudinal Examination of the National Health and Nutrition Examination Survey". Nicotine & Tobacco Research. 23 (9). Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco: 1512–1517. doi:10.1093/ntr/ntab047. LCCN 00244999. PMID 34213549. S2CID 235707832.
- ^ Nonnemaker J, Rostron B, Hall P, MacMonegle A, Apelberg B (September 2014). Morabia A (ed.). "Mortality and Economic Costs From Regular Cigar Use in the United States, 2010". American Journal of Public Health. 104 (9). American Public Health Association: e86–e91. doi:10.2105/AJPH.2014.301991. PMC 4151956. PMID 25033140. S2CID 207276270.
- ^ Shapiro JA, Jacobs EJ, Thun MJ (16 February 2000). "Cigar Smoking in Men and Risk of Death From Tobacco-Related Cancers" (PDF). Journal of the National Cancer Institute. 92 (4): 333–337. doi:10.1093/jnci/92.4.333. PMID 10675383. S2CID 7772405.
- ^ IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2004). Tobacco Smoke and Involuntary Smoking. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol. 83. IARC. pp. 1–1438. ISBN 978-92-832-1283-6. PMC 4781536. PMID 15285078. NBK316407.
- ^ Jha P, Peto R (2 January 2014). "Global Effects of Smoking, of Quitting, and of Taxing Tobacco". New England Journal of Medicine. 370 (1): 60–68. doi:10.1056/NEJMra1308383. PMID 24382066. S2CID 4299113.
- ^ a b Fagerström KO, Bridgman K (March 2014). "Tobacco harm reduction: The need for new products that can compete with cigarettes". Addictive Behaviors. 39 (3): 507–511. doi:10.1016/j.addbeh.2013.11.002. PMID 24290207.
The need for more appealing, licensed nicotine products capable of competing with cigarettes sensorially, pharmacologically and behaviourally is considered by many to be the way forward.
- ^ "IARC Monographs- Classifications". monographs.iarc.fr. International Agency for Research on Cancer. Retrieved 18 April 2017.
- ^ a b Rodu B, Godshall WT (2006). "Tobacco harm reduction: an alternative cessation strategy for inveterate smokers". Harm Reduction Journal. 3 (1): 37. doi:10.1186/1477-7517-3-37. PMC 1779270. PMID 17184539.
- ^ Phillips CV (2009). "Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments". Harm Reduction Journal. 6 (1): 29. doi:10.1186/1477-7517-6-29. PMC 2776004. PMID 19887003.
Hiding THR from smokers, waiting for them to decide to quit entirely or waiting for a new anti-smoking magic bullet, causes the deaths of more smokers every month than a lifetime using low-risk nicotine products ever could.
- ^ Cite error: The named reference
RCPwas invoked but never defined (see the help page). - ^ Sumner W (December 2005). "Permissive nicotine regulation as a complement to traditional tobacco control". BMC Public Health. 5 (1): 18. doi:10.1186/1471-2458-5-18. PMC 554785. PMID 15730554.
- ^ Tomar S, Fox B, Severson H (23 December 2008). "Is Smokeless Tobacco Use an Appropriate Public Health Strategy for Reducing Societal Harm from Cigarette Smoking?". International Journal of Environmental Research and Public Health. 6 (1): 10–24. doi:10.3390/ijerph6010010. PMC 2672338. PMID 19440266.
- ^ Action on Smoking and Health, May 2016, Use of electronic cigarettes (vapourisers) among adults in Great Britain [1]
- ^ Résultats de l'enquête cigarette électronique ETINCEL - OFDT, 2014
- ^ Shapiro H (4 November 2020). "Burning Issues: the Global State of Tobacco Harm Reduction 2020". p. 5.