Is Smokeless Tobacco Use an Appropriate Public Health Strategy for Reducing Societal Harm from Cigarette Smoking?

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Abstract

Four arguments have been used to support smokeless tobacco (ST) for harm reduction: (1) Switching from cigarettes to ST would reduce health risks; (2) ST is effective for smoking cessation; (3) ST is an effective nicotine maintenance product; and (4) ST is not a “gateway” for cigarette smoking. There is little evidence to support the first three arguments and most evidence suggests that ST is a gateway for cigarette smoking. There are ethical challenges to promoting ST use. Based on the precautionary principle, the burden of proof is on proponents to provide evidence to support their position; such evidence is lacking.

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Most cited references 89

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Judgment under Uncertainty : Heuristics and Biases

Daniel Kahneman, Paul Slovic, Amos Tversky (2013)

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Mortality from tobacco in developed countries: indirect estimation from national vital statistics.

R. Peto, A. Lopez, J Boreham … (1992)

Prolonged cigarette smoking causes even more deaths from other diseases than from lung cancer. In developed countries, the absolute age-sex-specific lung cancer rates can be used to indicate the approximate proportions due to tobacco of deaths not only from lung cancer itself but also, indirectly, from vascular disease and from various other categories of disease. Even in the absence of direct information on smoking histories, therefore, national mortality from tobacco can be estimated approximately just from the disease mortality statistics that are available from all major developed countries for about 1985 (and for 1975 and so, by extrapolation, for 1995). The relation between the absolute excess of lung cancer and the proportional excess of other diseases can only be approximate, and so as not to overestimate the effects of tobacco it has been taken to be only half that suggested by a recent large prospective study of smoking and death among one million Americans. Application of such methods indicates that, in developed countries alone, annual deaths from smoking number about 0.9 million in 1965, 1.3 million in 1975, 1.7 million in 1985, and 2.1 million in 1995 (and hence about 21 million in the decade 1990-99: 5-6 million European Community, 5-6 million USA, 5 million former USSR, 3 million Eastern and other Europe, and 2 million elsewhere, [ie, Australia, Canada, Japan, and New Zealand]). More than half these deaths will be at 35-69 years of age: during the 1990s tobacco will in developed countries cause about 30% of all deaths at 35-69 (making it the largest single cause of premature death) plus about 14% of all at older ages. Those killed at older ages are on average already almost 80 years old, however, and might have died soon anyway, but those killed by tobacco at 35-69 lose an average of about 23 years of life. At present just under 20% of all deaths in developed countries are attributed to tobacco, but this percentage is still rising, suggesting that on current smoking patterns just over 20% of those now living in developed countries will eventually be killed by tobacco (ie, about a quarter of a billion, out of a current total population of just under one and a quarter billion).

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Effect of smokeless tobacco (snus) on smoking and public health in Sweden.

J Foulds (2003)

To review the evidence on the effects of moist smokeless tobacco (snus) on smoking and ill health in Sweden. Narrative review of published papers and other data sources (for example, conference abstracts and internet based information) on snus use, use of other tobacco products, and changes in health status in Sweden. Snus is manufactured and stored in a manner that causes it to deliver lower concentrations of some harmful chemicals than other tobacco products, although it can deliver high doses of nicotine. It is dependence forming, but does not appear to cause cancer or respiratory diseases. It may cause a slight increase in cardiovascular risks and is likely to be harmful to the unborn fetus, although these risks are lower than those caused by smoking. There has been a larger drop in male daily smoking (from 40% in 1976 to 15% in 2002) than female daily smoking (34% in 1976 to 20% in 2002) in Sweden, with a substantial proportion (around 30%) of male ex-smokers using snus when quitting smoking. Over the same time period, rates of lung cancer and myocardial infarction have dropped significantly faster among Swedish men than women and remain at low levels as compared with other developed countries with a long history of tobacco use. Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Environ Res Public Health

Journal ID (publisher-id): 101238455

Title: International Journal of Environmental Research and Public Health

Publisher: Molecular Diversity Preservation International (MDPI)

ISSN (Print): 1661-7827

ISSN (Electronic): 1660-4601

Publication date (Print): January 2009

Publication date (Electronic): 23 December 2008

Volume: 6

Issue: 1

Pages: 10-24

Affiliations

[1 ] University of Florida College of Dentistry, Gainesville, 1329 SW 16th Street, Suite 5180 P.O. Box 103628, Gainesville, FL 32610-3628 USA FL, USA

[2 ] University of Wisconsin Comprehensive Cancer Center, #385 Warf Office Building, 610 Walnut Street, Madison, WI 53726 USA; E-Mail: bjfox@ 123456uwccc.wisc.edu

[3 ] Oregon Research Institute, 1715 Franklin Blvd., Eugene, OR 97403 USA; E-Mail: herb@ 123456ori.org

Author notes

* Author to whom correspondence should be addressed; E-Mail: stomar@ 123456dental.ufl.edu ; Tel: +1 352-273-5968; Fax: +1 352-273-5985;

Article

Publisher ID: ijerph-06-00010

DOI: 10.3390/ijerph6010010

PMC ID: 2672338

PubMed ID: 19440266

SO-VID: 5fdcbbf2-536f-4db5-9d85-581ed288e09f

License:

This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

Is Smokeless Tobacco Use an Appropriate Public Health Strategy for Reducing Societal Harm from Cigarette Smoking?

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Abstract

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Tobacco Prevention & Cessation

Most cited references 89

Judgment under Uncertainty : Heuristics and Biases

Mortality from tobacco in developed countries: indirect estimation from national vital statistics.

Effect of smokeless tobacco (snus) on smoking and public health in Sweden.

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