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      Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?

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      Journal of Public Health Policy

      Springer Science and Business Media LLC

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          Abstract

          The issue of harm reduction has long been controversial in the public health practice of tobacco control. Health advocates have been reluctant to endorse a harm reduction approach out of fear that tobacco companies cannot be trusted to produce and market products that will reduce the risks associated with tobacco use. Recently, companies independent of the tobacco industry introduced electronic cigarettes, devices that deliver vaporized nicotine without combusting tobacco. We review the existing evidence on the safety and efficacy of electronic cigarettes. We then revisit the tobacco harm reduction debate, with a focus on these novel products. We conclude that electronic cigarettes show tremendous promise in the fight against tobacco-related morbidity and mortality. By dramatically expanding the potential for harm reduction strategies to achieve substantial health gains, they may fundamentally alter the tobacco harm reduction debate.

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          Most cited references 10

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          The Strategic Dialogue on Tobacco Harm Reduction: a vision and blueprint for action in the US.

          The issues related to tobacco harm reduction continue to challenge the tobacco control research and policy communities. The potential for combusting tobacco products to reduce exposure and risk remains largely unknown, but this has not stopped manufacturers from offering such products making these claims. The role of oral tobacco products in a harm reduction regimen has also been a source of dialogue and debate. Within the last few years, major cigarette manufacturing companies have begun selling smokeless products for the first time, claiming to target current cigarette smokers. Other cigarette manufacturers are also offering smokeless products in markets around the world. The harm reduction debate has at times been divisive. There has been no unifying set of principles or goals articulated to guide tobacco control efforts. In particular, the research needs are extraordinarily high in order to drive evidence-based policy in this area and avoid the mistakes made with "light" cigarettes. This paper discusses recommendations from a strategic dialogue held with key, mostly US-based tobacco control researchers and policy makers to develop a strategic vision and blueprint for research, policy and communications to reduce the harm from tobacco for the US. Short-term and long-term objectives are described.
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            Tobacco-specific nitrosamines in new tobacco products.

            New tobacco products, designed to attract consumers who are concerned about the health effects of tobacco, have been appearing on the market. Objective evaluation of these products requires, as a first step, data on their potentially toxic constituents. Tobacco-specific nitrosamines (TSNAs) are an important class of carcinogens in tobacco products, but virtually no data were available on their levels in these products. In the present study, we analyzed several new products-Ariva, Stonewall, Exalt, Revel, Smokey Mountain, and Quest-for TSNAs and compared their TSNA levels with those in nicotine replacement products and conventional smokeless tobacco and cigarette brands. TSNAs were not detected in Smokey Mountain, which is a tobacco-free snuff product. The lowest levels among the new products containing tobacco were in Ariva and Stonewall (0.26-0.28 microg/g wet weight of product). The highest levels in the new products were found in Exalt (3.3 microg/g tobacco), whereas Revel and Quest had intermediate amounts. Only trace amounts were found in nicotine replacement products, and conventional brands had levels consistent with those reported in the literature. These results demonstrate that TSNA levels in new tobacco products range from relatively low to comparable with those found in some conventional brands.
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              Smokers' misperceptions of light and ultra-light cigarettes may keep them smoking.

              This study examined smokers' understanding of the relative tar deliveries of Ultra-light, Light, and Regular cigarettes, reasons for smoking Ultra-light/Light cigarettes, and the likelihood of both quitting smoking and switching to Regular cigarettes if they came to learn that one Ultra-light/Light cigarette gave the same amount of tar as one Regular cigarette. Ten- to fifteen-minute random-digit-dialed, computer-assisted telephone interviews (CATI) were conducted with both a national probability sample (n = 788) and a state random sample (n = 266) of daily smokers over the age of 18. Less than 10% of smokers in the national sample and only 14% of smokers in the state sample knew that one Light cigarette could give the same amount of tar as one Regular cigarette. Less than 10% of smokers in the state sample knew that one Ultra-light cigarette could give the same amount of tar as one Regular cigarette. Thirty-two percent of the Light and 26% of the Ultra-light smokers in the national sample, and 27% of Light and 25% of Ultra-light smokers in the state sample, said they would be likely to quit smoking if they learned one Light/Ultra-light equaled one Regular. Many Light and Ultra-light smokers are smoking these cigarettes to reduce the risks of smoking and/or as a step toward quitting. However, these smokers are unaware that one Ultra-light/Light cigarette can give them the same amount of tar and nicotine as one Regular cigarette. Many of the Ultra-light/Light smokers sampled in this study stated that they would be likely to quit if they knew this information. Mistaken beliefs about low-yield brands are reducing intentions to quit smoking.
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                Author and article information

                Journal
                Journal of Public Health Policy
                J Public Health Pol
                Springer Science and Business Media LLC
                0197-5897
                1745-655X
                February 2011
                December 9 2010
                February 2011
                : 32
                : 1
                : 16-31
                Article
                10.1057/jphp.2010.41
                21150942
                © 2011

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