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6th July 2010

6th July 2010. Reducing the toll of smoking-related disease and death: The case for tobacco harm reduction The rationale for establishing low-toxicity smokeless nicotine product policies: Why are the pros stronger than the cons? Lars Ramstrom Institute for Tobacco Studies, Sweden.

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6th July 2010

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  1. 6th July 2010 Reducing the toll of smoking-related disease and death: The case for tobacco harm reductionThe rationale for establishing low-toxicity smokeless nicotine product policies: Why are the pros stronger than the cons?Lars RamstromInstitute for Tobacco Studies, Sweden

  2. Reduction of harm from tobacco useis a top priority in public health. But,”Tobacco Harm Reduction”is a controversial issue.

  3. Tobacco Harm Reductionis mainly a matter of replacing cigarettes by a less harmful tobacco product. ”Low-tar” cigarettes are no candidates forharm reduction, but some ”low-toxicity” smokeless tobacco products are. One such product, Swedish SNUS, is dominating the debate on Tobacco Harm Reduction.

  4. Opponents of Tobacco Harm Reductiongenerally agree that switching to Snus can yield substantial reduction of tobacco-induced diseases for thoseINDIVIDUALSwho do thereby abstain from cigarettes, • but, there are concerns that unintended effects can incur negative effects onPUBLIC HEALTH.

  5. Some concerns: Is there a risk that snus serves as a gateway to smoking and thereby increases smoking?  snus becomes an additional use rather than a replacement?  nicotine addiction is strengthened by snus use?  snus is ineffektive as cessation aid?  snus use will weaken smokers’ effort to quit smoking?

  6. What can we learn by the evidence from Swedish population studies?

  7. 5.4% of all cases of onset of daily tobacco use Remaining ”secondary” smokers: 0.7% of all men Starting to smoke after onset of snus use is a very rare option − and most of those cases, 76%, end up by quitting smoking.

  8. Continuing daily dual users are a minority (12%) of all dual initiators and constitute just 1.8% of all men.

  9. Is nicotine addiction strengthened by switching to snus? • Nicotine addictiveness is mainly determined by the speed of delivery to the brain. • Nicotine delivery from snus is substantially slower than from cigarettes. • Snus use would therefore be deemed as less addictive than cigarette smoking.

  10. About a third of smokers who start snus use do subsequently quit all daily use of nicotine. This is not compatible with the idea that snus use were strengthening nicotine addiction.

  11. Rate of quitting daily smoking: • never snus: 57% • secondary snus use: 87% • secondary smoking: 76%

  12. Will snus use weaken smokers’ efforts to quit smoking?

  13. Efforts to quit smoking are manifested in quit attempts. • In the FSI / ITS study all Ever Daily Smokers were asked: “Have you ever made a serious attempt to quit smoking?” • The odds of having made a quit attempt at the time of the survey were significantly higher for those primary daily smokers who had subsequently started daily snus use as compared to those who had not. • OR for men 2.22, 95% CI 1.75 to 2.81 • OR for women 2.98, 95% CI 1.74 to 5.12

  14. Smokers who have started subsequent snus use appear to make more efforts to quit smoking than those who have not.

  15. SUMMARY • There is little or no scientific evidence to support arguments against Tobacco Harm Reduction. • There is a good deal of scientific evidence to reject arguments against Tobacco Harm Reduction. • There is a good deal of scientific evidence to support arguments for Tobacco Harm Reduction.

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