History
Given the varying legal, moral and historical status of tobacco, and the different types of tobacco and tobacco use in different cultures around the world, debates on tobacco harm reduction tend to be geographically defined arguments. For instance, cigarette smoking is the dominant form in the United States, with a smaller number of users availing themselves of cigars, pipes, and smokeless tobacco. The political climate over the last few decades has led to both restrictions in the sale and use of tobacco and widespread information (and misinformation) about the negative health effects of tobacco use. Despite this, tobacco in all its forms has remained a legal product in most societies. A notable exception is the European Union, where the most dangerous products (cigarettes) are available but smokeless tobacco products, which are far less hazardous, are banned The exception is Sweden, where there is a long tradition of smokeless tobacco use among men.
Cigarette manufacturers have attempted to design safer cigarettes for almost 50 years, but results have been marginal at best . Filters were introduced in the early 1950s, and manufacturers were selling low-yield cigarettes by the late 1960s. Initially it was thought that these innovations were harm reducing.For example, in 1976 investigators at the American Cancer Society published research concluding that light cigarettes were safer. The study authors wrote that “total death rates, death rates from coronary heart disease, and death rates from lung cancer were somewhat lower for those who smoked ‘low’ tar-nicotine cigarettes than for those who smoked ‘high’ tar-nicotine cigarettes.”
It is now established that use of Swedish and American smokeless tobacco confers only 0.1% to 10% of the risks of smoking (smokeless products in India and Asia contain higher levels of contaminants and confer higher risks). Two respected medical groups believe that ST may play a role in reducing smoking-attributable deaths. In 2007, Britain’s Royal College of Physicians concluded “…that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.” In 2008, the American Association of Public Health Physicians became the first medical organization in the U.S. to formally adopt a policy of “…encouraging and enabling smokers to reduce their risk of tobacco-related illness and death by switching to less hazardous smokeless tobacco products.”
Electronic Cigarettes are battery-powered devices that deliver vaporized propylene glycol/nicotine when users inhale while using them. The regulatory status of e-cigarettes in many countries is unclear, while in others the use or sale of electronic cigarettes is illegal (e.g. Australia and Hong Kong). Preliminary laboratory evaluation of one brand reveals that it contains virtually none of the harmful byproducts of tobacco combustion. Studies of the health risks are not available.
Proponents 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. Opponents argue that some aspects of harm reduction interfere with cessation and abstinence and might increase initiation. Smokers remain confused about tobacco harm reduction. In one survey about 66-75% of participants incorrectly perceived low-yield cigarettes as harm-reducing, while 75-80% mistakenly believed that switching to smokeless tobacco conferred no risk reduction