Cigarette smoking declines, and harm reduction helps american council on science and health. Tobacco harm reduction thr is about reducing the risks faced by adult tobacco smokers by providing them with accurate information about, and instituting regulatory policies that reflect, the comparative risks between cigarettes and noncombustible tobacco products and nicotine replacement therapies thereby encouraging smokers who do not quit tobacco entirely to consider switching to. Abstract background and aims cigarette smoking often results in nicotine dependence. Nicotine is the addictive element of tobacco but it is the tar and other toxins in tobacco smoke, not nicotine, that cause most of the harm. Accreditation is valid for 5 years from january 2010 and applies to guidance produced. Awareness and use of these devices has grown exponentially in recent years, with millions of people currently using them. Critics furthermore reject harm reduction measures for allegedly trying to establish certain forms of drug use as acceptable in society. Ecigarettes and the harmreduction continuum request pdf. Electronic cigarettes are a recent development in tobacco harm reduction. Distorting the approach article in journal of public health policy 374 september 2016 with 77 reads how we measure reads. A broadly shared goal of public policy toward cigarettes and other tobacco products. Among toxins in both cigarettes and ecigarettes, levels emitted by ecigarettes range from about a 10 th to a 400 th levels in cigarette smoke.
Centers for disease control and prevention cdc, a supporter of antivaping laws, found that ecigarette use among young people is associated with the use of other tobacco products including cigarettes. The specific harm reduction interventions may differ for different drugs. Changing perceptions of harm of ecigarette vs cigarette. How to think not feel about tobacco harm reduction ken warner. It recommends harm reduction approaches which may or may not include temporary or longterm use of licensed nicotinecontaining products. For example, 612month abstinence rates with no intervention are only around 3%. After an open period of discussion, the iom report definition of harm reduction was provided to include in the framework. Anything that decreases the risks from using tobacco or nicotine. Nice pathways are interactive and designed to be used online. Smoking causes cancer for example, lung, oral cavity, oesophagus, larynx, pancreas, bladder, kidney, chronic obstructive pulmonary disease copd, myocardial infarction, and stroke. The application of a harm reduction approach one that is widely accepted and used in other fields, such as opiate addiction may offer promise. Staying away from waterways and beaches if you plan on drinking alcohol, to reduce the risk of drowning. It aims to help people, particularly those who are highly dependent on nicotine, who. This survey study of data from 2 crosssectional nationally representative surveys examines how us adults perceive the harm of electronic cigarettes ecigarett.
Public comment regarding tobacco harm reduction to the u. Pdf ethical considerations of ecigarette use for tobacco. Tobacco harm reduction thr is a public health strategy to lower the health risks associated with using nicotine, as an example of the concept of harm reduction, a strategy for dealing with the abuse of other drugs. For information on attempts to reduce the harm from tobacco products see the tobacco products regulation page. Global and local perspectives on tobacco harm reduction. Takehomes eliminate misinformation on state government tobacco web pages such as. The tobacco harm reduction strategy is based on incorrect assumptions that smokers will. A recent cdc survey of adult behaviors found that more recent quitters, and those who have tried to quit, are using ecigarettes. Protect harm reduction alternatives to smoking cigarettes. However, nicotine itself is not very harmful, as inferred. The first question gauged participants general impression of the term harm reduction with respect to tobacco.
The term harm reduction is most often used in controversial contexts, like encouraging condom use and other safe sex practices, or providing heroin users with clean needles or methadone. We contend that, in the absence of all three elements, there is a danger that electronic cigarettes will delay the achievement of a tobaccofree world. These products are challenging not only smoked tobaccos stranglehold on the nicotine market but also the public health response to tobacco harm reduction, including by who. The chemical constituents in cigarettes and cigarette. A very important part of tobacco harm reduction is simply educating people about the risks of different sources of nicotine. Moral conservatism within government and communities has resulted in a reluctance to support the provision of opioid agonist therapy for people with opioid use disorders in. This includes not only harm reduction but also reduction in demand and supplytwo elements that are explicitly rejected by many advocates of electronic cigarettes. First, we need to make a distinction between harm reduction at the individual and population levels. Smokers remain confused about tobacco harm reduction. Tobacco harm reduction thr refers to strategies designed to reduce the. Definition harm reduction refers to policies, programmes and practices that aim primarily. Ecigarettes, being a less harmful alternative to smoking, have the potential to achieve harm reduction. Electronic cigarettes are estimated to be 100 to times safer than regular cigarettes.
Ecigarettes are not safe for youth, young adults, and pregnant women, as well as adults who do not currently use tobacco products. If students complete tasks sooner than the allotted time, challenge them to brainstorm more harm reduction strategies they practice day to day. How to think not feel about tobacco harm reduction. Tobacco harm reduction means helping smokers understand about lowrisk alternatives and making sure they have the opportunity to switch to them if they want. Cigarette harm reduction with scheduled electronic cigarette use. The unique contribution of ecigarettes for tobacco harm. Harm reduction is an internationally recognized tobacco control strategy. The period covered has seen important developments in both the scientific research and politics of thr, particularly the explosion of interest in electronic cigarettes and efforts by tobacco companies to promote lowrisk alternatives to smoking. The chemical constituents in cigarettes and cigarette smoke. High retention in an opioid agonist therapy project in durban, south africa.
Examination of harm reduction products and approaches will present a number of issues such as 1 the extent to which reduction of exposure to tobacco toxins must occur before beneficial effects are observed and treatment can be considered a success, that is, how to define a successful treatment outcome. In their paper, fairchild and colleagues find that harm reduction proposals fall across a continuum between tactics that, while allowing for the sale and use of ecigarettes, place strict limits on availability and policies that give smokers easier access to. Moral conservatism within government and communities has resulted in a reluctance to support the provision of opioid agonist therapy for people with opioid use disorders in south africa. Tobacco harm reduction thr is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. This gives us a practical and clear definition by which to differentiate those ecigarette users who we can define as relapsed to smoking as.
Moreover, research suggests that smokers are far more successful at switching to electronic cigarettes than to patch, gum, or inhalers. Eclipse delivers less tar than conventional cigarettes, but more carbon monoxide, so any harm reduction is likely to be limited. Whether ecigarettes are highly effective is a question of definition, but it is not an undocumented assertion to observe that they are certainly at least as effective as medicinal nrt4, 5. Chapter 5 ecigarette policy and practice implications. Nice has also produced guidelines on stop smoking services and smoking. Widely known examples are needle and syringe exchange programs and opioid substitution therapy for intravenous drug users to reduce the risk. Tobacco harm reduction provides people with the opportunity to reduce exposure to harmful inhaled tobacco smoke by substituting less harmful ways of consuming tobacco or nicotine 6. Smoking is an issue that has been at the heart of public health concerns. Thr2010 is an anthology of important writings about tobacco harm reduction, primarily from 2009 and early 2010. The continuing toll of tobacco use has prompted the search for means of harm reduction for those who cannot or will not stop using. Within this context, this article critiques hong kongs legal regime governing ecigarettes and the proposed prohibition of the product. Smoking tobacco is widely acknowledged as a leading cause of illness and death. Tobacco harm reduction, ecigarettes, and ecigarette use. Pdf smokers of any age can reap substantial health benefits by quitting.
I have just come across an interesting presentation by one maciej l goniewicz, phd, who works at the tobacco dependence research unit of queen mary university of london and the uk centre for tobacco control studies. Tobacco harm reduction describes actions taken to lower the health risks associated with using tobacco or nicotine. Recommendations for the appropriate structure, communication. Tobacco smoking is widely acknowledged as a leading cause of illness and death, and reducing smoking is vital to public health. For tobacco harm reduction, point 2 is exactly the same as that preeminent health ethics rule. Safety evaluation and risk assessment of electronic. This section focuses on nontobacco nicotine products such as nicotine replacement therapy and electronic cigarettes. Definition of harm reduction from harm reduction international harm reduction refers to policies, programmes and. This might be accomplished by smoking fewer tobacco cigarettes tc per. For the purposes of this report, a product is harm reducing if it lowers total tobacco related mortality and morbidity even though use of that product may involve continued exposure to tobacco related toxicants.
We identified the major ethical considerations surrounding the use of e cigarettes for tobacco harm reduction, including product safety, efficacy for smoking cessation and reduction, use among non. The case in favor of ecigarettes for tobacco harm reduction. Ecigarettes and their associated flavors function as a harm reduction tool that helps people quit smoking cigarettes. Cigarette harm reduction with scheduled electronic. The concept of tobacco harm reduction is well established. Cigarette smoking declines, and harm reduction helps. Farsalinos, in analytical assessment of ecigarettes, 2017. Electronic cigarettes and harm reduction peter hajek declaration of interest i have no links with any ecigarette manufacturers my research into safety and effects of ec is funded by national institute of health research, uk centre for tobacco and alcohol studies and uk medicines regulatory agency 1. Principles of harm reduction clearing the smoke ncbi bookshelf. Identify and evaluate the evidence regarding whether e cigarettes function as harm reduction for adult smokers, specifically examining whether e cigarettes increase or decrease or do not affect the overall rate of smoking cessation. Principal scientist epidemiology environmental health effects programme, esr. I argue in this piece that this debate is far from settled, that ecigarettes do not qualify as a harmreduction product, and, if anything, they can lead to one of the major blunders in public health.
The area of harm reduction may also be a case where we may need to take seriously the idea of precaution. Harm reduction at the crossroads the case of ecigarettes. The unique contribution of ecigarettes for tobacco harm reduction in. Jun 20, 2018 indeed, it is for this population of nonhelp seekers that the harm reduction role of e cigarettes may be most clearly realised.
It is an example of the concept of harm reduction, a strategy for dealing with the abuse of other drugs. Update on the scientific status of tobacco harm reduction, 20082010. Apr 15, 2020 high retention in an opioid agonist therapy project in durban, south africa. Factors suggesting substantial risk reduction for ecigarettes compared to cigarettes ecigarettes emit a fraction of 7,000 chemicals in cigarette smoke. Harm reduction is a framework for public health policy that focuses on reducing the harmful consequences of recreational drug use without necessarily reducing or eliminating the use itself. In one survey about 6675% of participants incorrectly perceived lowyield cigarettes as harmreducing, while 7580% mistakenly believed that switching to smokeless tobacco conferred no risk reduction. Jul 26, 20 this guideline covers reducing harm from smoking. The complexity of the issuehow to think about it and what to do about itranks thr among the most perplexing developments in the history of tobacco and health. Tobacco smoke is the cause of the most deadly epidemic of modern times. Ends regulatory and tax landscape electronic nicotine delivery systems ends, such as ecigarettes, eliquid, and vaping devices, have rapidly grown in popularity since they entered the u. Knowledge of the devastating consequences of tobacco use to human health has burgeoned in the 37 years since release of the first u. An example is the eclipse brand of cigarettes, now marketed in the united states with the claim of being a safer alternative to conventional cigarettes. While ecigarettes have the potential to benefit some people and harm others, scientists still have a lot to learn about whether ecigarettes are effective for quitting smoking. In october 2008 the american association of public health physicians aaphp became the first medical organization in the u.
Not driving if you plan on drinking alcohol or using drugs. Most all of public health, and a large part of medical care, is devoted to harm reduction. The global state of tobacco harm reduction gsthr maps the global, regional and national availability and use of safer nicotine products snp, the regulatory responses to these products, and the public health potential of tobacco harm reduction. Apr 10, 2004 an example is the eclipse brand of cigarettes, now marketed in the united states with the claim of being a safer alternative to conventional cigarettes. June 20 nice public health guidance 45 guidanceukph45 nice has accredited the process used by the centre for public health excellence at nice to produce guidance.
People from routine and manual occupational backgrounds are almost twice as likely. Sep 16, 2016 this includes not only harm reduction but also reduction in demand and supplytwo elements that are explicitly rejected by many advocates of electronic cigarettes. A convincing example of a successful thr strategy is. Identify and evaluate the evidence regarding whether ecigarettes function as harm reduction for adult smokers, specifically examining whether ecigarettes increase or. Toxicologist, environmental health effects programme, esr michael bates, ph. There is now substantial support for vaping as a harm reduction approach and an alternative to tobacco smoking from uk medical and public health bodies 1, 3. The rapid rise of smokefree nicotine products, especially vaping, is the most disruptive influence on smoking in decades.
Community tobacco control leaders perceptions of harm. Seven countries that overcame a major overdose crisis 22317 the polydrug poisoning epidemic. An era of tobacco harm reduction, real or as illusory as that associated with the introduction of light cigarettes, 14 appears to be rapidly approaching. They are marketed as less harmful alternatives to smoking. Factors suggesting substantial risk reduction for ecigarettes compared to cigarettes. Harm reduction is the strategy, policy, and philosophy of reducing risk and thus the morbidity and mortality associated with an action or condition.
Switching from high alcohol content drinks to low alcohol content drinks. Food and drug administration summarizing the rationale for tobacco harm reduction brad rodu 149 12. By contrast, others are concerned that the availability of these new products will expand the number of. Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social andor physical consequences associated with various human behaviors, both legal and illegal.
Harm reduction policies are used to manage behaviors such as recreational drug use and sexual activity in numerous settings that range from services through to geographical regions. June 20 nice public health guidance 45 guidanceukph45 nice has accredited the process used by the centre for public health excellence at nice to produce. Priorities for harm reduction a report to the new zealand ministry of health march 2000 jefferson fowles, ph. Indeed, it is for this population of nonhelp seekers that the harm reduction role of ecigarettes may be most clearly realised. Because most low tar cigarettes reduce tar by dilution methods for example, holes in the filters, most are of these are also low nicotine cigarettes. Hams articles and pages about alcohol and harm reduction both on and off site. Jan 19, 2018 in their paper, fairchild and colleagues find that harm reduction proposals fall across a continuum between tactics that, while allowing for the sale and use of e cigarettes, place strict limits on availability and policies that give smokers easier access to electronic cigarettes as an alternative to smoking. Cigarettes one of the major reasons cited for the use of electronic cigarettes ec is to reduce harm from smoking. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence ass. This paper makes the case for tobacco harm reduction thr with e cigarettes as a prominent thr modality being the only feasible policy option with the potential to substantially reduce tobaccoattributable illness and death in the united states over the next twenty years, and do so without adversely effecting initiation or quit rates. For illicit drugs the central defining characteristic of harm reduction is that it. Applying harm reduction to smoking tobacco control. Even if it is best for individual addicted smokers to switch to e cigarettes, and this is far from clear at the moment, this does not mean that we should promote e cigarettes as a general harm reduction strategy at the population level. Correspondingly, ecigarettes have been proposed by some as a harmreduction strategy and as a tool for smoking cessation, but the data to date do not support ecigarettes for harm reduction or cessation siegel et al.
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