6th July 2010
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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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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


Reduction of harm from tobacco useis a top priority in public health.

But,”Tobacco Harm Reduction”is a controversial issue.


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.


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.


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?


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


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.


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


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.


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.


  • Rate of quitting daily smoking:

  • never snus: 57%

  • secondary snus use: 87%

  • secondary smoking: 76%


Will snus use weaken smokers’ efforts to quit smoking?


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


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


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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