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Carmarthenshire. NHS TRUST. YMDDIRIEDOLAETH GIG. Sir Gaerfyrddin. Do harm reduction techniques make an impact on smokers health?. Keir Lewis First National Conference Manchester 29 th September 2007. Bryan Curtis aged 34 St Petersburg Times 1999. www.whyquit.com.
First National Conference
Manchester 29th September 2007
St Petersburg Times 1999
Prev Med 2004; 38 (3): 309-17
Am J Prev Med 2002; 23 (3): 143-9
Smokers who switch to SNUS virtually same benefit as complete quitters
To cause harm:
17-21 non-smokers start SNUS to offset 1 smoker switching to SNUS
Theoretical modelling on Australian data as old as 1998
Expert panels decided risk of cancer etc
Assumed each switch was final
No pregnant users etc
“At best a mere five percent of all adult men in Sweden have quit smoking with the use of SNUS”
First holder of the endowed chair in Tobacco Harm Reduction Research.
U.S. Smokeless Tobacco Co.
and Swedish Match AB,
who committed nearly ($3.4 m)
1. Ann J Med 1992; 93(1A):225-245 2. Glassman 2001 3. Andersen 2000
Considerable variation in absorption (7-79%!)
-amount of nicotine,
-pH of product,
-size of tobacco cutting
Also variation in carcinogens
‘Low NNK snus’ sounds like
‘Low tar cigarette’?
Length of follow-up?
1. ‘Non-current’ rather than ‘never’ users
2. Combined end-point not deaths
3. Still significant increase in IHD/MI/CVA!
European Commission and Scientific Committee on Emerging and Newly Identified
Health Risks (SCENIHR), is now inviting stakeholders to comment on the scientific
opinion on "Health Effects of Smokeless Tobacco Products" which has just been
The consultation will run until 28 September 2007.
Risk estimate ‘difficult’
Oral cancer risk – everywhere except Sweden?
"Is it just the smoke, stupid?” Keir Lewis, BASSP
Br J Ophthalmol. 2006;90(11):1374-7 BMJ 2004;328(7455):1538
Am J Obst Gynecol. 2003;189(4):939-43 Epidemiology 2006;17(1):47-51
- 3 trials of patches(OR 1.16) - 2 trials gum(OR 0.98)- 1 trial Bupropion(OR 1.0)
Cochrane Database Syst Rev. 2004;(3):CD004306
“When you can’t smoke –SNUS”
"I see it as a young adult marketing strategy.” -Cathryn Cushing, Oregon's Tobacco Prevention and Education Program, The Oregonian (1/7/07)
“The web site for Camel Snus seems aimed at young adult males to get them to start using products."
-Mitch Zeller, director Office of Tobacco Programs at the FDA during the1990s
Dr. Gunilla Bolinder, Director of Education at Stockholm's Karolinska University Hospital
You ‘snoose’ you lose