Reducing the toll of smoking-related disease and death:  The case for tobacco harm reduction   The rationale for establish...
Reduction of harm from tobacco use is a top priority in public health. But, ”Tobacco Harm Reduction” is a controversial is...
Tobacco Harm Reduction   is mainly a matter of replacing cigarettes by a less harmful  tobacco  product. ” Low-tar” cigare...
Opponents of  Tobacco Harm Reduction    generally agree that switching to Snus   can yield substantial reduction of   tob...
Some concerns: <ul><li>Is there a risk that    snus serves as a gateway to smoking   and thereby increases smoking?  </li...
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 ons...
 
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? <ul><li>Nicotine addictiveness is mainly determined by the speed ...
About a third of smokers who start snus use do subsequently quit all daily use of nicotine. This is not compatible with th...
<ul><li>Rate of quitting daily smoking: </li></ul><ul><li>never snus: 57% </li></ul><ul><li>secondary snus use: 87% </li><...
 
Will snus use weaken smokers’ efforts to quit smoking?
Efforts to quit smoking are manifested in quit attempts. <ul><li>In the FSI / ITS study all  Ever Daily Smokers  were aske...
Smokers who have started subsequent snus use appear to make more efforts to quit smoking than those who have not.
SUMMARY <ul><li>There is little or no scientific evidence to support arguments against Tobacco Harm Reduction. </li></ul><...
Upcoming SlideShare
Loading in …5
×

The rationale for establishing low-toxicity smokeless nicotine product policies: Why are the pros stronger than the cons?

712 views

Published on

Oral presentation by Lars Ramström at Euroscience Open Forum (ESOF) Turin, Italy July 2-7 2010

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
712
On SlideShare
0
From Embeds
0
Number of Embeds
284
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • The primary smokers WITH secondary snus use are the most successful quitters. They end up with a very small fraction continuing smoking (13%). The primary smokers WITHOUT secondary snus use end up with a much higher fraction continuing smoking (43%). Next question: Have all these general patterns of tobacco use been static, or has there been a development with large changes over time?
  • The primary smokers WITH secondary snus use are the most successful quitters. They end up with a very small fraction continuing smoking (13%). The primary smokers WITHOUT secondary snus use end up with a much higher fraction continuing smoking (43%). Next question: Have all these general patterns of tobacco use been static, or has there been a development with large changes over time?
  • In this diagram on primary initiation each bar represents a 10 year birth cohort of Swedish men. Over time there has been an increasing initiation of primary snus use (sectors at the top), associated with decreasing initiation of primary smoking (sectors in the middle). Total initiation of tobacco use has been decreasing across all cohorts from the next oldest one.
  • The primary smokers WITH secondary snus use are the most successful quitters. They end up with a very small fraction continuing smoking (13%). The primary smokers WITHOUT secondary snus use end up with a much higher fraction continuing smoking (43%). Next question: Have all these general patterns of tobacco use been static, or has there been a development with large changes over time?
  • The primary smokers WITH secondary snus use are the most successful quitters. They end up with a very small fraction continuing smoking (13%). The primary smokers WITHOUT secondary snus use end up with a much higher fraction continuing smoking (43%). Next question: Have all these general patterns of tobacco use been static, or has there been a development with large changes over time?
  • The primary smokers WITH secondary snus use are the most successful quitters. They end up with a very small fraction continuing smoking (13%). The primary smokers WITHOUT secondary snus use end up with a much higher fraction continuing smoking (43%). Next question: Have all these general patterns of tobacco use been static, or has there been a development with large changes over time?
  • The outcome of latest quit attempt shows similar patterns for men and women. Use of snus as cessation aid yields the highest proportion of ”quitting completely” and the lowest proportion of ”continuing daily smoking”. The Swedish experiences of reducing smoking and related diseases have raised a lot of international interest. A recent example is the October 2007 report by the Royal College of Physicians.
  • The rationale for establishing low-toxicity smokeless nicotine product policies: Why are the pros stronger than the cons?

    1. 1. 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 6th July 2010
    2. 2. Reduction of harm from tobacco use is a top priority in public health. But, ”Tobacco Harm Reduction” is a controversial issue.
    3. 3. Tobacco Harm Reduction is mainly a matter of replacing cigarettes by a less harmful tobacco product. ” Low-tar” cigarettes are no candidates for harm reduction, but some ”low-toxicity” smokeless tobacco products are. One such product, Swedish SNUS , is dominating the debate on Tobacco Harm Reduction.
    4. 4. Opponents of Tobacco Harm Reduction  generally agree that switching to Snus can yield substantial reduction of tobacco-induced diseases for those INDIVIDUALS who do thereby abstain from cigarettes, <ul><li>but, there are concerns that unintended effects can incur negative effects on PUBLIC HEALTH. </li></ul>
    5. 5. Some concerns: <ul><li>Is there a risk that  snus serves as a gateway to smoking and thereby increases smoking? </li></ul><ul><li> snus becomes an additional use rather than a replacement? </li></ul><ul><li> nicotine addiction is strengthened by snus use? </li></ul><ul><li> snus is ineffektive as cessation aid? </li></ul><ul><li> snus use will weaken smokers’ effort to quit smoking? </li></ul>
    6. 6. What can we learn by the evidence from Swedish population studies?
    7. 8. 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. 10. Continuing daily dual users are a minority (12%) of all dual initiators and constitute just 1.8% of all men.
    9. 11. Is nicotine addiction strengthened by switching to snus? <ul><li>Nicotine addictiveness is mainly determined by the speed of delivery to the brain. </li></ul><ul><li>Nicotine delivery from snus is substantially slower than from cigarettes. </li></ul><ul><li>Snus use would therefore be deemed as less addictive than cigarette smoking. </li></ul>
    10. 12. 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. 13. <ul><li>Rate of quitting daily smoking: </li></ul><ul><li>never snus: 57% </li></ul><ul><li>secondary snus use: 87% </li></ul><ul><li>secondary smoking: 76% </li></ul>
    12. 15. Will snus use weaken smokers’ efforts to quit smoking?
    13. 16. Efforts to quit smoking are manifested in quit attempts. <ul><li>In the FSI / ITS study all Ever Daily Smokers were asked: “Have you ever made a serious attempt to quit smoking?” </li></ul><ul><li>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. </li></ul><ul><li>OR for men 2.22, 95% CI 1.75 to 2.81 </li></ul><ul><li>OR for women 2.98, 95% CI 1.74 to 5.12 </li></ul>
    14. 17. Smokers who have started subsequent snus use appear to make more efforts to quit smoking than those who have not.
    15. 18. SUMMARY <ul><li>There is little or no scientific evidence to support arguments against Tobacco Harm Reduction. </li></ul><ul><li>There is a good deal of scientific evidence to reject arguments against Tobacco Harm Reduction. </li></ul><ul><li>There is a good deal of scientific evidence to support arguments for Tobacco Harm Reduction. </li></ul>

    ×