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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction
DEFINITION OF HARM REDUCTION
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. Many different policy strategies may contribute to harm reduction. However, this report focuses on tobacco products that may be less harmful or on pharmaceutical preparations that may be used alone or concomitantly with decreased use of conventional tobacco. The committee does not use the term “safer cigarette,” in particular, in order to avoid leaving the impression that any product currently known is “safe.” Every known tobacco-containing product exposes the user to toxic agents; every pharmaceutical product can have adverse effects.
HISTORY OF EFFORTS TO REDUCE HARM FROM CIGARETTES
There have been many efforts in the past to develop less harmful cigarettes, none of which has proved to be successful. One of the first innovations with the promise of harm reduction was the development of cigarettes with filters. Filters attempt to reduce the amount of toxicants that go into the smoke inhaled by the smoker. The next major modification of cigarettes with safety implications was “low-yield” cigarettes. These products emit lower tar, carbon monoxide (CO), and nicotine than other products as measured by the Federal Trade Commission (FTC) assay (the “smoking machine”). Many consumers believed, and still do, that these products pose less risk to health than other cigarettes.
However, data on the health impact of low-yield products are conflicting, in part due to a lack of systematic study early in the introduction of the products. Most current assessments of morbidity and mortality suggest that low-yield products are associated with far less health benefit, if any, than would be predicted based on estimates of reduced toxic exposure using FTC yields. In order to maintain the desired intake of nicotine, many smokers who changed to low-yield products also changed the way they smoked (e.g, compensated by inhaling more deeply than when smoking higher-yield products). Thus, their exposure to tobacco toxicants is higher than would have been predicted by standardized assays and people who have continued to use these products have not significantly reduced their disease risk by switching to them. Moreover, widespread use of these products might have increased harm to the population in the aggregate if tobacco users who might otherwise have quit did not, if former tobacco users resumed use, or if some people who would otherwise not have used tobacco did so because of perceptions that the risk with low-yield products was minimal.