Clearing the Smoke Assessing the Science Base for Tobacco Harm Reduction (2001) / Chapter Skim
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2 Principles of Harm Reduction
2 Principles of Harm Reduction
Pages 38-59
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From page 38... ...
explicitly assumes continuation of the undesired behavior as a possibility and (b) aims to lower the total adverse consequences, including those arising from continuation.
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From page 39... ...
In some instances the harm reduction considerations are only implicit, providing an ex post rationalization of decisions already made (e.g., automobile safety, MacCoun, 1998~. In others (e.g., needle exchange programs)
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From page 40... ...
from all sources; addiction itself; expenditures on regulation or enforcement, since these are costs borne by taxpayers; the increased intrusiveness of the state; and crime that might be generated by regulation or enforcement or by the behavior itself. These adverse consequences are borne by many different groups: users themselves; intimates of the user, particularly children and spouses; nonusers directly (e.g., through crime, in the case of illicit drugs, or traffic accidents in the case of alcohol)
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From page 41... ...
But tobacco harm reduction involves a large variety of potential interventions. They differ in some important dimensions, just as do automobile seat belts and needle exchange programs.
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From page 42... ...
Needle exchange programs attempt to reduce the harmfulness of the act of injecting drugs, without requiring abstinence. That is the approach embodied by products such as Eclipse, with heated tobacco or tobacco-like materials providing nicotine by a similar mechanism that allows continuation of the act of smoking but attempts to make it less harmful.
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From page 43... ...
Thus the safety effects of automobile innovations are less than expected due to both increased speeding and selective noncompliance regarding seat belts. Though there is strong and increasing social disapproval of unsafe driving, as expressed in congressional passage of legislation in 2000, urging states to reduce the maximum allowable Blood Alcohol Content (BAC)
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From page 44... ...
Harm reduction, despite its ostensible breadth, does not necessarily cover all potential adverse consequences. Automobile safety represents an instance of a successful harm reduction intervention.
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From page 45... ...
For example, a study of nine Philadelphia schools which provided reproductive health information, condoms, and general health referrals found that these schools showed no significant increases or decreases in condom use over time as compared to schools which did not install these programs (Furstenberg et al., 1997~. A study of Seattle schools which made condoms available in vending machines or in baskets at school health clinics concluded that students use a relatively large number of condoms distributed in this fashion, but this "did not lead to increases in either sexual activity or condom use" (Kirby et al.
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From page 46... ...
Since the evidence to date is that these interventions have at most a modest effect on the frequency and damage of the targeted behavior, the harm reduction framework has not been explicit. Alcohol Alcohol policy raises many harm reduction issues, reflecting the mixed social message with respect to alcohol's health consequences.
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From page 47... ...
Some harm reduction interventions in the alcohol field are indeed aimed directly at harms and seem unlikely to induce behavioral responses that would ameliorate their effects. For example, intoxication leads to numerous violent fights in pubs and bars.
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From page 48... ...
There is no credible evidence to date that drug use is increased among participants as a result of programs that provide legal access to sterile equipment. The available scientific literature provides evidence based on self-reports that needle exchange programs do not increase the frequency of injection among program participants and do not increase the number of new initiates to injection drug use" (Normand et al., 1995~.
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From page 49... ...
Some addicts use methadone when their heroin use has become particularly problematic, with the expectation of returning to heroin use when they are past this particular crisis. Methadone was a major ideological battlefront in the 1970s and 1980s (Rosenbaum, 1997; White House Conference for a Drug Free America, 1988~.
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From page 50... ...
For heroin, research on methadone and needle exchange programs provide evidence that they do reduce total harms resulting from use by currently dependent users; there is a weaker evidentiary base for concluding that initiation is unaffected. COMPARING OTHER HARM REDUCTION INTERVENTIONS TO THOSE FOR SMOKING These examples are offered for the insights they may provide as to the likely consequences of tobacco-related potential reduced-exposure products (PREPs)
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From page 51... ...
Low tar and filter cigarettes not only led more individuals to smoke but also on average led them to higher daily consumption. Early opening of bars on the Bowery may lead to higher alcohol consumption by chronic alcoholics, while needle exchange programs generally either reduce injecting frequency or leave it unchanged.
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From page 52... ...
52 to o .
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From page 53... ...
However the seat belts involve no endorsement of unsafe driving, while the modified tobacco products, if the government allows regulated claims of reduced harms, does provide endorsement of the very act of smoking tobacco. This heterogeneity complicates projections from the other harm reduction experiences to PREPs.
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From page 54... ...
However, the American public overwhelmingly supports restrictions or bans on tobacco use in indoor public places (The Gallup Organization, 2000) and restriction of youth access to tobacco products (American Heart Association, 1998~.
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From page 55... ...
An unsuccessful harm reduction intervention may lead to long-lasting and broadly distributed adverse consequences. For example, methadone maintenance might have turned out to increase heroin initiation and to prolong opiate addiction; it would be difficult to reverse those consequences or to be able to predict them in the early years of the intervention, let alone in advance of the decision.
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From page 56... ...
Finally, an undeniable history of suppression of information about the health risks of tobacco and tobacco product design changes leads many to seriously question any assessment of harm reduction potential by the manufacturers of the products. lust as harm reduction with respect to illicit drugs has been hurt by its association with the legalization movement, so too has the tobacco companies' use of false messages about the benefits of light and filter-tipped cigarettes created suspicion in the field of tobacco control.
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From page 57... ...
1989. The effect of fuel economy standards on automobile safety.
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From page 58... ...
. NHTSA (National Highway Traffic Safety Administration)
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From page 59... ...
Press Release: Research shows needle exchange programs reduce HIV infections without increasing drug use. [Online]
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