Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
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With the tobacco industry developing and test marketing a wide array of modified cigarettes and novel nicotine-delivery products, the era of tobacco harm reduction is upon us. Like today's new technologies, two previous generations of cigarette innovation-filtered cigarettes in the 1950s and low tar and nicotine cigarettes in the late 1960s and early 1970s were introduced to offer smokers an ostensibly less hazardous means of smoking, and therefore an alternative to quitting. ⋯ Will a new generation of harm reduction products improve the public's health, or will the experience of the past half-century be repeated? This paper examines the concept of tobacco harm reduction and describes the variety of methods employed in pursuit of it. Through an examination of the experience with filters and low tar and nicotine cigarettes, and an explicit consideration of today's issues and challenges, the paper focuses attention on the essential dimensions of the contemporary harm reduction debate: how science can establish whether novel products or methods will reduce risks to health for individual smokers, or at least exposures likely to influence risks; how a determination can be made as to the likely population impacts of the introduction and marketing of novel products; how health professionals and consumers can learn the potential and limits of harm reduction; and what role for governmental regulation is possible and desirable.
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The 2001 Institute of Medicine report Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction has helped to focus attention on the scientific basis for assessing tobacco harm reduction products. As the tobacco research and policy communities tackle the challenges of evaluating harm reduction, there are ethical issues that must also be addressed. ⋯ First we outline three overarching topics in tobacco harm reduction that would particularly lend themselves to study: (a) Is the pursuit of tobacco harm reduction an ethical goal? (b) What are the ethical considerations of tobacco harm reduction vis-à-vis pharmaceutical companies? and (c) What are the ethical considerations for harm reduction vis-à-vis tobacco companies? We then present one possible framework for analyzing the ethical issues that accompany particular tobacco harm reduction strategies. By considering the ethical dilemmas attendant to tobacco harm reduction in a prospective and thoughtful manner, we will be better prepared to handle the challenges that face us individually as researchers and collectively as a tobacco control community.
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A 1996 American Psychiatric Association (APA) guideline recommends the routine treatment of smoking for patients with psychiatric diagnoses. This study evaluates how often US physicians identified and treated smoking among these patients in the ambulatory setting just prior to publication of this guideline, by analysis of 1991-1996 data from the National Ambulatory Medical Care Survey, an annual survey of a random sample of US office-based physicians. Physicians were more likely to identify the smoking status of patients with psychiatric diagnoses compared to patients without these diagnoses (76% vs. 64% of visits, p<0.0001). ⋯ All physicians were more likely to counsel smokers with the diagnosis of anxiety but less likely to counsel smokers with the diagnosis of an affective disorder compared to smokers without these diagnoses. Physicians usually identified the smoking status of patients with psychiatric diagnoses but infrequently acted on this information by counseling smokers to quit. Physicians are missing an important opportunity to prevent tobacco-related morbidity and mortality among this group of patients.
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The aim of the study was to determine if smoking reduction using a nicotine inhaler in heavy cigarette smokers who wanted to reduce but not stop smoking results in decreased levels of known biomarkers of harm. The study design was a one-sample within-subject comparative open-label study of 23 (10 male and 13 female) subjects using a nicotine inhaler to reduce smoking, with follow-up at 24 weeks. A structured protocol was used with a smoking-reduction schedule from 40 or more cigarettes per day to 10 cigarettes per day by week 9. ⋯ Before widely promoting harm reduction as a treatment strategy for heavy smokers, more research needs to be performed to prove conclusively that such smokers who want to reduce but not stop can actually reduce and maintain their smoking rate at a level which is likely to reduce harm. It also needs to be determined whether a reduction in the smoking rate translates into reduction of harm. At the present, for heavy smokers, an abstinence approach seems to be more scientifically sound.
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Home smoking restrictions have primarily been promoted as a means of protecting non-smokers from secondhand tobacco smoke. However, research suggests that smokers who live in smoke-free homes may modify their smoking behavior. Population-based survey data from California (n = 8904) were used to confirm this association and to examine demographic and social characteristics of smokers who reported home smoking restrictions. ⋯ While Hispanics and Asians were more likely to report smoke-free homes than Non-Hispanic whites, African Americans were less likely to report them. After adjusting for demographics, smokers were nearly 6 times more likely to report smoke-free homes if they lived with a non-smoking adult and child compared to when there was no child or adult non-smoker in the household, and over 5 times more likely to report a smoke-free home if they believed in the harmfulness of secondhand smoke. Tobacco Control efforts to promote smoke-free homes may give family members leverage to encourage smokers to quit, and to modify smokers' behavior in ways that would help them quit and stay quit.