Harm reduction for smoking: Smokeless tobacco enters the debate
Does smokeless tobacco use have the potential to reduce the harm from smoking and improve public health overall? Since congressional approval for the FDA to regulate tobacco products in June, this question has come to the forefront of public health policy and now two papers are published on the topic, an in-depth epidemiologic review in Regulatory Toxicology and Pharmacology (authored by me) and a paper that outlines the debate in BMC Medicine by David Timberlake. The reduction in health risks from smoking needs to be balanced against any potential adoption by non-smokers who may develop a tobacco habit if smokeless tobacco use were to be promoted as a safer alternative to smoking tobacco. While the health effects of smokeless tobacco appear greatly reduced compared to those associated with cigarette smoking, there is little research examining if smokers would actually use smokeless tobacco as a substitute for cigarettes or tool to quit smoking. Well-designed clinical trials need to be conducted to determine if smokeless tobacco use would be effective tool in getting smokers to quit smoking and would be socially acceptable to the majority of smokers.
Swedish snus
Also, this research has primarily focused on moist snuff use (like Swedish snus) which is tobacco in a tea-bag like pouch which is placed in the oral cavity. The health risks of other forms of smokeless tobacco, in particular, locally made products in Asian and African countries, may be greatly different. Some of these products have additives which are known carcinogens. More research is needed and likely more questions will develop before we will know if promoting smokeless tobacco use for smoking cessation would help improve public health overall but it is an important area to investigate with FDA regulation of tobacco on the horizon.
