Abstract
BackgroundLeading themes have guided tobacco control efforts, and these themes have changed over the decades. When questions arose about health risks of tobacco, they focused on two key themes: 1) how bad is the problem (i.e., absolute risk) and 2) what can be done to reduce the risk without cessation (i.e., prospects for harm reduction). Using the United States since 1964 as an example, we outline the leading themes that have arisen in response to these two questions. Initially, there was the recognition that “cigarettes are hazardous to health” and an acceptance of safer alternative tobacco products (cigars, pipes, light/lower-tar cigarettes). In the 1980s there was the creation of the seminal theme that “Cigarettes are lethal when used as intended and kill more people than heroin, cocaine, alcohol, AIDS, fires, homicide, suicide, and automobile crashes combined.” By around 2000, support for a less-dangerous light/lower tar cigarette was gone, and harm reduction claims were avoided for products like cigars and even for smokeless tobacco which were summarized as “unsafe” or “not a safe alternative to cigarettes.”DiscussionThe Surgeon General in 2014 concluded that by far the greatest danger to public health was from cigarettes and other combusted products. At the same time the evidence base for smokeless tobacco and alternative nicotine delivery systems (ANDS) had grown. Product innovation and tobacco/nicotine bio-behavioral, epidemiological and public health sciences demonstrate that low nitrosamine smokeless tobacco (e.g., Swedish snus), and ANDS have substantially lower harms than cigarettes. Going forward, it is important to sharpen themes and key messages of tobacco control, while continuing to emphasize the extreme lethality of the inhaled smoke from cigarettes or from use of any combusting tobacco product.SummaryImplications of updating the leading themes for regulation, policymaking and advocacy in tobacco control are proposed as an important next step. A new reframing can align action plans to more powerfully and rapidly achieve population-level benefit and minimize harm to eliminate in our lifetime the use of the most deadly combustible tobacco products and thus prevent the premature deaths of 1 billion people projected to occur worldwide by 2100.
Highlights
Leading themes have guided tobacco control efforts, and these themes have changed over the decades
By the end of that century, cigarette smoking had been recognized as a major cause of premature death and disability, [3] and health authorities from around the world had mobilized to stop the public health tragedy of tobacco use [4]
When questions arose about the ill-effects of a very popular product like tobacco, they usually focused on two key themes: 1) how bad is the problem and 2) what can be done to reduce the risk without giving up such products
Summary
Understanding and managing differential risks of alternative nicotine delivery products (ANDS), noncombusted tobacco products, and combusted tobacco products Since 1964, major themes missed a core principle: The substantially greatest harm is from the toxic smoke of combusted, inhaled tobacco. Given the relative risks of different classes of tobacco/ANDS products, one should not let a broad commitment to “tobacco control” distract from the most important goal of cigarette/combustible smoking elimination Those who have come to treat all tobacco/nicotine products as repugnant would have an expected resistance to any loosening of the dominant themes and frameworks appropriate to the prior 50 years of the tobacco product and control landscape. Aligned common ground about the relative harms of the different classes of tobacco and nicotine delivery products would more powerfully drive motivated consumer behavior change in the direction of reducing the death and disease burden, overwhelmingly caused by use of lethal combustibles/cigarettes.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
