Background Snus (a form of smokeless tobacco) is less dangerous than cigarettes. Some health professionals argue that snus should be promoted as a component of a harm reduction strategy, while others oppose this approach. Major US tobacco companies (RJ Reynolds and Philip Morris) are marketing snus products as cigarette brand line extensions. The population effects of smokeless tobacco promotion will depend on the combined effects of changes in individual risk with population changes in tobacco use patterns.
Objective To quantitatively evaluate the health impact of smokeless tobacco promotion as part of a harm reduction strategy in the US.
Methods A Monte Carlo simulation of a decision tree model of tobacco initiation and use was used to estimate the health effects associated with five different patterns of increased smokeless tobacco use.
Results With cigarette smoking having a health effect of 100, the base case scenario (based on current US prevalence rates) yields a total health effect of 24.2 (5% to 95% interval 21.7 to 26.5) and the aggressive smokeless promotion (less cigarette use and increased smokeless, health-concerned smokers switching to snus, smokers in smokefree environments switching to snus) was associated with a health effect of 30.4 (5% to 95% interval 25.9 to 35.2). The anticipated health effects for additional scenarios with lower rates of smokeless uptake also overlapped with the base case.
Conclusions Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level.
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An earlier version of the material in this paper was presented as a plenary lecture at the 2008 Society for Research on Nicotine and Tobacco, titled ‘Innovative Approaches to Harm Reduction;’ and the same version as an abstract at the 14th World Conference on Smoking or Health.
Funding This work was supported by National Cancer Institute Grant CA-61021, the Flight Attendant Medical Research Institute (FAMRI) and the Centers for Disease Control and Prevention. SAG is American Legacy Foundation Distinguished Professor in Tobacco Control. The funding agencies played no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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