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The US tobacco control community’s view of the future of tobacco harm reduction
  1. K E Warner,
  2. E G Martin
  1. Department of Health Management & Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to:
 Kenneth E Warner
 Department of Health Management & Policy, School of Public Health, University of Michigan, 109 South Observatory Road, Ann Arbor, Michigan 48109-2029, USA;


Objective: Tobacco harm reduction (THR) has garnered recent attention due to the introduction of novel nicotine delivery products ostensibly intended to reduce risk for inveterate cigarette smokers. This study evaluates the grassroots tobacco control community’s knowledge, opinions, and beliefs about THR.

Design: A web/mail survey conducted in October and November 2002, with a telephone survey of a sample of non-respondents.

Subjects: The 2833 US based registrants for the 2001 National Conference on Tobacco or Health.

Main outcome measures: Respondents’ awareness of THR, perception of its importance, support for regulation, and perception of which THR products should be recommended to inveterate cigarette smokers.

Results: 70% of respondents were aware of THR but respondents had low recognition of specific products at the forefront of the debate, such as Swedish snuff. Half believe THR will reduce smoking cessation and cause nicotine experimentation by children; 63% anticipate unintended adverse side effects. More expect THR to have a negative than a positive impact on health. Large majorities support government regulation of THR and conventional tobacco products, but fewer than 30% expect legislation regulating either. Most would recommend nicotine patches (76%) and gum (70%) to inveterate smokers, but no other product was supported by a majority. Scientists are more supportive of THR than activists, while respondents focusing on national/international issues are more supportive than those concentrating on local/state issues.

Conclusions: Many members of the US tobacco control community are unaware of the THR “movement”, while others possess only rudimentary familiarity with it. If and as THR achieves an increasingly prominent role on the tobacco-or-health scene, this community will have to become educated about THR, and be prepared to advocate for regulatory policies that will maximise the potential for positive outcomes. The potential for negative outcomes remains significant.

  • tobacco
  • harm reduction
  • survey

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