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Quitting cigarettes completely or switching to smokeless tobacco: do US data replicate the Swedish results?
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  • Published on:
    Re: Response to Ramstrom

    The authors’ response to my comments fails to disqualify my criticism. A large part of their response consists of a misinterpretation of some of my points. This appears to be due to confusion about terminology. Unfortunately, terminology practices are not as perfectly unequivocal as would be desirable. If the authors had been well enough familiar with the international scientific literature in this field, they should ha...

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    Conflict of Interest:
    None declared.
  • Published on:
    Response to Ramstrom

    If we understand him correctly, Ramstrom considered our findings on what has happened in the U.S. too obvious to be interesting. It is obvious because, for over 50 years, Sweden has had a particular smokeless tobacco product, snus, that the US did not have [1]. He apparently considered the history of U.S smokeless tobacco use (which is over 100 years) of no significance and he was confident that the U.S. smokeless tobac...

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    Conflict of Interest:
    None declared.
  • Published on:
    Potential utility of switching to smokeless tobacco

    The study by Zhu et al. "Quitting Cigarettes Completely or Switching to Smokeless Tobacco:Do U.S. Data Replicate the Swedish Results?" has raised a number interesting questions. [1] However, the conclusions of the study need further scrutiny in addition to the previously published comments.

    The main conclusion “The Swedish results are not replicated in the U.S.” is certainly true, but not very interesting since...

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    Conflict of Interest:
    None declared.
  • Published on:
    Response to Nitzkin March 24 eletter

    We appreciate Dr. Nitzkin’s desire to improve the current FDA bill. Our paper clearly stated that smokers are generally uninformed about the relative risk of various tobacco products and that is an issue that the public health community still must address (1). However, it is important not to equate providing accurate risk information with promoting the use of specific tobacco products. Nitzkin does not seem to make this...

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    Conflict of Interest:
    None declared.
  • Published on:
    Response to Zhu February 24 e-letter

    This note is in response to the latest communication from Zhu, relative to whether a harm reduction component to tobacco control programming in the United States would yield public health benefits. Zhu is very skeptical. Nitzkin and Rodu are certain such a benefit would accrue. In his latest posting, Zhu suggests that Rodu “only did half the math” -- and suggested that one can read anything one wants into the available...

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    Conflict of Interest:
    None declared.
  • Published on:
    Response to Rodu’s and Bergen & Phillips’ Comments

    Rodu is correct in stating that because the U.S. population is so large, even a small percentage of cigarette smokers switching to smokeless would mean many thousands of people [1]. However, he has done only half the math- the other half is that exclusive smokeless users also switch to cigarettes. In fact, it is easy to see from Table 2 in Zhu et al. that the number switching from smokeless to cigarettes is much greater th...

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    Conflict of Interest:
    None declared.
  • Published on:
    Evidence From Zhu et al. That American Smokers Have Switched to Smokeless Tobacco

    Zhu et al. reported that 0.3% of men who were exclusive current smokers in 2002 became smokeless tobacco users at follow-up in 2003 (1). Similarly, they reported that 1.7% of men who were former smokers of one year or less duration and 0.3% of men who were former smokers for a longer time were smokeless tobacco users in 2003.

    These percentages are quite small, prompting the first author to issue a statement in...

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    Conflict of Interest:
    None declared.
  • Published on:
    Response to Zhu et al. (1, 2)
    • Paul Bergen, Research Associate
    • Other Contributors:
      • Carl V. Phillips

    The authors of this paper (1), the responders (3), and most everyone else agree that smoking is high risk, and that the use of smokeless tobacco is fairly low risk. In any other area, the obvious conclusion would be to encourage smokers to switch to the lower risk alternative.

    However, what follows instead is a strange and yet quite common argument that because many smokers might not switch, this alternative...

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    Conflict of Interest:
    None declared.
  • Published on:
    Response to Nitskin and Rodu's Comments

    Nitzkin and Rodu raise several interesting points about harm reduction and how they would like to see the current FDA bill (HR1108/S625) be improved [1]. However, the purpose of Zhu et al.’s paper is not to advocate for or against harm reduction. It is simply to examine whether current US data replicate the Swedish results [2].

    If large numbers of US smokers could be induced to switch to smokeless tobacco, tha...

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    Conflict of Interest:
    None declared.
  • Published on:
    Promoting Snus Will Save Lives in the USA
    • Joel L Nitzkin, Chair of the AAPHP Tobacco Control Task Force
    • Other Contributors:
      • Brad Rodu, Professor, University of Louisville

    Zhu, et al., when comparing tobacco-related behaviors in the U.S. and Sweden concluded that “promoting smokeless tobacco for harm reduction in countries with ongoing tobacco control programs may not result in any positive population effect on smoking cessation.” [1]

    We believe that this conclusion is too pessimistic.

    Promotion of snus in the U.S., as a low-risk alternative for smokers unable or unwillin...

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    Conflict of Interest:
    None declared.