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Introduction to tobacco harm reduction as a complementary strategy to smoking cessation
  1. Jack E Henningfield
  1. Clinical Pharmacology Branch, National Institute on Drug Abuse, Addiction Research Center, PO Box 5180, Baltimore, Maryland 21224, USA
  1. Correspondence to : Dr Jack E Henningfield.

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Reducing the prevalence of tobacco use through prevention and treatment efforts is universally supported by health professionals because of the enormous potential for reducing the devastating public health effects of tobacco use. In contrast, efforts to reduce the adverse effects of tobacco in those who continue to smoke have generally been viewed as ineffective and counterproductive. Recent data and projections suggest that this latter assumption needs re-evaluation.


In the United States, the prevalence of cigarette smoking has been relatively stable at about 26-27% for nearly five years, and smoking by youth has been stable or possibly even increasing over the past decade.13 Thus, in the absence of a dramatic lowering of prevalence of tobacco use or of the consequences of its use, more than one million people will continue to die prematurely every two to three years for many years to come, and many millions more will suffer unnecessarily and be disabled by tobacco.4

The worldwide scenario is even bleaker. Annual morbidity is expected to increase from three million per year to 10 million per year over the next two decades, with half a billion of the world’s current population dying of tobacco related disease.4 Some of these deaths will be among non-smokers who cannot escape environmental smoke because of the high prevalence of smoking.

These grim projections do not detract from the considerable success of public health efforts, nor do they suggest that we should diminish efforts that have proved effective at reducing the prevalence of smoking in the United States from its all time high levels in the 1960s. However, the evidence that progress has slowed in the USA and that tobacco addiction and its associated diseases continue to increase worldwide supports the need for a re-examination of strategies to reduce the death …

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  • The views expressed in this paper are those of the author and do not reflect an official position of the US federal government or its agencies.