Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives

Summary of Study

Bottom Line: Harm minimization is a pragmatic approach that can complement proven current tobacco control efforts of prevention and cessation. Its primary goal is to move the whole population of smokers of toxic combusted tobacco products to exclusive use of much safer products like e-cigarettes as quickly and as early as possible in their individual smoking careers.

Inhaled tobacco smoke remains the single biggest threat to public health. A reframing of societal nicotine use through the lens of harm minimization is an extraordinary opportunity to enhance the impact of tobacco control efforts. There is a continuum of harm of nicotine-containing products, from the high harm of combusted tobacco to much lower harms of noncombustible nicotine delivery with or without tobacco. 

E-cigarettes have the potential to disrupt the 120-year dominance of the cigarette and challenge the field on how the tobacco pandemic could be reversed if nicotine is decoupled from lethal inhaled smoke. They may provide a means to compete with, and even replace, combusted cigarette use, saving more lives more rapidly than previously possible because of their characteristics most likely to displace smoking: (a) lower harm, (b) sufficient appeal, and (c) sufficiently satisfying nicotine delivery.

The public must be accurately educated about the relative harms of nicotine-containing products relative to smoking. Policies and regulations must be aligned on the basis of proportionate harm.

Population simulation modeling estimates millions of life years saved by employing the principles of harm minimization and switching smokers to e-cigarette use over a 10-year period yields up to 6.6 million fewer premature deaths with 86.7 million fewer life years lost. 

America and the world need a candid smoking control champion—a figure like C. Everett Koop, Surgeon General during the first eight years of the AIDS epidemic—to get out the latest accurate information about e-cigarettes that could save millions of smokers’ lives. Ethics and integrity in responsibly interpreting the scientific evidence with rigor and with common sense, demand it.

Even if the risk of harm to some youth who otherwise would not have smoked is marginally increased, such risks must be weighed against the substantial and immediate benefits of displacing smoking with safer nicotine products among both youth and adults. 

Read the full report here.

Feature Charticle

Nicotine Products Along the Harm Minimization ContinuumAnnual Review of Public Health

Findings:

  • There is a continuum of harm of nicotine-containing products, from the high harm of combusted tobacco to much lower harms of noncombustible nicotine delivery with or without tobacco. 
  • A reframing of societal nicotine use through the lens of harm minimization is an extraordinary opportunity to enhance the impact of tobacco control efforts.
  • E-cigarettes have the potential to disrupt the 120-year dominance of the cigarette and challenge the field on how the tobacco pandemic could be reversed if nicotine is decoupled from lethal inhaled smoke.