Tobacco Harm Reduction Products Work, Study Shows

Published September 1, 2007

The June 16 issue of the internationally acclaimed medical journal The Lancet reports a study related to the use of Swedish snus, a kind of smokeless tobacco that’s being promoted as a measure for harm reduction in smokers.

The study suggests current smokers who switched to Swedish snus–prepared from air-dried tobacco, which is a type of snuff–rather than continuing to smoke, had substantial health gains, such as lower risk of cancers and cardiovascular disease, said lead author Coral E. Gartner of the University of Queensland in Australia.

Tobacco harm reduction is a general term describing the scientific, policy, legal, and communications issues associated with continued use of tobacco but in forms that may reduce the risks of contracting tobacco-related disease.

Jonathan Foulds, director of the Tobacco Dependence Program, a harm-reduction research group based in New Jersey, agrees with the study’s findings.

“I do not believe that attempts to produce and market cigarettes containing slightly lower levels of some toxins is likely to improve public health,” Foulds said. “However I do believe that increased marketing of low-toxin smokeless tobacco products–without toxic additives like areca nut–has the potential to improve public health by taking market share from cigarettes.”

Modifying Products

The harmful effects of smoking are well documented, but some experts believe that for people who are unable to quit smoking, harm reduction may be a valid option. Several products, called potential reduced exposure products (PREPs) contain tobacco, and many advocates of their use claim PREPs have less harmful effects due to the reduced presence of toxins and carcinogens.

PREPs are produced by modifying tobacco products through adding chemicals or certain fermentation processes, genetically engineering the tobacco plant, or using oral, non-combustible tobacco products.

“Swedish snus is such a product that is not just a ‘potentially’ reduced exposure product, but is a reduced exposure product, compared to traditional cigarettes, by virtue of the fact that it has been shown to contain and deliver low levels of toxins,” Foulds explained, “and most importantly, the simple fact that it does not deliver smoke to the lungs.”

In the Lancet study, Gartner and colleagues found “snus could produce a net benefit to health at the population level if it is adopted in sufficient numbers by inveterate smokers. Relaxing current restrictions on the sale of snus is more likely to produce a net benefit than harm, with the size of the benefit dependent on how many inveterate smokers switch to snus.”

Debating Results

Public health researchers debated whether the public should be informed that using oral smokeless tobacco such as Swedish snus is less hazardous to health than smoking tobacco. A debate on the subject was published in the July 3 issue of the journal PLoS Medicine.

Two researchers from the University of Sydney in Australia, Simon Chapman and Becky Freedman, argued that if tobacco companies are allowed to market snus, they will use the opportunity to promote other forms of tobacco as well.

“Snus enthusiasts in the public health community focus on snus’ potential to take people away from smoking,” Chapman and Freedman wrote. “However, transnational tobacco companies are already marketing snus using slogans that mention smoking, such as: ‘When you can’t smoke, snus.'”

Gartner and her colleague Wayne Hall took part in the debate, and in a news release they said, “On the Swedish experience, there is a strong prima facie case on public health and ethical grounds for recommending snus to inveterate smokers who want to reduce their health risks and for considering public policies, such as lower taxes for snus and public information campaigns, to promote its use by smokers.”

Dr. Sanjit Bagchi ([email protected]) writes from India.

For more information …

“Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study,” by Carol E. Gartner et al., published in The Lancet on June 16, 2007, is available through PolicyBot™, The Heartland Institute’s free online research database. Point your Web browser to and search for document #21715.