Tobacco harm reduction: Past history, current controversies and a proposed approach for the future

Tobacco harm reduction remains a controversial topic in tobacco control. Tobacco harm reduction involves providing tobacco users who are unwilling or unable to quit using nicotine products with less harmful nicotine-containing products for continued use. The skepticism towards harm reduction is based in part on the experience with low-yield tar/nicotine cigarettes, which were presumed to be associated with lower health risks than higher-yield cigarettes and marketed as such by cigarette manufacturers.

Tobacco harm reduction matters

A recent Lancet Editorial1 about the slow pace of tobacco control around the world singled out the UK as a leader in reducing the number of smokers. It has accomplished this feat, the Editorial stated, through measures such as increased tobacco taxes, comprehensive smoke-free laws in public spaces, and health warnings on product packages.

Yet, there was no mention of alternative nicotine delivery devices, such as e-cigarettes and heated tobacco products, even though strong evidence shows that smokers who used e-cigarettes in combination with in-person counselling were twice as likely to quit as those who used other nicotine replacement products.