Barriers to Tobacco Harm Reduction as a Viable Public Health Strategy: Stakeholder Voices
Tobacco harm reduction has proven to be effective in helping adult smokers, who are unable or unwilling to quit smoking, transition to less harmful tobacco and nicotine alternatives.
Tobacco harm reduction operates in an integrated framework that incorporates regulatory, law enforcement, public health and health system policies, and industry in equal measure.
Innovative, reduced-risk nicotine and tobacco products should be made available as viable smoking harm reduction and cessation tools.
The perils of smoking combustible cigarettes are well documented. Although smoking rates in the United States have dropped from 40 percent at the time of the U.S. Surgeon General’s Report in 1964 to 12.5 percent in 2020, the practice is now more concentrated in communities suffering from the greatest economic, health, education and social disparities.
The United States has embraced harm reduction as a public health strategy over the years, ranging from mandating helmets and seat belts to lifting the ban on the use of federal dollars to fund syringe exchange programs, all of which have improved health outcomes at the population level. Harm reduction is a pragmatic public health approach that aims to mitigate the health risks associated with a range of behaviors—rather than expecting individuals to cease engaging in the harmful behavior regardless of their capability or willingness to do so. Despite the acceptance of harm reduction for activities with lower death and disease rates than cigarette smoking, tobacco harm reduction (THR) continues to remain a controversial topic.
To reduce smoking-related disparities, this policy study explores barriers related to the inclusion of tobacco in traditional health care and harm reduction settings by highlighting perspectives from a diverse array of stakeholders. We interviewed 17 experts from harm reduction coalitions, policy, academia, social work, nursing, law enforcement, mental health care and health care, from both rural and urban areas. These conversations resulted in recommendations that could accelerate harm reduction efforts for adult smokers who are unable or unwilling to quit. Two key messages were echoed by interviewees. First, THR should be viewed as an integrated framework that incorporates regulatory, law enforcement, public health and health system policies in equal measure. Second, innovative, reduced-risk nicotine and tobacco products should be made available as viable smoking harm reduction tools.