Policy Studies Tobacco Harm Reduction

Reducing smoking: A guide for state policy makers

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A review of public health literature related to smoking cessation suggests smoking bans and efforts to stop minors from smoking can be very effective. They help in two ways: reducing smoking where banned and de-normalizing cigarette smoking. Tobacco taxes may be reaching the limits of their effectiveness as a public health measure in many jurisdictions. When a state’s tobacco tax is much higher than neighboring jurisdictions, smuggling and cross-border purchasing become major issues. Warnings on tobacco packages raise awareness of hazards, but appear to have little or no effect on initiation of smoking by teens or on smoking cessation. Some initiatives may do more harm than good. Nicotine replacement and other pharmaceutical therapies are remarkably ineffective. They fail about 90 percent of smokers who use them as directed, when results are measured six to twelve months later.

Tobacco harm reduction, defined as encouraging smokers to switch to lower-risk, smoke-free tobacco products or e-cigarettes, is a promising option, but one opposed by public health authorities unwilling to consider use of any non-pharmaceutical tobacco product in the context of a public health initiative. Supported abrupt cessation, defined as promotion of web-based educational materials or 1-6 hours of pre-cessation education or counseling and control of contraband tobacco products, deserves far more attention than it has gotten to date.

These options are not supported by current tobacco-control programs because the definitive research to demonstrate their effectiveness on individual and population bases has not yet been done.

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