Tobacco Harm Reduction Messages Targeted to Smokers

• Video Introduction
• What is Tobacco Harm Reduction?
• Are Messages Promoting THR Necessary?
• Supportive messages for smokers
• Support for Governments to Mandate THR Messages Targeted to Smokers
  • United Nations – Universal Declaration of Human Rights
  • WHO Framework Convention on Tobacco Control
  • Ottawa Charter for Health Promotion
• Perspectives From Health Advocates
• See Also

Video Introduction

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What is Tobacco Harm Reduction?

Tobacco Harm Reduction (THR) is understood by different people to mean different things. In this document we use the definition of THR used by the World Health Organisation.

Harm Reduction in relation to tobacco is to decrease morbidity and mortality among continuing tobacco and nicotine users who are unwilling or unable to quit, with due consideration of effects at the population level.

The Scientific Basis of Tobacco Product Regulation
Part 5.1: Harm reduction and smokeless tobacco products: regulatory recommendations and research needs. Main recommendations
World Health Organisation

The means by which we achieve the goal of decreasing morbidity & mortality of combustible tobacco products such as cigarettes or roll-your own tobacco is via non‑combustible forms of tobacco or nicotine as might be found in Smokeless Tobacco (primarily Swedish snus – SLT products should not be viewed as a contiguous group given some forms from Asia are quite harmful) e‑cigarettes or ‘vaping’ and Heated Tobacco Products (such as IQOS, Glo & the hybrid e‑cig/HTP – Ploom).

 

 

Are Messages Promoting THR Necessary?

Research suggests that the general population, as well as people who smoke, hold many misperceptions as to the dangers of smoking. One common misperception is in relation to nicotine itself.

“[Does nicotine cause cancer?] No. Nicotine is a common chemical compound found in tobacco plants, and its effect is to make tobacco addictive rather than to cause cancer directly. People who are addicted are more likely to continue to expose themselves to the carcinogens in smoked … tobacco.”

Does nicotine cause cancer?
International Agency for Research on Cancer

The perception of reduced risk products containing nicotine (e.g. snus, e‑cigarettes / vaping or heated tobacco products) among the general population is also somewhat skewed:

“Public perceptions of harm from e‑cigarettes remain inaccurate with only 17% of respondents correctly stating that e‑cigarettes are a lot less harmful than smoking.”

Use of e‑cigarettes (vapourisers) among adults in Great Britain
Action on Smoking & Health

“The majority of young adults reported that nicotine was responsible for a “relatively” or “very large” part of the health risks (66%) and cancer (60%) caused by smoking. More than half of young adults (55%) believed that nicotine is a cause of cancer. Between 23% and 43% of young adults responded “don’t know” to items on nicotine. Females, blacks, Hispanics, and those with less than some college education were more likely to report true or “don’t know” vs. false to “nicotine is a cause of cancer” and had higher odds of believing that nicotine was responsible for a “relatively” or “very large” part of the health risks of smoking and cancer caused by smoking. Past 30-day tobacco users had lower odds of reporting these beliefs.”

Prevalence and correlates of nicotine and nicotine product perceptions in U.S. young adults, 2016
Villanti AC, Naud S, West JC, Pearson JL, Wackowski OA, Niaura RS, Hair E, Rath JM

“In this study, the proportion of US adults who perceived e‑cigarettes to be as harmful as or more harmful than cigarettes increased substantially from 2012 to 2017. The findings of this study underscore the urgent need to accurately communicate the risks of e‑cigarettes to the public, which should clearly differentiate the absolute from the relative harms of e‑cigarettes.”

Changing Perceptions of Harm of e‑Cigarette vs Cigarette Use Among Adults in 2 US National Surveys From 2012 to 2017
Jidong Huang, PhD; Bo Feng, PhD; Scott R. Weaver, PhD; et al

Consumers who have a positive view of the health gains of using reduced risk products are more likely to benefit from them.

“U.S. adult dual users of e‑cigarettes and cigarettes who perceive e‑cigarettes as less harmful than cigarettes appear to be more likely to switch to exclusive e‐cigarette use, more likely to remain dual users, and less likely to switch to exclusive cigarette use one year later than dual users with other perceptions of e‑cigarette harm.”

Perceived Relative Harm of Using E‑Cigarettes Predicts Future Product Switching among U.S. Adult Cigarette and E‑Cigarette Dual Users
Alexander Persoskie, Erin Keely O’Brien, Karl Poonai.

Supportive messages for smokers

Australians who smoke, as well as others who do not, are in favor of providing supportive messages to smokers.

“You can’t always shame smokers for smoking, because it is addictive…so you have to balance ‘this is really bad’ but we also need to support them as well”

18YO Female Non-smoker

 

“I think using positive messages might be effective, because then it is not being harped on again, rather strategies and options so you feel supported”

45YO Female Smoker

Do health warnings on cigarette sticks dissuade smokers and non‑smokers?
A focus group and interview study of Australian university students.
Drovandi A, Teague PA, Glass B, Malau-Aduli B

Support for Governments to Mandate THR Messages Targeted to Smokers

Australia, the first country to introduce plain packaging for cigarettes, was forced to spend almost 40 million Australian dollars defending their decision in the court of the World Trade Organisation, when challenged by the tobacco industry.

Fortunately, there is already strong international support for governments to mandate the introduction of THR Messages Targeted to Smokers on, or in, packs of smoked tobacco products.

United Nations – Universal Declaration of Human Rights

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

Universal Declaration of Human Rights
Article 25. Part 1
United Nations

Excise imposed upon tobacco products to encourage smoking cessation have reached such levels that those of low socioeconomic status who continue to smoke pay much of their meager resources on it. This is typically done at the expense of other items that support the health and well-being of the person who smokes, including bountiful, healthy foods and medical care for themselves and their dependents.

WHO Framework Convention on Tobacco Control

PART I: INTRODUCTION. Article 1 Use of terms

“(d) “tobacco control” means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke;”

WHO Framework Convention on Tobacco Control
PART I: INTRODUCTION. Article 1: Use of terms
Framework Convention on Tobacco Control

Since harm reduction is an inherent part of the tobacco control which Parties to the Convention agreed to implement, a governing body has international backing to bring THR messages to the people who smoke.

Ottawa Charter for Health Promotion

“to acknowledge people as the main health resource; to support and enable them to keep themselves, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health, living conditions and well-being;”

Ottawa Charter for Health Promotion
Commitment to Health Promotion
Pledge by Conference Participants

Enabling citizens to protect their own health using reduced risk THR products, is supported by the Ottawa Charter for Health Promotion.

Perspectives From Health Advocates

“Accurate information on differential harms needs to be communicated when snus and e‑cigarettes are legally available on the nicotine market. The extent of inaccurate health beliefs regarding these products, as demonstrated in many studies, implies that significant efforts will be required to bring the smoker’s knowledge in line with epidemiologically based evidence. Irrespective of the anticipated difficulty involved in constructing relative health-risk messages and irrespective of the fear of misinterpretations by some persons, the health authorities should work to facilitate better informed choices by tobacco consumers. Such public health information should not be left in the hands of an industry marketing products to simply promote sales.”

Karl E Lund, Ph.d
Senior Researcher
Norwegian Institute of Public Health

We’re worried that in fact a lot of the members of the public still think that using an e-cigarette is as harmful as smoking a cigarette. … It would be tragic if smokers didn’t quit and carried on smoking, because they haven’t tried an e-cigarette.

Professor John Newton
PHE Director of Health Improvement
U.K. government promotes vaping as smoking cessation tool

 

 See also

• PowerPoint presentation of the video at top of page.
  Feel free to adapt & use it as needed.
• Denial of Nicotine Health Information Is a Breach of Human Rights
• Can vapes save the world from smoking?