STAGE 5. Defining the action plan

What steps should be completed?

Step 1: Specify intervention actions

SMOKING-RELATED HARM REDUCTION PROGRAMMES

An exhaustive review by the US Institute of Medicine¹ highlights the absence of conclusive evidence on most strategies for reducing tobacco-induced harm. Many of the harmful effects of tobacco on health appear after many years, so it is very difficult to prove conclusively that a particular strategy has long-term damage-reduction effects.

A Cochrane review² concluded that there is insufficient evidence on long-term benefit to strongly support the use of interventions designed to help smokers reduce tobacco use.

Regarding the effectiveness of the different strategies to reduce smoking-related harm that were tested, the following factors can be noted:

• There is no evidence for the effectiveness of switching to a potentially less damaging tobacco product. 
• There is relatively convincing evidence that smokeless tobacco is less damaging than smoked tobacco.^3,4
• Although there is evidence that a significant percentage of smokers can reduce daily tobacco use in the medium term, reductions in the risks of some diseases, and the associated mortality, are very small or non-existent when smokers reduce their cigarette consumption. In fact, two studies on tobacco reduction carried out in Scandinavia^5,6 concluded that even reducing cigarette consumption by at least 50% for many years did not reduce the occurrence of tobacco-related diseases.
• The evidence does not support long-term use of nicotine replacement therapy to maintain tobacco abstinence.

 

References:

1 Stratton K, Shetty P, Wallace R, Bondurant S (eds.). (2001). Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction. Institute of Medicine, Committee to Assess the Science Base for Tobacco Harm Reduction. Washington, D.C.: National Academy Press.

2 Stead LF & Lancaster T. (2008). Intervenciones para reducir los daños causados por el consumo continuo de tabaco (Revisión Cochrane traducida). In: La Biblioteca Cochrane Plus, 2008 Número 4. Oxford: Update Software Ltd. (Translated by The Cochrane Library). Issue 3. Chichester, UK: John Wiley & Sons, Ltd.

3 Foulds J, Ramstrom L, Burke M, Fagerström K. (2003). The effect of smokeless tobacco (snus) on public health in Sweden. Tobacco Control. 12: 3349-59.

4 Rodu B & Godshall WT. (2006). Tobacco harm reduction: an alternative cessation strategy for inveterate smokers. Harm Reduction Jorunal. 3: 37.

5 Godtfredsen NS et al. (2002). Smoking reduction, smoking cessation, and mortality: a 16-year followup of 19,732 men and women from The Copenhagen Centre for Prospective Population Studies. Amercan Journal of Epidemiology. 156(11): 994-1001.

6 Tverdal A & Bjartveit K. (2006). Health consequences of reduced daily cigarette consumption. Tobacco Control. 15(6): 472-80.