There was a strong consensus among public health experts that given the alternative of using LN-SLT or cigarette smoking, use of LN-SLT was a lot less dangerous compared to smoking-on the order of about 90% less risky, said K. Michael Cummings, PhD, MPH, Chair of the Department of Health Behavior in the Division of Cancer Prevention and Population Sciences at Roswell Park Cancer Institute in Buffalo, NY, one of the authors of the study, who added that this consensus was particularly strong in regard to lung cancer risk but less so for oral cancer risk.
Explore This IssueJune 2007
Dr. Cummings thinks that health professionals, although well meaning, need to be better educated about the different risks posed by the different brands of smokeless tobacco brands. I think the data are compelling that tobacco with low nitrosamine content is less risky compared to [those with] high nitrosamine content, he said. In the US, Copenhagen and Red Rooster are really dirty products that probably should be banned. Arriva and Stonewall, two low-nitrosamine products, are probably not so different from a nicotine lozenge.
Given this, Dr. Cummings believes that smokeless tobacco is a viable alternative to smoking-with a caveat. I would only recommend smokeless tobacco as an alternative to smoking after exhaustively advising a smoker to quit smoking without medications or by using an FDA-approved stop-smoking medication, he said, adding that in my 26 years of helping smokers to quit, I only know of a few smokers who quit smoking by using smokeless tobacco.
For Dr. Thun, strategies that focus on harm reduction are distracting from the current strategies that are effective but not yet fully implemented. Thus the debate about ‘harm reduction’ seems premature, he said, and a distraction from other approaches the we know are safe and effective.
Do People Really Switch?
Another major argument against recommending smokeless tobacco as a viable alternative for smoking cessation is concern that smokers will not switch completely but perhaps will augment their smoking with chewing-for instance, by chewing in public places where smoking is banned and then smoking where they can.
Smokers who use these products to postpone quitting by assuaging their nicotine craving in settings where smoking is prohibited and then lighting up whenever possible, magnify their risk of lung cancer and other smoking-related diseases by prolonging the duration of their smoking, said Dr. Thun.
Dr. Winn agreed that there is insufficient evidence to determine if advising people to switch to smokeless tobacco is at all useful in getting people to quit smoking.