Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure 英文参考文献.docVIP

The PLoS Medicine Debate Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure? Coral E. Gartner, Wayne D. Hall, Simon Chapman, Becky Freeman B ackground to the debate: The tobacco control community is divided on whether or not to inform the given that it takes 40 to 50 years to evaluate their potential harms or bene?ts [3]. public that using oral, smokeless tobacco (Swedish snus) is less hazardous to health than smoking tobacco. Proponents of “harm reduction” point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the bene?ts of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden’s experience is likely to be speci?c to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a “gateway” to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control) have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction. Low nitrosamine oral snuff, or Swedish snus, is not vulnerable to the criticisms levelled at light cigarettes. Snus has been used by substantial proportions of nicotine consumers in Sweden over the past several decades, which has allowed its effects on smoking prevalence and health to be studied. Similar to other types of smokeless tobacco products, snus may increase the risk of some cancers [5,6,7], and there may be some risk of cardiovascular disease caused by nicotine. But its cardiovascular risks are certainly lower tha