Managing nicotine without smoke to save lives now: Evidence for harm minimization
Managing nicotine without smoke to save lives now: Evidence for harm minimization
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DOI：
10.1016/j.ypmed.2018.06.010
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发表时间：
2018-12-01
影响因子：
5.1
通讯作者：
Niaura, Raymond S.
中科院分区：
文献类型：
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作者：
Abrams, David B.;Glasser, Allison M.;Niaura, Raymond S.
烟草控制在预防和戒烟方面取得了长足的进步，但如果没有大规模的行为改变，死亡率就不会迅速下降。目前，燃烧烟草吸入的烟雾是导致全球720万人过早死亡的主要原因，美国每年有53万人过早死亡。一系列不可燃尼古丁产品（NNPs）已经出现，并扰乱了市场。更迅速地拯救生命将需要社会接受在三维框架内定位一个“甜蜜点”，在这个框架内，NNP同时：1。毒性较小，2.吸引人（可以大规模接触吸烟者），以及3。令人满意（尼古丁输送充足），以取代吸烟。对于这种消除吸烟的危害最小化框架，需要重点关注“吸烟控制”（而不是一般的烟草控制）。通过采用这些经济上可行的NNP作为解决方案的一部分，NNP可以成为吸烟控制的重要盟友。科学的综合表明，政策和法规可以充分保护青少年，同时加速戒烟。尽管尼古丁依赖的一些风险可以减轻但不能消除，但没有可信的证据反驳NNPs取代吸烟可以挽救生命的说法。但是科学证据和宣传选择性地夸大了NNP的危害而不是好处。准确的沟通对于消除对NNP危害的误解并向吸烟者保证他们可以成功地用NNP取代吸烟至关重要。现在拯救更多的生命是一种可行和务实的方式，呼吁所有利益相关者和派别在传统的烟草控制范围内保持一致，而不是使尼古丁禁令的未实现和不可实现的完美永久化。
Tobacco control has made strides in prevention and cessation, but deaths will not decline rapidly without massive behavior change. Currently, inhaled smoke from combusting tobacco is chiefly responsible for prematurely killing 7.2 million people worldwide and 530,000 in the United States annually. An array of noncombustible nicotine products (NNPs) has emerged and has disrupted the marketplace. Saving lives more speedily will require societal acceptance of locating a "sweet spot" within a three-dimensional framework where NNPs are simultaneously: 1. Less toxic, 2. Appealing (can reach smokers at scale), and 3. Satisfying (adequate nicotine delivery) to displace smoking. For this harm minimization framework to eliminate smoking, a laser focus on "smoking control" (not general tobacco control) is needed. By adopting these economically viable NNPs as part of the solution, NNPs can be smoking control's valued ally. Synthesis of the science indicates that policy and regulation can sufficiently protect youth while speeding the switch away from smoking. Despite some risks of nicotine dependence that can be mitigated but not eliminated, no credible evidence counters the assertion that NNPs will save lives if they displace smoking. But scientific evidence and advocacy has selectively exaggerated NNP harms over benefits. Accurate communication is crucial to dispel the misperception of NNPs harms and reassure smokers they can successfully replace smoking cigarettes with NNPs. Saving more lives now is an attainable and pragmatic way to call for alignment of all stakeholders and factions within traditional tobacco control rather than perpetuate the unrealized and unrealizable perfection of nicotine prohibition.