Obsolete tobacco control themes can be hazardous to public health: the need for updating views on absolute product risks and harm reduction
Obsolete tobacco control themes can be hazardous to public health: the need for updating views on absolute product risks and harm reduction
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DOI：
10.1186/s12889-016-3079-9
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发表时间：
2016-05-24
影响因子：
4.5
通讯作者：
Abrams, David B.
中科院分区：
文献类型：
--
作者：
Kozlowski, Lynn T.;Abrams, David B.
背景：主要主题指导了烟草控制工作，这些主题在过去几十年中发生了变化。当出现有关烟草健康风险的问题时，他们着重于两个关键主题：1)问题有多严重（即绝对风险）和2)在不戒烟的情况下可以采取哪些措施来减少风险（即减少危害的前景）。我们以1964年以来的美国为例，概述了在回答这两个问题时出现的主要主题。最初，人们认识到“香烟对健康有害”，并接受更安全的替代烟草产品（雪茄、烟斗、清淡/低焦油香烟）。在20世纪80年代，有一个开创性的主题被创造出来：“香烟在被故意使用时是致命的，它比海洛因、可卡因、酒精、艾滋病、火灾、凶杀、自杀和车祸致死的人数加起来还要多。”到2000年左右，对危险性较低的轻质/低焦油香烟的支持消失了，对雪茄甚至无烟烟草等产品的危害减少声明也被避免了，这些产品被总结为“不安全”或“不是香烟的安全替代品”。讨论：2014年，卫生局局长得出结论，到目前为止，对公众健康的最大威胁来自香烟和其他燃烧产品。与此同时，无烟烟草和替代尼古丁输送系统（ANDS）的证据基础也在增长。产品创新和烟草/尼古丁生物行为、流行病学和公共卫生科学表明，低亚硝胺无烟烟草（如瑞典鼻烟）和二手烟的危害比卷烟低得多。今后，必须突出烟草控制的主题和关键信息，同时继续强调从香烟或使用任何燃烧烟草制品吸入的烟雾的极端致命性。摘要：建议将更新烟草控制监管、政策制定和宣传的主要主题作为重要的下一步。新的重新规划可以使行动计划协调一致，更有力和迅速地实现人口层面的利益，并尽量减少危害，在我们有生之年消除使用最致命的可燃烟草制品，从而防止预计到2100年全世界将有10亿人过早死亡。
Background: Leading themes have guided tobacco control efforts, and these themes have changed over the decades. When questions arose about health risks of tobacco, they focused on two key themes: 1) how bad is the problem (i.e., absolute risk) and 2) what can be done to reduce the risk without cessation (i.e., prospects for harm reduction). Using the United States since 1964 as an example, we outline the leading themes that have arisen in response to these two questions. Initially, there was the recognition that "cigarettes are hazardous to health" and an acceptance of safer alternative tobacco products (cigars, pipes, light/lower-tar cigarettes). In the 1980s there was the creation of the seminal theme that "Cigarettes are lethal when used as intended and kill more people than heroin, cocaine, alcohol, AIDS, fires, homicide, suicide, and automobile crashes combined." By around 2000, support for a less-dangerous light/lower tar cigarette was gone, and harm reduction claims were avoided for products like cigars and even for smokeless tobacco which were summarized as "unsafe" or "not a safe alternative to cigarettes."Discussion: The Surgeon General in 2014 concluded that by far the greatest danger to public health was from cigarettes and other combusted products. At the same time the evidence base for smokeless tobacco and alternative nicotine delivery systems (ANDS) had grown. Product innovation and tobacco/nicotine bio-behavioral, epidemiological and public health sciences demonstrate that low nitrosamine smokeless tobacco (e.g., Swedish snus), and ANDS have substantially lower harms than cigarettes. Going forward, it is important to sharpen themes and key messages of tobacco control, while continuing to emphasize the extreme lethality of the inhaled smoke from cigarettes or from use of any combusting tobacco product.Summary: Implications of updating the leading themes for regulation, policymaking and advocacy in tobacco control are proposed as an important next step. A new reframing can align action plans to more powerfully and rapidly achieve population-level benefit and minimize harm to eliminate in our lifetime the use of the most deadly combustible tobacco products and thus prevent the premature deaths of 1 billion people projected to occur worldwide by 2100.