Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA
Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA
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DOI：
10.1136/tc.2009.031427
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发表时间：
2010-08-01
期刊：
影响因子：
5.2
通讯作者：
Glantz, Stanton A.
中科院分区：
文献类型：
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作者：
Mejia, Adrienne B.;Ling, Pamela M.;Glantz, Stanton A.
鼻烟（一种无烟烟草）的危害比香烟小。一些卫生专业人员认为，鼻烟应该作为减少危害战略的一个组成部分加以推广，而另一些人则反对这种做法。美国主要烟草公司（雷诺烟草公司和菲利普莫里斯烟草公司）将鼻烟产品作为香烟品牌系列的延伸进行营销。无烟烟草推广对人口的影响将取决于个人风险变化与烟草使用模式人口变化的综合影响。目的定量评估无烟烟草推广作为美国减少危害战略的一部分对健康的影响。方法采用烟草开始和使用决策树模型的蒙特卡罗模拟来估计五种不同的无烟烟草使用增加模式对健康的影响。结果吸烟对健康的影响为100，根据美国目前的流行率，在基本情况下，吸烟对健康的影响为24.2(5%至95%区间21.7至26.5)，积极的无烟推广（减少香烟使用，增加无烟、关注健康的吸烟者改用鼻烟，无烟环境中的吸烟者改用鼻烟）对健康的影响为30.4（5%至95%区间25.9至35.2）。对无烟吸收率较低的其他情景的预期健康影响也与基本情景重叠。推广无烟烟草作为一种更安全的香烟替代品不太可能在人群层面上带来实质性的健康益处。
Background Snus (a form of smokeless tobacco) is less dangerous than cigarettes. Some health professionals argue that snus should be promoted as a component of a harm reduction strategy, while others oppose this approach. Major US tobacco companies (RJ Reynolds and Philip Morris) are marketing snus products as cigarette brand line extensions. The population effects of smokeless tobacco promotion will depend on the combined effects of changes in individual risk with population changes in tobacco use patterns.Objective To quantitatively evaluate the health impact of smokeless tobacco promotion as part of a harm reduction strategy in the US.Methods A Monte Carlo simulation of a decision tree model of tobacco initiation and use was used to estimate the health effects associated with five different patterns of increased smokeless tobacco use.Results With cigarette smoking having a health effect of 100, the base case scenario (based on current US prevalence rates) yields a total health effect of 24.2 (5% to 95% interval 21.7 to 26.5) and the aggressive smokeless promotion (less cigarette use and increased smokeless, health-concerned smokers switching to snus, smokers in smokefree environments switching to snus) was associated with a health effect of 30.4 (5% to 95% interval 25.9 to 35.2). The anticipated health effects for additional scenarios with lower rates of smokeless uptake also overlapped with the base case.Conclusions Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level.