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Evidence investigating interventions to reduce the harm from continued tobacco use (e.g. smoking reduction or use of ‘less risky’ products, including snus) is limited; however there is some evidence to suggest that NRT can help people to reduce their smoking and ultimately quit in the long-term. Evidence of any health benefits of harm reduction among continuing smokers is equivocal; therefore the focus of harm reduction should currently be as a stepping stone to quitting, rather than as an end goal.

Possible ways to reduce harm for smokers who are not interested in or able to quit include reducing the number of cigarettes smoked, or switching to alternative nicotine or tobacco products. No RCTs have been found that directly tested whether harm reduction strategies reduced the harms to health caused by smoking. However, a review found a number of trials that tested nicotine replacement therapy (NRT) as an intervention to assist reduction, and found that it significantly increased the likelihood of reducing cigarettes per day by at least 50% and the likelihood of ultimately quitting smoking. Use of nicotine patches to facilitate temporary abstinence, bupropion, varenicline, electronic cigarettes, snus, and were investigated by one trial each. The evidence for all five intervention types was therefore imprecise, and it is unclear whether or not these aids increase the likelihood of smoking reduction or cessation. Two trials investigating two different types of behavioural advice and instructions on reducing cigarettes per day also provided imprecise evidence. Four studies of PREPs (cigarettes with reduced levels of tar, carbon and nicotine, and in one case delivered using an electronically-heated cigarette smoking system) showed some reduction in exposure to some toxicants, but it is unclear whether this would substantially alter the risk of harm. Epidemiological evidence from a separate systematic review suggests that the harms of snus use are less than those of smoking. The lack of evidence makes it difficult to draw conclusions about the benefits of harm reduction approaches. Currently the most persuasive evidence for a health benefit of harm reduction approaches comes from evidence suggesting that a reduction in amount smoked is associated with later cessation.

Hughes JR, Carpenter MJ. The feasibility of smoking reduction: An update. Addiction. 2005; 100: 1074-1089.

Clearing the smoke: The science base for tobacco harm reduction. Institute of Medicine, 2001. Summary and full report.

Hope or Hazard? What research tells us about ‘Potentially Reduced-Exposure’ Tobacco Products. University of Minnesota Transdisciplinary Tobacco Use Research Centre. 2005.

Hughes JR, Carpenter MJ. Does smoking reduction increase future cessation and decrease disease risk? A qualitative review. Nicotine Tob Res. 2006; 8: 739-749. logo
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