Tobacco Harm and Smokeless Tobacco - Case Study Example

Advocacy Activity Name Professor Course Date Introduction The use of tobacco products and especially the cigarette poses many health concerns. The cigarette is harmful because most of the toxins that are harmful are produced when the cigarette is burned. Alternative tobacco options available include potentially reduced exposure products, nicotine replacement therapy and smokeless tobacco products. This policy paper advocates for the adoption of smokeless tobacco products to reduce tobacco-related harm. Nature and impact of tobacco related harm Cigarette smoking is the most preventable cause of diseases in Australia. Smoking is associated with a number of diseases including heart diseases and cancer. For a long time, a range of strategies has been used to encourage smokers to stop and discourage new users from taking up the behavior. Despite these strategies and the near universal awareness of the adverse health effects associated with smoking, a lot of people continue to smoke cigarettes. The use of tobacco related products, and especially cigarettes, exposes the user and others to a number of chemicals, many of which pose adverse health effects. The primary chemicals, which cause these effects, are hydrocarbons, carbon monoxide, polycyclic aromatic and other chemicals found in small quantities. Most of these chemicals are produced during combustion when the tobacco is heated to high temperatures. Smoked tobacco is, therefore, the most harmful tobacco product. Risks involved with smoked tobacco include various forms of cancer, cardiovascular and oral diseases, and adverse reproductive outcomes (Bondurant et al. 2011). The health benefits associated with smoking cessation are considerable and cover a wide spectrum including increased life expectancy for the individual and benefits to the society. However, the efforts to reduce the harm associated with the use of tobacco by preventing initiation and encouraging cessation have shown little success. The unchanged rate of tobacco use and the ever-increasing initial cigarette smokers, especially among the young generation, implies that tobacco harm will continue to be a challenge to the health care sector. The continued use of tobacco necessitates policies aimed at reducing harm for those who cannot stop using tobacco (Lawson 2012). Effects of tobacco harm Cigarette smoking affects several individuals and is not restricted to the primary users only. Cigarettes affect the individual smoking it in a number of ways. The most notable effect of smoking on the individual is health related issues. Tobacco smoking is the cause of numerous health- related complications that include several types of cancer and other health issues. Apart from these health issues it is also noteworthy that the nicotine contained in tobacco is addictive. This addition makes it difficult for active smokers to quit the habit. These health-related issues associated with smoking are not restricted to the primary user but extends to the public health sector. The public health sector is affected as the management and treatment of tobacco related complications costs a lot of money and unnecessarily eats into the public health budgets. These complications continue to take up a substantial portion of the health care budget (Warner 2012). Additionally, tobacco smoking also affects non-smokers by exposing them to secondary smoking. Secondary smoking, like primary smoking, poses serious health risks to those exposed to it. These risks are similar to the risks posed by primary smoking. Tobacco-related harm, therefore, affect a wide spectrum of individuals in the community and reduction of this harm is important (Bondurant et al. 2011). Context of tobacco harm Tobacco-related harm continues to be a major health concern despite attempts to reduce this harm. There have been several attempts to reduce this harm in the past. Initial attempts saw the introduction of filters. Cigarette filters reduce the amount of toxins inhaled by the smoker. Although the filters reduce the harm associated with tobacco, the reduction is very small. Efforts to reduce harm subsequently lead to the production of low yield cigarettes. Low yield cigarettes, unlike the conventional cigarettes, emit less carbon monoxide, less tar and nicotine. Although these cigarettes reduce, harm related to tobacco, this reduction is also very marginal. This is because users have to use more and inhale harder to derive the desired levels of nicotine. Moreover, low yield cigarettes still cause second-hand smoking (Foulds and Branstetter 2012). Heavy taxation of cigarettes is an effective measure in discouraging the use of cigarettes. However, this strategy results in financial constraints for poor smokers who are addicted to nicotine. Without other measures to help nicotine addicts, heavy taxation cannot be entirely effective. Heavy taxation also affects the economy since tobacco is a legal drug. It is notable that efforts to reduce tobacco related harm take four broad approaches. These approaches are efforts to prevent the use of tobacco from occurring, measures aimed at stopping the use of tobacco, strategies to prevent the use of tobacco from affecting third parties and measures to reduce harm to the smoker. The goal of any public health policy on tobacco harm is to achieve the greatest possible reduction in disease, injury, and deaths associated with the use of tobacco (Warner 2002). Tobacco harms reduction. Traditional tobacco control methods focus on reducing the incidence of initial smokers and encouraging active smokers to quit. The limited success of these methods, especially in encouraging active smokers to quit is due to nicotine addition. However, there is established intervention methods that significantly reduce the harm associated with tobacco. These methods involve prevention, treatment, and cessation and harm reduction (Bondurant et al 2011). Tobacco harm reduction is centered on the idea that the substance itself is not an issue. Most of the toxins associated with tobacco are produced during the combustion of tobacco during smoking. The nicotine that is obtained from cigarettes poses posses very little harm but combustion of tobacco produces a lot of harm. Therefore, changing the method of delivery would significantly reduce the harm associated with tobacco. Accordingly, this approach does not require compete discontinuation of tobacco but a switch to a less harmful tobacco product. A switch to a different mode of delivery would be more appealing to tobacco users than cessation. Examples of harm reduction strategies include potentially reduced exposure products (PREPs), nicotine replacement therapy (NRT), replacement products for temporary abstinence and smokeless tobacco products (Gartner et al. 2007). This policy paper advocates for the adoption of a tobacco harm reduction policy to address the harm associated with tobacco in Australia. Tobacco harm reduction is preferred because it provides the potential to significantly reduce the harm associated with tobacco. Harm reduction methods can also be used to aid cessation. Moreover, tobacco harm reduction would not only reduce harm to the individual but also eliminate secondary smoking and reduce health care costs (Lawson 2012). Policy objectives The objective of this policy paper is to reduce tobacco related harm by informing tobacco smokers who are not willing or are unable to quit that switching to smokeless tobacco products significantly reduce the harm associated with tobacco. Nicotine is addictive and switching to smokeless tobacco reduces the harm associated with tobacco while providing an aid during cessation. Smokeless tobacco products The solution adopted by this policy paper is the use of smokeless tobacco products. There are various smokeless tobacco products, which include oral snuff, chewing snuff, nasal snuff, compressed tobacco lozenges, and dissolve strips. Smokeless tobacco products that are relevant for harm reduction are those, which contain low levels of toxins. These products range from the Swedish snus, which is a moist tobacco product to the e-cigarettes that produce nicotine-containing vapor. These products eliminate the toxins that are produced when tobacco is burned (Warner 2002). Nicotine replacement therapy (NRT) NRT is by far the most acknowledged intervention for tobacco use. NRT involves the use of products such as lozenges, inhalers, and gum. NRT products reduce tobacco craving and can assist in tobacco cessation. NRT products can also be used in the end as alternatives for tobacco. NRT products present the lowest risk compared to other products and are the best tobacco harm reducing products. However, smokers do not readily accept the use of NRT products as this approach is presented as medical intervention to assist tobacco cessation. NRT products also provide a lesser nicotine delivery profile compared to cigarettes and may not give its users the buzz associated with cigarettes. This means that NRT products cannot be used as alternatives. Furthermore, current legislation in Australia does not permit the use of nicotine for recreation unless the nicotine is contained in tobacco (Foulds & Branstetter 2012). E-cigarettes E-cigarettes are the most prominent products used in tobacco harm reduction. E cigarettes are either metal or plastic tubes that contain a nicotine fluid. This fluid is heated by batteries in the tube and gives off a vapor that is inhaled. This process eliminates the production of toxins produced during tobacco combustion in cigarettes. E-cigarettes emulate the conventional cigarettes in almost every aspect. They look and are handled like cigarettes. The only shortcoming of e-cigarettes is its cost, which might not be affordable to all cigarette smokers (Lawson 2012). Swedish snus Sweden poses the lowest mortality rates associated with tobacco mainly because of the widespread use of smokeless tobacco products. The widespread use of the snuff, also called the snus, is a model for successful tobacco harm reduction. It is noteworthy that although Sweden has similar prevalence rate of tobacco users as other countries, the prevalence rate for cigarette smokers is very low. This occurrence is attributed with the use of snus, which can also be used to aid cessation (Gartner et al. 2007). From the Swedish experience, it is clear that the use of the snus leads to reduced tobacco associated mortality rates. This reduction would lead to significant short and long-term savings in the health care sector. The use of is practical and there is evidence to support its success. The use of these products is also realistic about the condition of many tobacco users. This approach takes into consideration the fact that nicotine is highly addictive and complete cessation may only work for a small subset of the population. Additionally, unlike nicotine replacement therapy, snus provides a delivery profile that is almost similar to that of cigarettes. This implies that the Swedish snus can easily be used as a substitute for cigarettes (Gartner et al. 2007). Frame for acceptability Although not all smokeless tobacco products reduce the harm associated with tobacco, this policy paper advocates for those products that are harm reduction. An example of a product that substantially reduces this harm is the Swedish snus. The snus, unlike other products, is pasteurized rather than fermented. The snus is also stored under refrigeration, which minimizes the formation of bacteria. This process reduces the formation of carcinogens. The reduced levels of carcinogens and the absence of combustion significantly reduce the harm associated with tobacco. Additionally, these products do not cause second hand smoking and eliminates the risk of accidental fires (Warner 2002). The Swedish experience and the presence of epidemiological evidence show that smokeless tobacco is important in reducing the harm associated with tobacco. However, the public due to the stigma associated with tobacco use may not readily accept the use of these products. In this regard, it is imperative to inform adequately the public about the benefits associated with the use of smokeless tobacco products. In doing so it is vital to elaborate the benefits of these products for both the individual and the public at large (Gartner et al. 2007). The use of these products benefits the smokers as it reduces nitrosamines associated with tobacco. Smokeless tobacco products also benefit other parties as it eliminates the occurrence of second -hand smoking as well as reducing tobacco related health care costs. It is also noteworthy that the desired intervention for tobacco use is complete cessation. However, due to nicotine addition this goal becomes hard to attain. Therefore, adopting a smokeless tobacco product not only reduces the harm associated with tobacco but also aids tobacco cessation (Gartner et al. 2007). Tools and strategies for adoption The implementation of a tobacco- harm reduction policy that advocates for the adoption of smokeless tobacco products would require a slight change in legislation. In Australia, medical nicotine is only licensed for smoking cessation and not for recreational use. The health regulatory authority should collaborate with other health care stakeholders to develop an integrated approach for the use of smokeless tobacco products in reducing the harm associated with tobacco. Such a strategy would employ price differential to trigger a change, especially among poor smokers. This policy would be developed by the tobacco market as well as the health care sector but this must have strong political support in order to be effective (Foulds & Branstetter 2012). Increasing the availability of smokeless tobacco products in Australia would be the most important step in the adoption of smokeless tobacco products. In order to increase the availability of these products it is essential to encourage the development of low harm nicotine products intended for maintenance use. This would require the re examination of legislation on the use of smokeless tobacco products. This would also require the government to give priority to tobacco- harm reduction policies. The government should therefore determine the necessary legislative changes for the implementation of tobacco- harm reduction policies (Lawson 2012). Most tobacco smokers do not understand that it is the smoke and not the nicotine that is more harmful. As a result, most of these smokers do not perceive the use of smokeless tobacco products as reducing the harm associated with tobacco. The risk is that smokers may not take up the use of these products due to lack of information. It is therefore essential to inform and encourage cigarette smokers to switch to smokeless tobacco products. This would require both marketing and financial incentives (Warner 2002). Smokeless tobacco products should not only be available but smokers should also understand its benefits. Nicotine is addictive and all nicotine products should be controlled. The use of smokeless tobacco products can only be adopted if the regulatory framework in place recognizes these products. Policy makes should take into consideration deaths and diseases caused by cigarette smoking if alternative smokeless products are not available. Regulatory obstacles for the use of smokeless tobacco products should be reviewed. Hence, they should be replaced with policies that encourage production, promotion, and retailing of these products. Other incentives would include tax advantages, consumer education, and research projects to quantify the benefits associated with smokeless tobacco products (Gartner et al. 2007). Conclusion People are addicted to nicotine and not cigarette smoke but they end up dying from the smoke. Changing the mode of nicotine delivery would significantly reduce the harm associated with tobacco. The purpose of reducing the prevalence of smoking is to reduce the burden of death and diseases associated with tobacco. Reduction of cigarette smoking is an effective way of reducing this burden. Increasing the prices of cigarettes can be used to discourage people from smoking. However, a price increase in tobacco products is regressive because nicotine is addictive which makes its prices inelastic. Therefore, an increase in tobacco prices affects poor smokers, as they have to spend more. The use of smokeless tobacco products, and especially the Swedish snus, reduces the harm associated with tobacco by reducing tobacco toxins and eliminating second hand smoking. These products can also be used to aid cessation. Reference list Bonusrant, S, Wallace, R, Shetty, P, & Stratton K, 2011, Clearing the smoke: Assessing the science base of tobacco harm reduction. National Academic Press. Foulds, J & Branstetter S 2012, ‘Tobacco harm reduction‘, Harm reduction reduction in substance use and high risk behavior. Garner, C, Hall, W, Vos, T, Bertram, M, Wallace, A & Lim, S 2007, ‘Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study‘,The lancet vol 369 no 9578. Lawson, E 2012, ‘Tobacco harm reduction: thinking the unthinkable‘The British Journal of general practice, vol 62 no 599 pp. 314. Warner, K 2002, ‘Tobacco harm reduction: promise and perils‘ Nicotine and tobacco research, vol 2 no 4 pp. 61-71. Read More

smoking is the cause of numerous health- related complications that include several types of cancer and other health issues. Apart from these health issues it is also noteworthy that the nicotine contained in tobacco is addictive. This addition makes it difficult for active smokers to quit the habit. These health-related issues associated with smoking are not restricted to the primary user but extends to the public health sector. The public health sector is affected as the management and treatment of tobacco related complications costs a lot of money and unnecessarily eats into the public health budgets.

These complications continue to take up a substantial portion of the health care budget (Warner 2012). Additionally, tobacco smoking also affects non-smokers by exposing them to secondary smoking. Secondary smoking, like primary smoking, poses serious health risks to those exposed to it. These risks are similar to the risks posed by primary smoking. Tobacco-related harm, therefore, affect a wide spectrum of individuals in the community and reduction of this harm is important (Bondurant et al. 2011). Context of tobacco harm Tobacco-related harm continues to be a major health concern despite attempts to reduce this harm.

There have been several attempts to reduce this harm in the past. Initial attempts saw the introduction of filters. Cigarette filters reduce the amount of toxins inhaled by the smoker. Although the filters reduce the harm associated with tobacco, the reduction is very small. Efforts to reduce harm subsequently lead to the production of low yield cigarettes. Low yield cigarettes, unlike the conventional cigarettes, emit less carbon monoxide, less tar and nicotine. Although these cigarettes reduce, harm related to tobacco, this reduction is also very marginal.

This is because users have to use more and inhale harder to derive the desired levels of nicotine. Moreover, low yield cigarettes still cause second-hand smoking (Foulds and Branstetter 2012). Heavy taxation of cigarettes is an effective measure in discouraging the use of cigarettes. However, this strategy results in financial constraints for poor smokers who are addicted to nicotine. Without other measures to help nicotine addicts, heavy taxation cannot be entirely effective. Heavy taxation also affects the economy since tobacco is a legal drug.

It is notable that efforts to reduce tobacco related harm take four broad approaches. These approaches are efforts to prevent the use of tobacco from occurring, measures aimed at stopping the use of tobacco, strategies to prevent the use of tobacco from affecting third parties and measures to reduce harm to the smoker. The goal of any public health policy on tobacco harm is to achieve the greatest possible reduction in disease, injury, and deaths associated with the use of tobacco (Warner 2002).

Tobacco harms reduction. Traditional tobacco control methods focus on reducing the incidence of initial smokers and encouraging active smokers to quit. The limited success of these methods, especially in encouraging active smokers to quit is due to nicotine addition. However, there is established intervention methods that significantly reduce the harm associated with tobacco. These methods involve prevention, treatment, and cessation and harm reduction (Bondurant et al 2011). Tobacco harm reduction is centered on the idea that the substance itself is not an issue.

Most of the toxins associated with tobacco are produced during the combustion of tobacco during smoking. The nicotine that is obtained from cigarettes poses posses very little harm but combustion of tobacco produces a lot of harm. Therefore, changing the method of delivery would significantly reduce the harm associated with tobacco. Accordingly, this approach does not require compete discontinuation of tobacco but a switch to a less harmful tobacco product. A switch to a different mode of delivery would be more appealing to tobacco users than cessation.

Examples of harm reduction strategies include potentially reduced exposure products (PREPs), nicotine replacement therapy (NRT), replacement products for temporary abstinence and smokeless tobacco products (Gartner et al. 2007).

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