Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives

Abstract

Inhalation of the toxic smoke produced by combusting tobacco products, primarily cigarettes, is the overwhelming cause of tobacco-related disease and death in the United States and globally. A diverse class of alternative nicotine delivery systems (ANDS) has recently been developed that do not combust tobacco and are substantially less harmful than cigarettes. ANDS have the potential to disrupt the 120-year dominance of the cigarette and challenge the field on how the tobacco pandemic could be reversed if nicotine is decoupled from lethal inhaled smoke. ANDS may provide a means to compete with, and even replace, combusted cigarette use, saving more lives more rapidly than previously possible. On the basis of the scientific evidence on ANDS, we explore benefits and harms to public health to guide practice, policy, and regulation. A reframing of societal nicotine use through the lens of harm minimization is an extraordinary opportunity to enhance the impact of tobacco control efforts.

Keywords: e-cigarettes; harm minimization; nicotine; smoking; tobacco.

Figure 1.

Products along the harm minimization continuum. Adapted from Nutt et al., 2014 (77).

Figure 2.

Multidimensional framework for nicotine containing products, considering (1) harmfulness, (2) appeal, and (3) dependence.

Figure 3.

Markov state transition model of cigarette and e-cigarette use. Adapted from Cobb et al., 2015 (20).