ined are some antidepressants, antagonists and medications that alter the metabolism of nicotine. Finally, these treatment methods must be considered carefully for special populations of smokers, including adolescents, individuals with comorbid conditions or medically compromised individuals, and pregnant women.

OTHER POTENTIAL HARM REDUCTION METHODS: BEHAVIORAL STRATEGIES AND TOBACCO CONTROL POLICIES

Altering tobacco products and using pharmacological agents to reduce smoking are not the only methods of harm reduction. Behavioral methods and tobacco control policies have also led to reduced smoking. These approaches have to be considered so that the pharmacological approaches aimed at reducing an individual’s smoking behavior can be complemented or augmented by behavioral and public policy approaches. Furthermore, changes in tobacco products aimed at reducing toxicity must be marketed only in the context of a comprehensive tobacco control policy whose primary goals are prevention of smoking initiation and total cessation of smoking. The normative belief that any tobacco use is harmful must be maintained (IOM, 2000).

Harm Reduction Using Behavioral Methods

Even as early as the 1970s, researchers observed that a significant “number of habitual smokers reported that they wanted to give up smoking but found it extremely difficult to reduce their rate of smoking or quit entirely” (Shapiro et al., 1971). This observation led to a number of studies using behavioral interventions aimed at reducing smoking. The behavioral means for achieving a reduction in smoking included smoking at fixed intervals and increasing the intervals between cigarettes; smoking a cigarette only when signaled to smoke (e.g., Levinson et al., 1971; Shapiro et al., 1971); changing smoking behavior, such as taking shorter puffs, reducing the number of puffs, and reducing the percentage of the cigarette smoked (e.g., Frederiksen and Simon, 1978; Glasgow et al., 1983); contingency contracting (Frederiksen and Peterson, 1976); and eliminating smoking in specific situations (e.g., Foxx and Axelroth, 1983; Glasgow, 1978). In addition, although they represent more of a pharmacological than a behavioral approach, gradually lowering the nicotine content in cigarettes (e.g., Foxx and Brown, 1979; Prue et al., 1981) and graduated filters (McGovern and Lando, 1991) have also been used as methods for reducing nicotine. All of these methods have shown some degree of success in reducing the number of cigarettes smoked, with concomitant reductions in extent of nicotine exposure. Two studies have compared the



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