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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction
(automobile safety regulation); this is the approach used for tobacco harm reduction products that rely on removal of some toxicants from tobacco.
Shift to less toxic mode of ingestion. Needle exchange programs attempt to reduce the harmfulness of the act of injecting drugs, without requiring abstinence. That is the approach embodied by products such as Eclipse, with heated tobacco or tobacco-like materials providing nicotine by a similar mechanism that allows continuation of the act of smoking but attempts to make it less harmful.
Behavioral change therapies (controlled drinking); many tobacco harm reduction strategies will require behavior change as a complement to product innovation.
Adding a less harmful but dependency-creating product to the available mix of dangerous products (methadone for heroin addicts); this is the rationale for nicotine replacement therapy for long-term use.
This section provides a brief description of the nature of each of the non-tobacco interventions listed and how they have fared in the harm reduction framework. It also describes the extent to which they have had the effects predicted for them when introduced. The examples presented are, by nature, imperfect analogies of tobacco harm reduction but are offered to highlight the positive and negative implications of harm reduction interventions.
Automobile Safety Regulation
Automobiles are a source of numerous injuries and fatalities; in 1998 there were 41,200 deaths in the United States associated with automobiles (National Safety Council, 1999). Some of these, but not all, are a consequence of unsafe operation of vehicles, in particular driving while intoxicated or driving at high speed. The National Highway Traffic Safety Administration (NHTSA) estimates that speeding was a contributing factor in 30% of such deaths (NHTSA, 1999a). It was also estimated that in 1994, 16,600 traffic fatalities were alcohol-related (CDC, 1995). A series of product innovations, including seat belts, anti-lock braking systems, and air bags have led to large improvements in the crash-worthiness of vehicles. Lap/shoulder safety belts, when used, reduce the risk of moderate to fatal injury to front seat passenger occupants by approximately half (NHTSA, 1999b). Federal law now requires their installation in new vehicles and all states mandate that they be used.
From the earliest days of these innovations, there has been a research interest in behavioral adjustments that might reduce the effectiveness of these innovations. Given that cars are safer, drivers may be more inclined to exceed the legal speed limit as well as exercise reduced care with respect