The Harm Reduction Debate

2. The Harm Reduction Debate • Current context of the debate • - Snus enthusiasts vs. pessimists • Switching from cigarettes to snus alone will reduce individual risk • But: What will happen on a population basis?

3. Current Smokeless Advertising Cigarette-branded smokeless tobacco products Appear to promote dual use Free with purchase of cigarette pack Marketing messages • Convenient, discreet, for smokefree places • New demographic groups?

4. UST Conference for Investors December 19, 2007

5. Data used in Modeling CDC MMWR reports National Health Interview Survey data U.S.T. marketing documents and shareholder presentations Phillip Morris documents IARC Monographs Peer Reviewed Literature Tobacco trade journals

6. Modeling Assumptions Four mutually exclusive groups of smokers Stable Health concerned Smoke-free environment Price sensitive Non-users do not initiate tobacco use as dual users Snus use is not widely prevalent in the U.S. population Changes arise from the current pattern of use Smokeless not used as a cessation aid

7. Stable

8. Health Effect: Base Case

9. Health Effect: Base Case

10. Health Effect: Base Case

11. Results Health Effect: 24.2 (21.5, 27.2)

14. Conclusions Promotion of smokeless as a safer alternative to cigarettes unlikely to provide population health benefits Promotion of smokeless may actually lead to an increase in harm at the population level

15. Public Health Implications • Other risks of promotion of smokeless as less harmful than cigarettes include: • Undermining effective policies • Confusing public messages • Legitimizing tobacco companies • Focus on proven harm reduction strategies that rapidly reduce tobacco use and disease • Taxes, regulation, litigation

18. What would have to happen to cut health effects in half? • Increase smokeless initiation by 5x, all from cigarettes • Cut dual use in smokeless initiators from .40 to .15 • Cut smokeless to cigarettes from .17 to .03 • All smokers health concerned • Increase smokeless 15x • 75% from cigarettes, rest from quitters • 25% become dual users • Reasonable assumptions?