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Tobacco Harm Reduction

Tobacco Harm Reduction. Buyer/Hagan/Burr v. Kennedy/Waxman A Public Health Perspective Live Video Presentation to TMA Meeting, Williamsburg, VA, May 18, 2009. Joel L. Nitzkin, MD, MPH,DPA,. Chair, Tobacco Control Task Force American Association of Public Health Physicians.

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Tobacco Harm Reduction

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  1. Tobacco Harm Reduction • Buyer/Hagan/Burr v. Kennedy/Waxman • A Public Health Perspective • Live Video Presentation to TMA Meeting, Williamsburg, VA, May 18, 2009 AAPHP Tobacco Control Task Force

  2. Joel L. Nitzkin, MD, MPH,DPA, Chair, Tobacco Control Task Force American Association of Public Health Physicians AAPHP Tobacco Control Task Force

  3. Tobacco Harm Reduction • Background • Public Health Perspective • Deaths due to Tobacco Products • Opposition to Harm Reduction • The Two Proposed Bills • AAPHP Recommendations • JLN Contact Information • AAPHP web site; tobacco issues page AAPHP Tobacco Control Task Force

  4. Public Health Perspective • Future illness and death from tobacco products • Near-term (next 30 years) – current smokers • Far-term – current and future teens AAPHP Tobacco Control Task Force

  5. Deaths Due to Tobacco Products • Cigarette smokers • 400,000 per year • Major causes • Lung Cancer • Other Lung Disease • Other Cancer • Heart Disease • Environmental Tobacco Smoke • 38,000 per year (lung cancer and heart disease) • All Other • Less than 10,000 per year (other cancer) AAPHP Tobacco Control Task Force

  6. Deaths due to Tobacco Products • The problem is cigarettes • (not other tobacco products) • The problem is products of combustion • (not specific chemicals in tobacco) • (smoking also kills non-smokers) • Safe cigarette probably not possible AAPHP Tobacco Control Task Force

  7. Options for Reducing Deaths from Cigarettes • Cessation • Harm Reduction • (smokers switching to less hazardous products to maintain their nicotine addiction) AAPHP Tobacco Control Task Force

  8. Smoking Cessation • Spontaneous quit rates • About 3% per year • Almost all “cold turkey” • With counseling and NRT’s • Increases rate to about 5% (when measured 1 year post-intervention) AAPHP Tobacco Control Task Force

  9. Harm Reduction • Switching from cigarettes to snus or alternative nicotine delivery products (sticks, strips, e-cigarettes, etc) • Eventual reduction in risk – 99% or better • Lives saved over first 20 years – about 50% • Increased risk of death in smokers continues 5-15 years after quitting • Of 8 million smokers who will die of a tobacco-related illness over next 20 years – 4 million could be saved by harm reduction (AAPHP projection) AAPHP Tobacco Control Task Force

  10. The Case Against Harm Reduction • Most people do not believe risk reduction 99% or better • Should we encourage use of products that will kill 400 to 4,000 people per year? • Will marketing reduced risk products addict more teens to nicotine? • Will that addiction lead more teens to cigarettes? • No research to “prove” the efficacy of harm reduction in the United States • Concept of “Tobacco Free Society” AAPHP Tobacco Control Task Force

  11. Kennedy/Waxman(as seen by AAPHP) • Focused entirely on teens; totally ignores current smokers • Gives image, but not substance of effective federal regulation • De-facto ban on new reduced risk products (new = after 2/15/07) • Favors Altria/Philip Morris • Promotes concept of reduced exposure cigarette • Does nothing of substance to reduce teen tobacco use • Some version of this bill will become law AAPHP Tobacco Control Task Force

  12. Buyer/Hagan/Burr(as seen by AAPHP) • Focused on current tobacco users (largely ignores teen initiation of tobacco use) • Minimal regulation of marketing • Criminalizes youth, lets store owners off with token penalties • Even-handed re tobacco industry stakeholders • No chance of becoming law AAPHP Tobacco Control Task Force

  13. AAPHP Recommendsmultiple amendments to Kennedy/Waxman • Favor harm reduction • Eliminate concept of reduced exposure cigarettes • Reduce restrictions on regulatory agency • Add graphic warnings to cigarettes • Authorize federal agency health education, surveillance and research • Agency other than FDA • Address illicit and contraband products AAPHP Tobacco Control Task Force

  14. Joel L. Nitzkin, MD, MPH, DPA • Chair, AAPHP Tobacco Control Task Force • (504) 899-7893 • (800) 598-2561 • Cell (504) 606-7043 • Jln-md@mindspring.com • New Orleans, Louisiana AAPHP Tobacco Control Task Force

  15. AAPHP Tobacco Issues Page • www.aaphp.org • Click on “tobacco issues” • Multiple background and policy documents AAPHP Tobacco Control Task Force

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