Tobacco Harm Reduction as a Path to Restore Trust in Tobacco Control

Abstract

The controversy of tobacco harm reduction in the United States persists despite evidence that an important audience of tobacco prevention and control, i.e., the people who use or are likely to use nicotine and tobacco products, are engaging in practices that may be considered harm reduction. Despite this, a significant proportion of the US tobacco control and prevention field continues to be guided by a precept that there is “no safe tobacco,” therefore failing to acknowledge practices that may be used to reduce the harms associated with consuming combustible forms of nicotine and tobacco. In this commentary, we argue that ignoring the potential benefits of harm reduction strategies may unintentionally lead to an erosion of trust in tobacco control among some members of the public. Trust in tobacco control as an institution is crucial for the success of tobacco control efforts. To ensure trust, we must return to our basic principles of doing no harm, developing programs that are responsive to people’s experiences, and providing resources in assisting people to reduce the harms that may be associated with practices, such as smoking, which adversely affect health. Only by respecting an individual’s priorities can we cultivate trust and develop tobacco prevention efforts that are grounded in the realities of people’s lives and responsive to their needs.

Trust in Tobacco Control

“…Specific SGM intragroup differences in institutional trust were beyond the scope of the present study but would benefit from future research efforts seeking to support the development of culturally-responsive policies. This lack of trust, if widespread, may make tobacco control efforts less effective at addressing persistent inequities (Annechino & Antin 2019;Antin et al 2021). Thankfully, however, participant perspectives also highlight the strong potential of harm reduction approaches as a promising 'path' towards promoting trust in tobacco control among priority populations like SGM young adults who use NT (Antin et al 2021).…”

“I Can’t Make Perfect Choices All the Time”: Perspectives on Tobacco Harm Reduction Among Young Adults Who Identify as Sexual and Gender Minorities

“…However, participants, like Valentina and Stewart, also expressed tremendous uncertainty about whether this practice was in fact harm reducing. 57 As Valentina said: "So mentally, I'm just like, 'Okay. I'm technically not smoking a cigarette' [by vaping]...The not-okay part is not knowing like: 'Okay.…”

“…73 Therefore, messaging that isn't shaped by principles of pragmatism and nonjudgement, thus not providing the nuanced information that people want in a nonjudgmental way, may ultimately sow seeds of distrust and yield unintended responses. 57,74 In addition to an emphasis on principles of pragmatism and nonjudgment for tobacco harm reduction programs and policies, participants' narratives also stressed the importance of being practical and nonjudgmental towards themselves as they attempted to practice tobacco harm reduction. Like many participants, Violet Adams talked about the importance of being "gentle" with themself, balancing the harms associated with tobacco with other stressors that contribute to their everyday lives, like the COVID-19 pandemic.…”

Harm perceptions of vaping nicotine relative to cigarette smoking among sexual and gender minority young adults

“…One potential strategy is THR, yet these approaches remain controversial within many tobacco control and prevention agencies [12][13][14], especially given the cooptation of harm reduction by Big Tobacco [15]. THR strategies are defined by the substitution of less toxic forms of NT (e.g., e-cigarettes, snus, nicotine replacement therapies) for extremely toxic combustible products (e.g., cigarettes) [16,17].…”