Public health implications of smokeless tobacco use as a harm reduction strategy

Am J Public Health. 2006 Nov;96(11):1934-9. doi: 10.2105/AJPH.2005.075499. Epub 2006 Oct 3.


Harm reduction strategies involve promoting a product that has adverse health consequences as a substitute for one that has more severe adverse health consequences. Smokeless tobacco low in nitrosamine content offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the potential for such products to serve as a gateway to more harmful tobacco products, public misinterpretation of "less harmful" as "safe," distraction from the public health goal of tobacco elimination, and ethical issues involved in advising those marketing these harmful products. We offer a research agenda to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.

MeSH terms

  • Advertising
  • Cardiovascular Diseases / etiology
  • Consensus Development Conferences as Topic
  • Consultants
  • Humans
  • Mouth Diseases / etiology
  • Neoplasms / etiology
  • Nitrosamines / analysis
  • Nitrosamines / toxicity
  • Public Health / ethics*
  • Reproductive Medicine
  • Risk Assessment*
  • Risk Reduction Behavior*
  • Safety*
  • Smoking / adverse effects
  • Smoking Prevention
  • Tobacco Industry / ethics*
  • Tobacco Use Disorder / complications
  • Tobacco Use Disorder / prevention & control*
  • Tobacco, Smokeless / chemistry
  • Tobacco, Smokeless / toxicity*
  • United States
  • Virginia


  • Nitrosamines