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Nicotine Tob Res. 2010 Nov;12(11):1055-67. doi: 10.1093/ntr/ntq147. Epub 2010 Sep 16.
The use of smokeless tobacco as part of a strategy to reduce the harm from cigarette smoking is a topic of debate within the tobacco control and public health communities. One concern voiced regarding endorsement of such a tactic is the possibility of actually increasing harm should current smokers adopt dual cigarette/smokeless tobacco use (dual use), which could lead to unintended consequences by perpetuating cigarette smoking, diminishing tobacco cessation, or increasing tobacco-related harm.
Here, we review the available literature on health effects and trajectories of use among dual users from a variety of U.S. and European epidemiological studies.
These data suggest that there are not any unique health risks associated with dual use of smokeless tobacco products and cigarettes, which are not anticipated or observed from cigarette smoking alone. Furthermore, studies show that dual users smoke fewer cigarettes than exclusive smokers, and studies of tobacco use patterns over time (tobacco use trajectory data) indicate that dual users are more likely than exclusive cigarette smokers to cease smoking.
Overall, the concern about dual use appears to be contradicted by the evidence in the literature that dual use of smokeless tobacco and cigarettes may result in reduction in smoking-related harm as smoking intensity is decreased and smoking cessation increases.
将无烟烟草作为减少吸烟危害策略的一部分，这在烟草控制和公共卫生领域是一个存在争议的话题。对于这种策略的认可，人们表达了一种担忧，即如果当前吸烟者采用双重使用香烟/无烟烟草（双重使用），那么实际上可能会增加危害，这可能会通过延续吸烟、减少戒烟或增加与烟草相关的危害而带来意想不到的后果。
在这里，我们从各种美国和欧洲的流行病学研究中，回顾了关于双重使用者健康影响和使用轨迹的现有文献。
这些数据表明，双重使用无烟烟草制品和香烟不会带来任何独特的健康风险，这些风险不会单独从吸烟中预期或观察到。此外，研究表明，双重使用者吸烟的数量少于只吸香烟的人，而且对随时间变化的烟草使用模式（烟草使用轨迹数据）的研究表明，与只吸香烟的人相比，双重使用者更有可能戒烟。
总体而言，关于双重使用的担忧似乎与文献中的证据相矛盾，即双重使用无烟烟草和香烟可能会减少吸烟相关的危害，因为吸烟强度降低，戒烟率增加。
