Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Am J Public Health. 2010 Dec;100(12):2487-92. doi: 10.2105/AJPH.2009.175091.
We evaluated changing patterns of tobacco use following a period of forced tobacco abstinence in a US military cohort to determine rates of harm elimination (e.g., tobacco cessation), harm reduction (e.g., from smoking to smokeless tobacco use), and harm escalation (e.g., from smoking to dual use or from smokeless tobacco use to smoking or dual use).
Participants were 5225 Air Force airmen assigned to the health education control condition in a smoking cessation and prevention trial. Tobacco use was assessed by self-report at baseline and 12 months.
Among 114 baseline smokers initiating smokeless tobacco use after basic military training, most demonstrated harm escalation (87%), which was 5.4 times more likely to occur than was harm reduction (e.g., smoking to smokeless tobacco use). Harm reduction was predicted, in part, by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history, and risk-taking.
When considering a harm reduction strategy with smokeless tobacco, the tobacco control community should balance anticipated benefits of harm reduction with the risk of harm escalation and the potential for adversely affecting public health.
我们评估了美国军事队列在强制戒烟期间之后烟草使用模式的变化，以确定消除危害（例如戒烟）、减少危害（例如从吸烟改为使用无烟烟草）和危害升级（例如从吸烟改为双重使用或从使用无烟烟草改为吸烟或双重使用）的比率。
参与者是被分配到戒烟和预防试验健康教育对照组的 5225 名空军士兵。在基线和 12 个月时通过自我报告评估烟草使用情况。
在基本军事训练后开始使用无烟烟草的 114 名基线吸烟者中，大多数人表现出危害升级（87%），比减少危害（例如从吸烟改为使用无烟烟草）的可能性高出 5.4 倍。减少危害部分由更高的家庭收入和认为从香烟转为使用无烟烟草对健康有益的信念预测。危害升级的预测因素包括年龄较小、饮酒、吸烟史较长和冒险行为。
当考虑使用无烟烟草的减少危害策略时，烟草控制界应该权衡减少危害的预期益处与危害升级的风险以及对公共健康产生不利影响的可能性。
