Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, 323 Kimball Tower, 3435 Main Street, Buffalo, NY, 14214-8028, USA.
Harm Reduct J. 2018 Apr 16;15(1):21. doi: 10.1186/s12954-018-0228-8.
Before the 1980s in the USA, smokeless tobacco carried no health warnings, was not judged to cause disease, and was a declining practice. In 1986, the federal government passed legislation requiring rotating warnings on "mouth cancer," "gum disease and tooth loss," and "This product is not a safe alternative to cigarettes." This paper explores the history of the establishment of these warnings with emphasis on the 'not a safe alternative' warning and the bases for claiming that smokeless was 'not safe' (absolute harm) versus 'not safer than cigarettes' (relative harm).
Results of searches of Truth Tobacco Industry Document archives and transcripts of legislative hearings were analyzed. Critical assessments were made of the evidence-base.
New evidence of oral cancer causation emerged along with a much-publicized case of a teenager dying of oral cancer. Public health concerns also arose over a widespread, successful marketing campaign implying smokeless was a safe alternative to cigarettes. Industry wanted pre-emptive federal warnings, to prevent a diversity of pending state warnings. To avoid an addiction warning, the industry accepted a compromise 'not a safe alternative' warning, which had not been initially proposed and which the cigarette industry may have sought in order to constrain the smokeless tobacco industry. The evidence presented supported smokeless only as 'not safe' and not 'as harmful as cigarette smoking.'
The comparative warning was a compromise to prevent an addiction warning and consistent with the preferences of cigarette companies. Prior surveys indicated that the public generally did not view smokeless tobacco as harmless, but they did generally report smokeless as less harmful than cigarettes despite expert interpretations to the contrary. As would not have been appreciated by public health supporters at the outset, subsequent research has shown that the 'not a safe alternative' message is misinterpreted by consumers to indicate that smokeless is 'not safer' than cigarettes-which was not established and has been disconfirmed by subsequent assessments of that question. Though many countries have banned smokeless tobacco (but not cigarettes), where smokeless is legally available accurate information on the nature of harms and differential harms needs to be developed.
在美国 20 世纪 80 年代以前，无烟烟草没有健康警示，也不被认为会导致疾病，而且使用人数呈下降趋势。1986 年，联邦政府通过立法，要求对“口腔癌”、“牙龈疾病和牙齿脱落”以及“本产品不是香烟的安全替代品”进行轮换警示。本文重点探讨了这些警示的建立历史，特别强调了“不是安全替代品”的警示，以及声称无烟烟草“不安全”（绝对危害）与“不比香烟安全”（相对危害）的依据。
对真相烟草业文件档案和立法听证会记录进行了搜索，分析了结果。对证据基础进行了批判性评估。
出现了新的口腔癌病因证据，同时也有一起广为人知的青少年死于口腔癌的案例。公众健康也对一场广泛成功的营销活动感到担忧，该活动暗示无烟烟草是香烟的安全替代品。为了避免成瘾警示，该行业接受了预先联邦警示，以防止各种即将出台的州警示。为了避免“不是安全替代品”的警示，该行业接受了一个妥协的“不是安全替代品”的警示，这一警示最初并没有被提议，而香烟行业可能已经在寻求这个警示，以限制无烟烟草行业。提出的证据仅支持无烟烟草“不安全”，而不是“像吸烟一样有害”。
相对警示是一种妥协，以防止成瘾警示，并符合香烟公司的偏好。之前的调查表明，公众通常不认为无烟烟草无害，但他们确实普遍认为无烟烟草比香烟危害小，尽管专家的解释与此相反。正如一开始不被公共卫生支持者所理解的那样，随后的研究表明，“不是安全替代品”的信息被消费者误解为表明无烟烟草“不比香烟安全”，这一点并未得到证实，也被后来对该问题的评估所否定。尽管许多国家已经禁止无烟烟草（但不禁香烟），但在合法提供无烟烟草的地方，需要制定关于危害和差异危害的准确信息。
