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Int J Environ Res Public Health. 2009 Jan;6(1):10-24. doi: 10.3390/ijerph6010010. Epub 2008 Dec 23.

Is smokeless tobacco use an appropriate public health strategy for reducing societal harm from cigarette smoking?

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  • 1University of Florida College of Dentistry, Gainesville, Gainesville, FL 32610-3628, USA.


Four arguments have been used to support smokeless tobacco (ST) for harm reduction: (1) Switching from cigarettes to ST would reduce health risks; (2) ST is effective for smoking cessation; (3) ST is an effective nicotine maintenance product; and (4) ST is not a "gateway" for cigarette smoking. There is little evidence to support the first three arguments and most evidence suggests that ST is a gateway for cigarette smoking. There are ethical challenges to promoting ST use. Based on the precautionary principle, the burden of proof is on proponents to provide evidence to support their position; such evidence is lacking.


Smokeless tobacco; harm reduction; smoking cessation; smoking initiation

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