Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction

Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction

by Kathleen Stratton, Padma Shetty, Robert Wallace, Stuart Bondurant
     
 

ISBN-10: 0309072824

ISBN-13: 9780309072823

Pub. Date: 10/01/2001

Publisher: National Academies Press

Despite overwhelming evidence of tobacco's harmful effects and pressure from anti-smoking advocates, current surveys show that about one-quarter of all adults in the United States are smokers. This audience is the target for a wave of tobacco products and pharmaceuticals that claim to preserve tobacco pleasure while reducing its toxic effects.

Clearing the

Overview

Despite overwhelming evidence of tobacco's harmful effects and pressure from anti-smoking advocates, current surveys show that about one-quarter of all adults in the United States are smokers. This audience is the target for a wave of tobacco products and pharmaceuticals that claim to preserve tobacco pleasure while reducing its toxic effects.

Clearing the Smoke addresses the problems in evaluating whether such products actually do reduce the health risks of tobacco use. Within the context of regulating such products, the committee explores key questions:

  • Does the use of such products decrease exposure to harmful substances in tobacco?
  • Is decreased exposure associated with decreased harm to health?
  • Are there surrogate indicators of harm that could be measured quickly enough for regulation of these products?
  • What are the public health implications?


This book looks at the types of products that could reduce harm and reviews the available evidence for their impact on various forms of cancer and other major ailments. It also recommends approaches to governing these products and tracking their public health effects.

With an attitude of healthy skepticism, Clearing the Smoke will be important to health policy makers, public health officials, medical practitioners, manufacturers and marketers of "reduced-harm" tobacco products, and anyone trying to sort through product claims.

Product Details

ISBN-13:
9780309072823
Publisher:
National Academies Press
Publication date:
10/01/2001
Pages:
656
Product dimensions:
6.00(w) x 9.00(h) x (d)

Table of Contents

Contents

EXECUTIVE SUMMARY....................1
SECTION I: INTRODUCTION, BACKGROUND, AND CONCLUSIONS 1 INTRODUCTION....................21
History of Harm Reduction....................26
Definitions....................27
Nicotine....................28
Pharmaceutical Products....................29
Regulatory Issues and Authorities....................30
Committee Charge and Process....................31
Application of Risk Assessment to Tobacco Harm Reduction....................33
Operating Precepts....................35
2 PRINCIPLES OF HARM REDUCTION....................38
Conceptual Framework for Harm Reduction....................39
Applications....................41
Comparing Other Harm Reduction Interventions to Those for Smoking....................50
Conclusions....................53
3 HISTORICAL PERSPECTIVE AND LESSONS LEARNED....................60
Tobacco Marketing: Early Health Claims....................60
Health Impact of Low-Yield Products....................66
Risk Perception....................67
Potential Influence of PREPs on Tobacco Use Behaviors....................73
Summary and Relevance to PREPs....................76
4 PRODUCTS FOR TOBACCO EXPOSURE REDUCTION....................82
Tobacco and Tobacco Products....................82
Pharmaceutical Products....................95
Other Potential Harm Reduction Methods: Behavioral Strategies and Tobacco Control Policies....................116
Regulation of Exposure Reduction Products....................122
5 THE SCIENTIFIC BASIS FOR PREP ASSESSMENT....................140
Tobacco Smoke andToxicology....................147
Exposure and Biomarker Assessment in Humans....................150
Nicotine Pharmacology....................161
Cancer....................163
Cardiovascular Disease....................167
Nonneoplastic Respiratory Disease....................170
Reproductive and Developmental Effects....................172
Other Health Effects....................174
6 SURVEILLANCE FOR THE HEALTH AND BEHAVIORAL CONSEQUENCES OF EXPOSURE REDUCTION....................180
Existing Tobacco Surveillance Systems....................183
Proposed Surveillance System Enhancements....................188
Issues and Limitations Regarding Surveillance Systems for Assessing Tobacco-Related Health Outcomes....................195
Summary and Recommendations....................197
7 IMPLEMENTATION OF A SCIENCE-BASED POLICY OF HARM REDUCTION....................201
Next Steps: An Overview....................203
Principles for Regulating Potential Reduced-Exposure Products....................206
Summary....................228
8 PRINCIPAL CONCLUSIONS....................231
SECTION II: EVIDENCE FOR THE SCIENCE BASE 9 NICOTINE PHARMACOLOGY....................243
Basic and Human Pharmacology....................243
Pharmacokinetics....................246
Pharmacodynamics....................252
Research Agenda....................269
10 TOBACCO SMOKE AND TOXICOLOGY....................283
Physical and Chemical Characteristics of Tobacco Smoke....................283
Toxicity of Tobacco Smoke....................287
Assessment of Potential Exposure Reduction Products....................293
Synergistic Effects with Other Pollutants....................298
Molecular Biology Testing Tools....................298
Smokeless Tobacco Toxicity....................299
General Research Agenda and Recommendations....................302
11 EXPOSURE AND BIOMARKER ASSESSMENT IN HUMANS....................309
External Exposure Assessment: The FTC Method and Questionnaire Data....................317
Biomarkers of Exposure....................323
Biomarkers Estimating the Biologically Effective Dose....................326
Biomarkers of Potential Harm....................333
Host Susceptibility....................344
Genetic Predispositions to Smoking Addiction....................347
Biomarker Assessment for Environmental Tobacco Smoke Exposure....................348
Development and Validation of Biomarker Assays, Including Quality Control....................348
Conclusions....................349
Research Agenda....................352
12 CANCER....................367
Mutagenesis and DNA Damage....................368
Carcinogenesis....................370
Tobacco Mutagens and Carcinogens....................373
Scientific Methods for Assessing Harm Reduction Strategies....................379
Lung Cancer....................392
Oropharyngeal Cancers....................415
Bladder Cancer....................418
Endometrial Cancer....................421
Environmental Tobacco Smoke....................422
Cigar Smoking....................425
Smokeless Tobacco Products....................426
Studies of Nicotine Mutagenicity and Carcinogenicity....................429
Conclusions....................430
Research Agenda....................434
Special Issues in Study Designs....................438
13 CARDIOVASCULAR DISEASE....................470
Coronary Heart Disease....................471
Extracardiac Vascular Disease....................481
Other Variables Influenced by Smoking....................482
Surrogate Markers....................483
Conclusions....................486
Research Agenda....................491
14 NONNEOPLASTIC RESPIRATORY DISEASES....................500
Biomarkers of Respiratory Diseases....................501
Chronic Obstructive Pulmonary Disease....................503
Asthma....................518
Respiratory Infections....................525
Summary and Conclusions....................530
Research Agenda....................532
15 REPRODUCTIVE AND DEVELOPMENTAL EFFECTS....................543
Fertility Impairment....................544
Spontaneous Abortions....................545
Placental Complications....................545
Preterm Delivery....................546
Low Birthweight....................547
Sudden Infant Death Syndrome (SIDS)....................549
Congenital Malformations....................549
Cognitive and Behavioral Deficits in Childhood....................550
Fetal Lung Development....................551
Smokeless Tobacco....................551
Conclusions....................552
Recommendations....................553
16 OTHER HEALTH EFFECTS....................560
Peptic Ulcers....................560
Surgical Wound Healing....................561
Inflammatory Bowel Disease....................561
Rheumatoid Arthritis....................562
Oral Disease....................563
Dementia....................564
Orthopedic Consequences....................565
Ocular Disease....................565
Dermatologic Conditions....................566
Diabetes....................567
Renal Disease....................567
Schizophrenia....................568
Depression....................568
Weight Change....................569
Drug Interactions....................570
Fire Safety....................570
Parkinson's Disease....................571
Preeclampsia....................572
Summary....................572
Recommendations....................573
A PRESENTATIONS AND SUBMISSIONS....................583
B COMMITTEE BIOGRAPHICAL SKETCHES....................586
C TIME LINE OF TOBACCO EVENTS....................593
INDEX....................607

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