Chaffee, BW

Elias, J.

Hendlin, Y.H. (Yogi)

Ling, P.M.

English

Erasmus University Digital Repository

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/316024323Don't throw smokeless tobacco users under the busArticle  in  Addictive behaviors · April 2017DOI: 10.1016/j.addbeh.2017.04.007CITATIONS0READS174 authors, including:Some of the authors of this publication are also working on these related projects:Special issue on biosemiotic ethics (Zeitschrift für Semiotik). View projectPublic Health Policy View projectJesse EliasProvidence Health and Services8 PUBLICATIONS   37 CITATIONS   SEE PROFILEYogi HendlinErasmus University Rotterdam40 PUBLICATIONS   112 CITATIONS   SEE PROFILEAll content following this page was uploaded by Yogi Hendlin on 07 May 2018.The user has requested enhancement of the downloaded file.Accepted ManuscriptDon't throw smokeless tobacco users under the busJesse Elias, Yogi Hendlin, Benjamin W. Chaffee, Pamela M. LingPII: S0306-4603(17)30146-6DOI: doi: 10.1016/j.addbeh.2017.04.007Reference: AB 5141To appear in: Addictive BehaviorsReceived date: 7 March 2017Accepted date: 3 April 2017Please cite this article as: Jesse Elias, Yogi Hendlin, Benjamin W. Chaffee, PamelaM. Ling , Don't throw smokeless tobacco users under the bus. The address for thecorresponding author was captured as affiliation for all authors. Please check ifappropriate. Ab(2017), doi: 10.1016/j.addbeh.2017.04.007This is a PDF file of an unedited manuscript that has been accepted for publication. Asa service to our customers we are providing this early version of the manuscript. Themanuscript will undergo copyediting, typesetting, and review of the resulting proof beforeit is published in its final form. Please note that during the production process errors maybe discovered which could affect the content, and all legal disclaimers that apply to thejournal pertain.ACCEPTED MANUSCRIPTDon't Throw Smokeless Tobacco Users Under The Bus   Jesse Elias, MA jesse.elias@ucsf.edu, Yogi Hendlin, PhD yogi.hedlin@ucsf.edu, Benjamin W Chaffee*, DDS, MPH, PhD benjamin.chaffee@ucsf.edu, Pamela M Ling MD, MPH pamela.ling@ucsf.edu  Center for Tobacco Control Research & Education, Suite 366 Library, 530 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143-1390, United States of America  *Correspondence: Benjamin W Chaffee, DDS, MPH, PhD benjamin.chaffee@ucsf.edu Phone: 1 (415) 476 - 9226  ACCEPTED MANUSCRIPTACCEPTED MANUSCRIPTAccording to Kozlowski and Sweanor (2017), the FDA’s $36 million effort to educate youth and veterans on the dangers of smokeless tobacco (ST) is money wasted: they claim that youth already know ST is dangerous. To the authors, the FDA violates public health ethics by failing to explicate the far greater comparative risk cigarettes pose. Given that 57% youth and 44% of young adult ST users also smoke, they claim that addressing ST’s harms amounts to “shutting the barn door after the horse has escaped.”  This argument fails to recognize that the FDA spends far more on its anti-smoking campaign than its ST campaign, and ignores the fact that ST use, independent of smoking, causes oral cancer, pancreatic cancer, and cardiovascular disease (US Department of Health and Human Services, 2004, Boffetta et al., 2008). The public deserves education about a product that nearly 80% of users – many of whom live in rural, under-served communities – initiate before their eighteenth birthday and which causes 2,300 oral cancer cases annually (Substance Abuse and Mental Health Services Administration, 2016).   The authors characterize the FDA campaign as emphasizing what the public already knows. The cigarette companies (which now own the major American ST companies) have argued in court that consumers know the risks of smoking in order to blame smokers for tobacco related disease (Milberger et al., 2006). While both youth and adults readily acknowledge ST oral health risks (Liu et al., 2015, Couch et al., 2016), ST users tend to discount these risks as personally unlikely (Helme et al., 2012), often holding unrealistic expectations of the ease of quitting before health consequences occur (Couch et al., 2016). The FDA campaign is needed to counteract these misperceptions. The need for continuous anti-ST campaigns mirrors the need for ongoing anti-smoking campaigns: though people recognize that cigarettes are dangerous, each year millions initiate and continue to smoke. There is causal evidence that such anti-tobacco media campaigns reduce youth smoking (US Department of Health and Human Services, 2012).  While cigarettes are deadlier, this does not diminish the gravity of ST use. Rural male populations with higher rates of ST use than smoking must not be overlooked. The FDA and other public health agencies are already at a major resource disadvantage in comparison to an industry that now invests over a half-billion dollars annually to promote ST products, twice as much as ten years ago (Federal Trade Commission, 2016). Limited public resources should not be used to recast tobacco products with well-established health consequences as acceptable smoking alternatives.  The tobacco harm reduction approach concedes a permanent role in society for tobacco and nicotine. That smoking persists does not mean the “barn door” isn't worth closing, or disease from smokeless is acceptable because smoking is worse. Such a framing is a disservice to those who desire to quit tobacco completely and fails to acknowledge the important risks incurred by the younger, oft-ignored, rural, lower income and less educated groups that are more likely to use ST. True tobacco harm reduction proponents should both strongly back the FDA’s proposed rule ACCEPTED MANUSCRIPTACCEPTED MANUSCRIPTto reduce nitrosamines in ST (Food and Drug Administration, 2017), and support eliminating flavored and menthol tobacco products (including fruit, mint and wintergreen flavored ST) that disproportionately appeal to youth.   Author Disclosures  1. Role of Funding Sources No funding support was provided for the preparation of this manuscript.  2. Contributors All authors materially participated in the preparation of this manuscript. JE prepared the first draft of the manuscript. JE, YH, BC, and PL reviewed and critically revised the submission.   3. Conflict of Interest All authors declare that they have no conflicts of interest.  BOFFETTA, P., HECHT, S., GRAY, N., GUPTA, P. & STRAIF, K. 2008. Smokeless tobacco and cancer. The lancet oncology, 9, 667-675. COUCH, E. T., DARIUS, E., WALSH, M. M. & CHAFFEE, B. W. 2016. Smokeless Tobacco Decision-Making Among Rural Adolescent Males in California. Journal of Community Health, 1-7. FEDERAL TRADE COMMISSION 2016. Federal Trade Commission Smokeless Tobacco Report for 2014. In: COMMISSION, F. T. (ed.). FOOD AND DRUG ADMINISTRATION 2017. Tobacco Product Standard for N-Nitrosonornicotine Level in Finished Smokeless Tobacco Products. In: SERVICES, D. O. H. A. H. (ed.). Federal Register. HELME, D. W., COHEN, E. L. & PARRISH, A. J. 2012. Health, masculinity and smokeless tobacco use among college-aged men. Health communication, 27, 467-477. HERSHEY, J. C., NIEDERDEPPE, J., EVANS, W. D., NONNEMAKER, J., BLAHUT, S., HOLDEN, D., MESSERI, P. & HAVILAND, M. L. 2005. The theory of" truth": how counterindustry campaigns affect smoking behavior among teens. Health Psychology, 24, 22. KOZLOWSKI, L. T. & SWEANOR, D. T. 2017. Young or adult users of multiple tobacco/nicotine products urgently need to be informed of meaningful differences in product risks. Addictive Behaviors. ACCEPTED MANUSCRIPTACCEPTED MANUSCRIPTLIU, S. T., NEMETH, J. M., KLEIN, E. G., FERKETICH, A. K., KWAN, M.-P. & WEWERS, M. E. 2015. Risk perceptions of smokeless tobacco among adolescent and adult users and nonusers. Journal of health communication, 20, 599-606. MILBERGER, S., DAVIS, R. M., DOUGLAS, C. E., BEASLEY, J. K., BURNS, D., HOUSTON, T. & SHOPLAND, D. 2006. Tobacco manufacturers’ defence against plaintiffs’ claims of cancer causation: throwing mud at the wall and hoping some of it will stick. Tobacco control, 15, iv17-iv26. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION 2016. Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville, Maryland: Center for Behavioral Health Statistics and Quality. US DEPARTMENT OF HEALTH AND HUMAN SERVICES 2004. The Health Consequences of Smoking: A Report of the Surgeon General. US DEPARTMENT OF HEALTH AND HUMAN SERVICES 2012. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.    ACCEPTED MANUSCRIPTACCEPTED MANUSCRIPTHighlights  Educating youth and veterans on smokeless tobacco dangers is not money wasted  While cigarettes are deadlier, smokeless tobacco use causes grave health effects  The persistence of smoking does not make disease from smokeless acceptable  True tobacco harm reduction would be reducing nitrosamines and eliminating flavors ACCEPTED MANUSCRIPTView publication stats

Don’t throw smokeless tobacco users under the bus.

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Don’t throw smokeless tobacco users under the bus.

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