Cigarette smokers and harm reduction: Views on a “harmful but safer” versus a “quit or die” approach

The 46 million Americans who continue to smoke are given two unpleasant alternatives. They are either expected to quit smoking or bear the consequences and eventually die. Harm reduction, a term used to describe policies and programs designed to reduce the negative effects of substance use, has been suggested as an alternative approach yet has received little attention in the United States. The aim of this presentation is to explore persistent smokers' knowledge and perception regarding harm reduction, and how they describe the effects of government regulations, worksite and home smoking bans as well as the utilization of nicotine replacement therapies. In this presentation we draw on qualitative interviews with adult cigarette smokers in a Southeastern metropolitan area. Interviews were conducted with a community-recruited sample of current smokers. A modified constant comparison approach was used to analyze the data. Our findings show that government imposed regulations on smoking, smoking bans at worksites and in homes, and the utilization of nicotine replacement therapies have an impact on the numbers of cigarettes smoked. Nicotine replacement therapies play a role in reducing cigarette smoking and considering quitting. For some persistent smokers, reducing the amount and frequency of smoking and choosing “safer” tobacco products are harm reduction outcomes that have been shown to lead to greater success in eventual cessation. Based on these findings we suggest that changing the current public health message from “quit or die” to a message of “harmful but safer” might be beneficial in terms of reducing smoking rates.