The Federal Government Wants Population-Level Evidence But Refuses to Collect It

In 2008, I published (along with epidemiologist Carl V. Phillips) the first population-level evidence that American men have quit smoking by switching to smokeless tobacco. The study appeared in Harm Reduction Journal, and it is available here.

We used data from the 2000 version of the annual National Health Interview Survey (NHIS), which is “the principal source of information on the health of the civilian…population of the U.S.” Each year, the Centers for Disease Control and Prevention (CDC) uses NHIS to estimate smoking prevalence in the U.S.

Every few years, the National Cancer Institute (NCI) sponsors an NHIS supplement that asks questions related to cancer risks. In the 2000 survey, current and former smokers were asked about the method they had used when they either successfully (former smokers at the time of the survey) or unsuccessfully (current smokers) tried to quit smoking. One of those methods was switching to smokeless tobacco.

We estimated that 359,000 American male smokers had tried to switch to smokeless tobacco during their most recent quit attempt. Of these smokers, 73% (261,000, termed “switchers”) were former smokers at the time of the survey, representing the highest proportion of success among all methods. In comparison, the nicotine patch had been used by an estimated 2.9 million men in their most recent quit attempt, but only 35% were former smokers at the time of the survey. Of the 964,000 men who had used nicotine gum, 34% became former smokers. Of the 98,000 men who used the nicotine inhaler, 28% quit successfully. None of the estimated 14,000 men who had tried the nicotine nasal spray became former smokers. Forty-two percent of switchers reported quitting smoking all at once, which was higher than among former smokers who used medications (8–19%). Forty-six percent of switchers were current smokeless tobacco users at the time of the survey.

Quit-Smoking Method	Percent Successful
Switch to Smokeless	73%
Nicotine Patch	35%
Nicotine Gum	34%
Nicotine Inhaler	28%
Nicotine Nasal Spray	0%

In summary, we showed that switching to smokeless tobacco compared favorably with pharmaceutical nicotine as a quit-smoking aid among American men in 2000, despite the fact that few smokers knew that switching provides almost all of the health benefits of complete tobacco abstinence. This study shows that tobacco harm reduction is a viable cessation option for American smokers.

We were excited about the results from the 2000 NHIS, and we expected to see an increase in switching in the 2005 survey, which contained the NCI cancer supplement. Over that period awareness of tobacco harm reduction was growing; over 20 articles and reports were published by think tanks and prominent journalists (read them here), and there was a congressional hearing on tobacco harm reduction in 2003 (see my testimony here).

We were therefore astounded to learn that switching to smokeless tobacco was removed as a quitting option in the 2005 NCI cancer supplement. Just as tobacco harm reduction gained increased visibility and more American smokers were likely making the switch, NCI closed the books on this important topic. Some would ask: Did anti-tobacco officials at NCI also expect an increase in switching and chose not to document it?

Federal officials have just released a draft of the 2010 NHIS Survey Questionnaire, available here. Once again, NCI is sponsoring a supplement, and once again the switch-to-smokeless quit-smoking option is absent.

The omission this year is especially egregious, as the new tobacco law requires the FDA to evaluate the impact of tobacco harm reduction on the population. How can a tobacco harm reduction be evaluated if the federal government refuses to collect the data?