The Original Proposal

The detrimental health effects of cigarette smoking, including the increased risk of cancer, heart and circulatory disorders and respiratory diseases are well established. Although most smokers express a desire to quit, 46 million Americans continue to smoke because of the nicotine addiction associated with the habit, and 419,000 smokers die each year from smoking-related illnesses. This paper describes the magnitude of the health risks related to various forms of tobacco use and recommends smokeless tobacco as a substitute for cigarettes by persons who are unable or unwilling to quit smoking. This proposal is made because smokeless tobacco is associated with far fewer and considerably less serious health consequences than is smoking. Of primary concern is oral cancer, the annual incidence of which is estimated at 26 cases per 100,000 smokeless tobacco users. If all American smokers used smokeless tobacco instead, this would result in 6,000 deaths from oral cancer per year. This is only one twentieth of all smoking related cancers, less than one tenth of smoking related lung cancers, and less than half of the number of oral cancers now attributed to smoking. In addition, smokeless tobacco is not associated with emphysema and heart attacks. A public health policy that recognizes smokeless tobacco as an alternative to smoking would benefit individuals confronted with the unsatisfactory options of abstinence or continuing to smoke.