Smokeless tobacco, smoking cessation and harm reduction: an economic analysis

Good estimates place 'hard core' smoking rates in the United States at approximately 25%, with little change over the decade of the 1990s. This paper examines the possibilities of 'harm reduction' with the use of smokeless tobacco. Specifically, using an econometric model we seek to determine whether an increase in the use of smokeless tobacco would lead to reduced smoking rates in the United States. Applying our model to the NHANES III (National Health and Nutrition Examination Survey) we find that the use of smokeless tobacco by an average U.S. male smoker would increase the average probability of smoke cessation by over 10%. Approximately 3 million additional 'quits' would result for 26 million smokers. Our study permits an examination of cessation by age groups and we find that males who use smokeless tobacco between 16 and 65 have a 10-14% probability of quitting but that the probability falls beyond age 66. Important implications for life extension and health costs would attend these results with, under conservative assumptions, life years saved approximating 2.16 million and health care cost-savings of about $3 billion per year.