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The controversy of tobacco harm reduction in the United States persists despite evidence that an important audience of tobacco prevention and control, i.e., the people who use or are likely to use nicotine and tobacco products, are engaging in practices that may be considered harm reduction. Despite this, a significant proportion of the US tobacco control and prevention field continues to be guided by a precept that there is "no safe tobacco," therefore failing to acknowledge practices that may be used to reduce the harms associated with consuming combustible forms of nicotine and tobacco. In this commentary, we argue that ignoring the potential benefits of harm reduction strategies may unintentionally lead to an erosion of trust in tobacco control among some members of the public. Trust in tobacco control as an institution is crucial for the success of tobacco control efforts. To ensure trust, we must return to our basic principles of doing no harm, developing programs that are responsive to people's experiences, and providing resources in assisting people to reduce the harms that may be associated with practices, such as smoking, which adversely affect health. Only by respecting an individual's priorities can we cultivate trust and develop tobacco prevention efforts that are grounded in the realities of people's lives and responsive to their needs.

Introduction: To address gaps in existing research, the current study used a mixed‐methods approach to describe, contextualise and understand harm perceptions of vaping nicotine relative to cigarette smoking and associations with nicotine and tobacco (NT) use among young adults who identify their genders and sexualities in ways that classify them as sexual and gender minorities (SGM). Methods: Results are based on cross‐sectional surveys and online qualitative interviews with 98 SGM young adults (18–25 years old) in California's San Francisco Bay Area who currently or formerly used combustible tobacco. We generated a measure assessing participants' relative harm perceptions of e‐cigarette use versus cigarette smoking and identified those who perceived cigarette smoking as more harmful than e‐cigarette use compared to those who perceived it to be equally or less harmful. Results: We found that relative harm perceptions of cigarette smoking versus e‐cigarette use are likely related to much uncertainty and confusion about the harms of e‐cigarette use. Moreover, findings illustrate that public health messages regarding the risks of e‐cigarette use may have unintended consequences of increasing cigarette use to replace e‐cigarette use for some SGM young adults, a practice that is incongruent with scientific evidence demonstrating that cigarettes and other combustible tobacco products are riskier than e‐cigarettes and other forms of NT use. Discussion and Conclusions: Results suggest the need for evidence‐based, clear, and direct messaging about the relative harms of cigarettes versus e‐cigarettes to reduce NT‐related inequities in SGM populations. [ABSTRACT FROM AUTHOR]

Introduction Cigarette smoking is among the most harmful ways to consume nicotine and tends to be concentrated among socially marginalized groups of people, including sexual and gender minorities (SGM). Though some approaches to tobacco control in the United States are harm reduction strategies (eg, smoke-free environments), often abstinence is an explicitly stated goal and discussions of tobacco harm reduction (THR) are controversial, particularly for young people. Despite this controversy in the tobacco field, emerging research suggests that THR may be gaining momentum as a "community-led" rather than "public health-led" health practice. To date, little is known about how SGM young adults negotiate their use of tobacco products, particularly in terms of minimizing the harms associated with smoking. Aims and Methods We conducted 100 in-depth interviews with SGM young adults ages 18–25 years living in the San Francisco Bay Area, to better understand participant perceptions and everyday practices related to THR. Results A thematic analysis of interview narratives revealed the ways in which participants relied upon various THR strategies while balancing their well-being within the context of broader socio-structural harms. Participants' narratives also underscored beliefs about the importance of pragmatic, nonjudgmental, and person-centered approaches to preventing inequities in tobacco-related illnesses. Conclusions Findings represent a significant departure from the mainstream discourse in the U. S. surrounding THR, by revealing how understanding the practice of THR among SGM young adults who use nicotine and tobacco can be instrumental in shaping approaches to tobacco control policy and prevention that may ultimately help to reduce inequities in tobacco-related illnesses. Implications Findings from this study present the perspectives and practices of THR among sexual and gender minority young adults and emphasize the importance of integrating this approach in tobacco control to better achieve tobacco-related equity. Results can be used to better design tobacco prevention, treatment, and policy strategies that are compassionate and responsive to the needs of these important priority populations. [ABSTRACT FROM AUTHOR]