My colleagues Manali Vora, Jesse Elias, and Pam Ling and I at the Center for Tobacco Control Research and Education at the University of California, San Francisco just Financial Conflicts of Interest and Stance on Tobacco Harm Reduction: A Systematic Review. (Also available at PubMed).
Here are some sources that have blogged about the paper:
Tobacco companies have actively promoted the substitution of cigarettes
with purportedly safer tobacco products (e.g., smokeless tobacco,
e-cigarettes) as tobacco harm reduction (THR). Given the tobacco,
e-cigarette, and pharmaceutical industries’ substantial financial
interests, we quantified industry influence on support for THR.
To analyze a comprehensive set of articles published in peer-reviewed
journals assessing funding sources and support for or opposition to
substitution of tobacco or nicotine products as harm reduction.
We searched PubMed, Embase, Web of Science, and PsycINFO with a
comprehensive search string including all articles, comments, and
editorials published between January 1, 1992 and July 26, 2016.
We included English-language publications published in peer-reviewed
journals addressing THR in humans and excluded studies on modified
cigarettes, on South Asian smokeless tobacco variants, on pregnant
women, on animals, not mentioning a tobacco or nicotine product, on US
Food and Drug Administration–approved nicotine replacement therapies,
and on nicotine vaccines.
Data Collection and Analysis.
We double-coded all articles for article type; primary product type
(e.g., snus, e-cigarettes); themes for and against THR; stance on THR;
THR concepts; funding or affiliation with tobacco, e-cigarette,
pharmaceutical industry, or multiple industries; and each author’s
country. We fit exact logistic regression models with stance on THR as
the outcome (pro- vs anti-THR) and source of funding or industry
affiliation as the predictor taking into account sparse data. Additional
models included article type as the outcome (nonempirical or empirical)
and industry funding or affiliation as predictor, and stratified
analyses for empirical and nonempirical studies with stance on THR as
outcome and funding source as predictor.
Searches retrieved 826 articles, including nonempirical articles (21%),
letters or commentaries (34%), editorials (5%), cross-sectional studies
(15%), systematic reviews and meta-analyses (3%), and randomized
controlled trials (2%). Overall, 23.9% disclosed support by industry;
49% of articles endorsed THR, 42% opposed it, and 9% took neutral or
mixed positions. Support from the e-cigarette industry (odds ratio
[OR] = 20.9; 95% confidence interval [CI] = 5.3, 180.7), tobacco
industry (OR = 59.4; 95% CI = 10.1, +infinity), or pharmaceutical
industry (OR = 2.18; 95% CI = 1.3, 3.7) was significantly associated
with supportive stance on THR in analyses accounting for sparse data.
Non–industry-funded articles were evenly divided in stance, while
industry-funded articles favored THR. Because of their quantity, letters
and comments may influence perceptions of THR when empirical studies
Public Health Implications.
Public health practitioners and researchers need to account for
industry funding when interpreting the evidence in THR debates. (Am J Public Health. Published online ahead of print May 16, 2019: e1–e8. doi:10.2105/AJPH.2019.305106)
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