title: You might as well smoke; the misleading and harmful public message about smokeless tobacco.
abstract: BACKGROUND
  Compared to smoking cigarettes, use of Western smokeless tobacco (ST) products is associated with a very small risk of life-threatening disease (with estimates in the range of a few percent of the risk from smoking, or even less). This means that smokers can realize substantial health benefits by switching to ST, an obvious substitute. But consumers and policy makers have little chance of learning that ST is much less dangerous than smoking because popular information provided by experts and advocates overstates the health risks from ST relative to cigarettes.
  
  
  METHODS
  To examine the extent of this overstatement in one medium, we conducted a systematic review of websites containing information about ST and health risks. We examined the content of 316 relevant websites identified by a Google search.
  
  
  RESULTS
  We found that when any substantive information about the risk from ST is given, the risk is almost universally conflated with the risk from cigarettes. Accurate comparative risk information was quite rare, provided by only a handful of websites, all appearing low in our search results (i.e., of low popularity and thus unlikely to be found by someone searching for information). About 1/3 of the websites, including various authoritative entities, explicitly claimed that ST is as bad as or worse than cigarettes. Most of the other sites made statements that imply the risks are comparable.
  
  
  CONCLUSIONS
  Through these websites, and presumably other information provided by the same government, advocacy, and educational organizations, ST users are told, in effect, that they might as well switch to smoking if they like it a bit more. Smokers and policy makers are told there is no potential for harm reduction. These messages are clearly false and likely harmful, representing violations of ethical standards.
authors.affiliation: University of Texas Medical School, Center for Clinical Research and Evidence Based Medicine, Houston, USA. carl.v.phillips@cphps.org
authors.forename: Carl V
authors.initials: CV
authors.lastname: Phillips
authors.forename: Constance
authors.initials: C
authors.lastname: Wang
authors.forename: Brian
authors.initials: B
authors.lastname: Guenzel
mesh_terms: D003146:Communications Media / Q000941:ethics; D006801:Humans; D007255:Information Services / Q000941:ethics*; D016247:Information Storage and Retrieval; D020407:Internet / Q000941:ethics*; D011634:Public Health; D018570:Risk Assessment / Q000941:ethics*; D012907:Smoking / Q000009:adverse effects; D040241:Social Marketing / Q000941:ethics*; D014030:Tobacco, Smokeless / Q000009:adverse effects*