Estimating the harms of nicotine-containing products using the MCDA approach.
BACKGROUND
An international expert panel convened by the Independent Scientific Committee on Drugs developed a multi-criteria decision analysis model of the relative importance of different types of harm related to the use of nicotine-containing products.


METHODS
The group defined 12 products and 14 harm criteria. Seven criteria represented harms to the user, and the other seven indicated harms to others. The group scored all the products on each criterion for their average harm worldwide using a scale with 100 defined as the most harmful product on a given criterion, and a score of zero defined as no harm. The group also assessed relative weights for all the criteria to indicate their relative importance.


RESULTS
Weighted averages of the scores provided a single, overall score for each product. Cigarettes (overall weighted score of 100) emerged as the most harmful product, with small cigars in second place (overall weighted score of 64). After a substantial gap to the third-place product, pipes (scoring 21), all remaining products scored 15 points or less.


CONCLUSIONS
Cigarettes are the nicotine product causing by far the most harm to users and others in the world today. Attempts to switch to non-combusted sources of nicotine should be encouraged as the harms from these products are much lower.
Imperial College London, UK.
David J
DJ
Nutt
Lawrence D
LD
Phillips
David
D
Balfour
H Valerie
HV
Curran
Martin
M
Dockrell
Jonathan
J
Foulds
Karl
K
Fagerstrom
Kgosi
K
Letlape
Anders
A
Milton
Riccardo
R
Polosa
John
J
Ramsey
David
D
Sweanor
D006801:Humans; D009538:Nicotine / Q000009:adverse effects*; D018570:Risk Assessment; D016540:Smoking Cessation; D062789:Tobacco Products / Q000009:adverse effects*
D009538:Nicotine