Background

Tobacco smoke is the cause of the most deadly epidemic of modern times. Smoking causes cancer (for example, lung, oral cavity, oesophagus, larynx, pancreas, bladder, kidney), chronic obstructive pulmonary disease (COPD), myocardial infarction, and stroke. The continuing toll of tobacco use has prompted the search for means of harm reduction for those who cannot or will not stop using tobacco. Numerous products that make implied or explicit claims to reduce the burden of smoking while allowing continued nicotine consumption are now entering the market. This report is concerned with the evaluation of these products.

Nearly one quarter of adult Americans—an estimated 47 million people—smoke cigarettes.1 Although this is far lower than the 42% recorded in 1965, the decline in the rates of smoking among adults appears to have levelled off during much of the 1990s.2 In a recent survey, 12.8% of middle school children and 34.8% of high school students reported some form of tobacco use during the month prior to their being interviewed.3 The vast majority of smokers begin tobacco use during adolescence.4 However, 70% of smokers say they want to quit5 and 34% of smokers make an attempt to quit each year. Thus, many but not all tobacco users find it very difficult to quit and continually expose themselves to known toxic agents.

Definition of harm reduction

For the purposes of this report, a product is harm reducing if it lowers total tobacco related mortality and morbidity even though use of that product may involve continued exposure to tobacco related toxicants. Many different policy strategies may contribute to harm reduction. However, this report focuses on tobacco products that may be less harmful or on pharmaceutical preparations that may be used alone or concomitantly with decreased use of conventional tobacco. The committee does not use the term “safer …