The issues related to tobacco harm reduction continue to challenge the tobacco control research and policy communities. The potential for combusting tobacco products to reduce exposure and risk remains largely unknown, but this has not stopped manufacturers from offering such products making these claims. The role of oral tobacco products in a harm reduction regimen has also been a source of dialogue and debate. Within the last few years, major cigarette manufacturing companies have begun selling smokeless products for the first time, claiming to target current cigarette smokers. Other cigarette manufacturers are also offering smokeless products in markets around the world. The harm reduction debate has at times been divisive. There has been no unifying set of principles or goals articulated to guide tobacco control efforts. In particular, the research needs are extraordinarily high in order to drive evidence-based policy in this area and avoid the mistakes made with “light” cigarettes. This paper discusses recommendations from a strategic dialogue held with key, mostly US-based tobacco control researchers and policy makers to develop a strategic vision and blueprint for research, policy and communications to reduce the harm from tobacco for the US. Short-term and long-term objectives are described.
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For a list of Strategic Dialogue on Tobacco Harm Reduction Group participants and affiliations, see Appendix
Funding: This dialogue process was funded by Robert Wood Johnson Foundation, American Legacy Foundation and the University of Minnesota, Transdisciplinary Tobacco Use Research Center (P50-DA013333).
Competing interests: CB: no conflicts of interest; NB: serves as a paid consultant to several pharmaceutical companies that market or are developing smoking cessation medications and also serves as a paid expert witness in litigation against tobacco companies; LB: no conflicts of interest; DB: testified against tobacco industry in multiple lawsuits; PC: no conflicts of interest; GC: no conflicts of interest; MD: no conflicts of interest; TE: consulted with the National Association of Attorneys General on issues related to potential reduced exposure products (PREPs) and PREP testing, and has received free of charge smokeless tobacco products from RJ Reynolds to test them in his laboratory (neither RJ Reynolds nor any other company has ever had any input into any work performed in his laboratory nor have they had any input into any reporting of results); GG: no conflicts of interest; DH: consulted for pharmaceutical companies (Pfizer, Abbott) that are marketing or developing smoking cessation medications (no honorarium received), received research grant from Nabi Biopharmaceuticals for clinical trial; CH: no conflicts of interest; SH: served as an expert witness for the plaintiff in a case in which US Smokeless Tobacco Company is being sued by the family of a man who died from oral cancer after years of using smokeless tobacco; JH: Pinney Associates (employer) provides consulting services to GlaxoSmithKline Consumer Healthcare on issues related to treating tobacco dependence. JH has interest in a nicotine delivering smoking cessation product under development; CH: owns pharmaceutical stock (Johnson and Johnson, Pfizer); KK: no conflicts of interest; SL: consultant/advisory committee member, speaker for Pfizer pharmaceutical company; consultant for Johnson and Johnson; DL: no conflicts of interest; SM: no conflicts of interest; MM: no personal conflicts of interest. The Campaign for Tobacco-Free Kids (employer) has received donations from pharmaceutical companies that make cessation products, albeit those donations are a very small percentage of the campaign’s budget; MP: no conflicts of interest; PP: no conflicts of interest; PShields: served as expert witness in tobacco litigation; PSlovic: no conflicts of interest; DS: receives, directly or indirectly, fees from the marketers of smoking cessation medicines. None of this money is significant enough in relation to his personal financial resources to be considered material; KW: Chair of the Pfizer Tobacco Independence Global Policy Advisory Board, for which an honorarium is received (which is immediately endorsed to a scholarship fund via employer); MZ: Pinney Associates (employer) provides consulting services to GlaxoSmithKline Consumer Healthcare on issues related to treating tobacco dependence.