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Questions for a tobacco-free future
  1. Elizabeth A Smith
  1. Correspondence to Dr Elizabeth A Smith, Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California St., Suite 455, San Francisco, CA 94118, USA; Libby.smith{at}

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Ritual tobacco use may have an ancient history, but there is nothing ‘natural’ about the way that tobacco now is grown, processed, sold and used. Cigarettes have been engineered for addictiveness, and in the process they have become more deadly.1 The tobacco industry has worked for a century to create the impression that tobacco use is inevitable and to shape the social mores that enable addiction. The once near-ubiquity of smoking, and the concomitant epidemic of disease, are human constructs. Tobacco control advocates can, and are, changing them.

Considering endgames marks a new phase of tobacco control. Ten years ago such ideas were not on the agenda, advocates perhaps having been intimidated by the spectre of alcohol prohibition and its failures and unintended consequences (a ghost the industry has invoked with alacrity). The very phrase ‘tobacco control’ suggests that tobacco is here to stay, and that its goals should be to restrict the time, place and/or manner of use in ways that do the least harm (particularly to non-users).

The need for an endgame comes from the recognition that we do not have to accept the industrial marketing of tobacco, and that current policies—successful as they have often been—will likely not make the tobacco problem disappear. Those policies were never intended to eliminate the tobacco industry; the best case scenario they offer involves endless skirmishes with the industry's ongoing attempts to expand its markets and thwart regulation. Discussion …

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