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Reflections on the ‘endgame’ for tobacco control
  1. Mitch Zeller
  1. Correspondece to Mitch Zeller, Pinney Associates, 4800 Montgomery Lane, Suite 400, Bethesda, MD 20814, USA; mzeller{at}

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The concept of an ‘endgame’ for tobacco control efforts is receiving increasing attention in advocacy, policy and academic circles. This may strike some as entirely premature in countries such as Bangladesh, where 63% of adults are exposed to secondhand smoke in the workplace,1 or the Russian Federation, where 60% of adult men still smoke.2

Nonetheless, experts in countries like Australia and New Zealand, with a decades-long commitment to comprehensive tobacco control, have grown increasingly serious about the so-called ‘endgame’.

Numerous potential endgame strategies are being explored, the most prominent of which are chronicled elsewhere in this supplement. We have yet to reach a consensus on which one or two strategies should be pursued. But when a group of global thought leaders gathered in 2012 to consider the endgame, there was convergence around the notion that we need new approaches to dramatically reduce consumption of conventional combusting cigarettes, if not other tobacco products that burn.

If such an approach is to succeed, it will be because policy makers and tobacco control advocates have overcome their reluctance and finally embraced a concept known as the ‘continuum of risk’. Over time, many policy thinkers—this author included—have seen their views on these issues evolve in just such a manner.

There is a spectrum or continuum of tobacco and medicinal products that aim to do the same thing—deliver nicotine …

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