Introduction

Cigarettes are the most addictive tobacco product and also the most deadly, causing the highest rates of tobacco-caused mortality and morbidity in most areas of the world.1 ,2 Although current tobacco control efforts have led to significant reductions in smoking prevalence, innovative strategies that can result in a more rapid elimination of cigarette smoking should be a high priority.1 ,3 In the US Surgeon General's report,1 reducing nicotine in cigarettes was considered as one potential strategy. In an article written by Tengs et al,4 in which the authors modelled the effects of reducing nicotine in cigarettes on public health, taking into account a potential black market, the following statement was made: ‘Policy makers would be hard-pressed to identify another domestic public health intervention, short of historical sanitation efforts, that has offered this magnitude of benefit to the population’. Hence, the main goal of the Advisory Note, Global Nicotine Reduction Strategy, issued by the Study Group on Tobacco Product Regulation (TobReg), was to provide a scientific review and examine the potential feasibility of reduced nicotine content cigarettes as an approach to tobacco control, and to describe the context in which this approach could be considered. This approach is bold, but worth serious consideration. Why? Because the tobacco control community has known for decades that the harms associated with smoking are primarily driven by its addictiveness. If the reinforcing effects of a drug are reduced, then continued use and consequently toxicant exposures will substantially diminish. However, this strategy is not suitable for all countries. As acknowledged in …