The overall goal of the conference reported in this supplement is to consider new strategies and interventions expected to lower the harm to society that result from tobacco smoking. In general, there are two ways to achieve a harm reduction goal. The first is to reduce the prevalence of smoking by using interventions that reduce smoking initiation, promote attempts to stop smoking, and increase the success of these attempts once initiated. A second approach to harm reduction is to limit exposure to the most harmful substances or behaviours related to an addiction, while conceding that the addiction itself will continue in some form.

Harm reduction has received serious consideration and discussion as a strategy for dealing with hard drug abuse, where limiting the risk of exposure to HIV infection is an important concern. The concept of harm reduction has had a more limited application to tobacco dependence; thus its consideration represents a novel contribution of the present meeting. Harm reduction to continuing smokers might be accomplished by changing the nature of the cigarettes so that fewer harmful products or smaller quantities of these products are derived from each cigarette, or by lowering the number of cigarettes smoked per day, or both.

There are various specific policy initiatives and strategies that could effectively promote these harm reduction goals. The purpose of this session is to describe some of the most promising strategies and policy initiatives that have been suggested to date, outline what these are likely to accomplish, and discuss the political realities surrounding implementation of these proposals. In this first paper of the session, I shall give an overview summary of the initiatives to provide a framework for the material and a basis for subsequent discussion by panel members and our invited speaker.

I have organised the policy initiatives into …