Harm Reduction

This page was last edited on at

In recent years a large number of new consumer tobacco and nicotine products have emerged on the market, including e-cigarettes and heated tobacco products. These are collectively referred to as new, novel, or alternative tobacco and nicotine products and the range of products available continues to grow. The tobacco control community is engaged in an ongoing discussion about the terminology used to describe these products.1 TobaccoTactics focuses mainly on the products in which the large transnational tobacco companies have an interest, and currently refers to them as “next generation products” (abbreviated as NGPs).

There is an ongoing scientific and policy debate about the role of these products in tobacco control, and whether they can help reduce the harms of tobacco. This page explores the concepts and issues around the topic and links to relevant pages on TobaccoTactics, research by the Tobacco Control Research Group (TCRG), and resources for further reading.

What is Harm Reduction?

The concept of harm reduction, first used in relation to illicit drugs, refers to policies and programmes which aim to reduce the harm from addictive behaviours for individuals, and the community and society in which they live.2345 Harm reduction recognises that, while the preferred goal is abstinence, this is not always achievable. Helping people change to less harmful alternatives may be a more effective approach.34 It therefore primarily aims to reduce drug-related harm rather than drug use.5

Tobacco Harm Reduction

The concept of tobacco harm reduction (THR) refers to reducing the levels of disease (morbidity) and death (mortality) from tobacco use among smokers. While eliminating exposure to nicotine altogether would result in the greatest reduction of harm, THR recognises that this is not always achievable, and users may not always be able or willing to quit. So THR advocates, as its primary goal, that users switch to using nicotine in its less harmful forms.

People smoke primarily because they are addicted to nicotine, but it is the other toxins in tobacco smoke that cause most of the harm. Nicotine can be obtained from a range of products, which vary in their level of harm and addictiveness. This “spectrum of harm” ranges from smoked tobacco (cigarettes) at the top, to medicinal nicotine (nicotine replacement therapy products, or NRT) at the bottom.67

It is hard to determine the exact position of other, newer products in this spectrum, especially their long-term effects on health. With a longer history of use in Scandinavia and the US, there has been research into the relative harms of snus for a number of years. It would generally be placed at the lower end of the spectrum.8

More recently there has been considerable research around the potential role of e-cigarettes, and some evidence that they might help individual smokers quit cigarettes. However,  they are not harm free and there are concerns around youth uptake and dual use with tobacco products.91011121314

The research around newer heated tobacco products (HTPs) is much less developed with as yet no randomised control trials (RCTs).111516 There is currently no evidence that HTPs are less harmful than cigarettes.

For individual smokers, quitting entirely is the best option for reducing harm. If smokers are not able to quit, the risk of disease from tobacco use can be reduced by switching completely to a genuinely less harmful product. Continuing to smoke cigarettes alongside other tobacco or nicotine products would not lead to the same health benefits.

Reducing Harm at Population Level

Although there is no single definition of harm reduction, it is generally acknowledged that it needs to reduce harm not only for the individual user but for the community and society in which they live.1718 In tobacco harm reduction, therefore, it is necessary to consider the impacts on the whole population rather than just those who currently smoke.19

A product might enable some smokers to quit or reduce their risk of disease. But if it still increases population level of harm, it cannot be considered as harm-reducing; for example if a large numbers of non-smokers took up the use of tobacco products; continued to smoke rather than quit; or continued to smoke cigarettes and use other products at the same time (dual or poly use).2021222324

Although individual smokers who switch fully to less harmful products can reduce their health risks, that does not mean that the introduction of one or more NGPs in a country will lead to reduced harm at a population level.25262728 This would depend on which products are available, whether they enable smokers to quit, and if they are genuinely lower risk than combustibles. It also depends on how they are used. If they are primarily taken up by smokers to quit, or by those who would otherwise have started smoking, this would help reduce overall levels of smoking and therefore reduce harm in the population. However, if they are taken up by people who have not used the products before (sometimes called “nicotine naïve” consumers), including children, this could lead to an increase in smoking, and increase harm.293031323334

A summary of these issues is provided by the National Academies of Sciences.13

Particular concerns about the potential for population benefit have been expressed by healthcare professionals, policy makers and tobacco control advocates low- and middle-income countries.353637

The impact at population (or country) level also depends on other inter-related factors, including:

  • the strength and enforcement of regulation controlling the NGP itself (e.g. its nicotine content and formulation as well as its price, promotion and availability)
  • the behaviour of the companies selling tobacco and NGPs: for example whether and how they market to youth, or circumvent regulation, such as smoke-free policies
  • the strength and enforcement of tobacco control regulation more generally (i.e. FCTC measures)
  • the degree of tobacco company interference, and the ability to counter it

Overall, quitting smoking entirely remains the best option both for individual smokers and from a public health perspective.

  • For up to date information on tobacco regulation, see the Tobacco Control Laws website, published by the Campaign for Tobacco Free Kids (CTFK).
  • Information on the regulation of specific products can be found on the pages linked below.
  • For information on tobacco companies’ interference in tobacco control, see the Global Tobacco Industry Interference Index.

The Role of the Tobacco Industry

Tobacco harm reduction has become controversial and, some feel, divisive in public health, in particular where the debate has focussed on the potential role for other nicotine and tobacco products such as e-cigarettes and snus.83839

One of the reasons harm reduction is a sensitive topic is that it can involve engagement with the tobacco industry, which has a history of manipulating public debate and health policy.

A History of Misinformation and Manipulation

In the 1960s and 1970s, public health scientists and officials in the US and UK encouraged smokers to switch to low-tar and low-nicotine cigarette brands.  They had been persuaded by an apparent commitment by tobacco companies to develop a “less hazardous cigarette”.4041 However, the tobacco industry concealed its own research which showed that these modified products would lead to ‘compensatory’ smoking behaviours (such as inhaling more strongly or taking more frequent puffs) and not in fact reduce the harms of smoking.404243

In the 1990s harm reduction claims were also made for early ‘heat not burn’ tobacco products, although these were not commercially successful at the time.42

Historians of public health have warned that, given the tobacco industry’s past misleading use of harm reduction claims to further its commercial and policy goals, THR strategies need to be approached with care and be supported by robust scientific evidence.43444546

The Industry’s Real Motive

In one word: profit. While tobacco companies continue to sell and promote their combustible products, global cigarette sales are decreasing.47

Tobacco companies have invested in, developed and promoted NGPs in the hope that this will prevent smokers from quitting entirely and attract new users. Ultimately, the aim is to offset the diminishing profits from conventional tobacco products. However, the main driver for tobacco company growth is still cigarettes; and this is likely to continue to be the case for the foreseeable future.384748

Evidence shows that the tobacco industry has never been genuinely interested in reducing harm. Its activities are primarily designed to serve its commercial objectives, in a variety of ways:

  • by claiming a commitment to harm reduction, and attempt to improve its reputation. This can be seen as an attempt to “‘renormalise’ an industry that wants to be seen as a responsible business with a legitimate product”.38474849
  • by using NGPs as tools to initiate dialogue with scientists, public health experts, politicians and policy makers, re-framing the industry as ‘part of the solution’ rather than being responsible for the problem. It continues to try to re-enter the policy arena from which it has increasingly, and successfully, been excluded (see below), to gain a ‘seat at the table’.4748
  • by attempting to weaken and undermine tobacco control regulations. Nearly a decade after the promotion of snus as a dual use product, tobacco companies are following the same strategy. British American Tobacco (BAT) has referred to the “additive opportunity” of NGPs; a way to gain both new nicotine users and give smokers “new consumption moments”, including in restaurants and other places where smoking is banned.3850 Philip Morris International (PMI) has promoted “IQOS friendly places” including hotels, clubs and other public spaces, where people can use Heated Tobacco Products (HTPs) despite smoking bans.51 The tobacco industry’s fundamental conflict of interest should prevent it from influencing the regulation of NGPs.
  • as a tactic to divide the public health community.444752

The main barrier to achieving public health benefits from harm reduction approaches is the behaviour of the tobacco industry. There is a fundamental conflict of interest between tobacco companies’ interests and public health. This is enshrined in the World Health Organization’s (WHO) Framework Convention for Tobacco Control (FCTC).  FCTC Article 5.3 requires the exclusion of the tobacco industry and its front groups from policy making. As the tobacco industry manipulates debates over harm reduction for policy advantage, Article 5.3 applies to those producers of NGPs who are part of the tobacco industry, and the third party organisations lobbying on its behalf.4748

Industry-Funded Research

The tobacco industry attempts to influence the scientific debates around NGPs and harm reduction. Research into new products and their impacts, at both individual and population level, is essential. The tobacco industry has a clear vested interest in showing that their products are safe, but they have an  history of manipulating the science around cigarettes.535455

They have also done this via third parties.5657

Evidence is beginning to emerge indicating that we should also be concerned about their NGP science,5859 particularly their heavy involvement in heated tobacco product science.11151658

Researchers from the Center for Tobacco Control Research at UCSF found that articles funded by the tobacco industry favoured harm reduction, while non-industry-funded articles, were “evenly divided in stance”.60 They also found a lack of empirical research, with more of the debate conducted in ‘opinion pieces’.61

A number of scientists influencing the debate on harm reduction or NGPs, are funded by the tobacco industry. Examples covered on TobaccoTactics include:

It has been argued that the best way to ensure independent science in this area is through a tax on tobacco companies.62 Until that happens, care must be taken when interpreting research funded directly – or indirectly – by the tobacco industry.

Implications for Global Tobacco Control

The WHO has published guidelines on NGPs and their regulation. An information sheet on HTPs was released in July 2018, recommending that “HTPs should be subject to the same policy and regulatory measures applied to all other tobacco products” in line with the FCTC.63

In March 2019, the Secretariat of the WHO FCTC issued an information note, which compiled all Conference of the Parties (COP) decisions related to e-cigarettes. A few months later, the Secretariat released a statement urging governments to remain vigilant, stating that:

“novel and emerging nicotine and tobacco products…are creating another layer of interference by the tobacco industry and related industries, which is still reported by Parties as the most serious barrier to progress in implementing the WHO FCTC”. 64 It also reminded Parties of their obligations under Article 5.3 to protect tobacco control policies and activities from all commercial and vested interests.64

According to the editor of the journal Tobacco Control, tobacco companies:

“continue to work to interject themselves into activities promoted under the WHO Framework Convention on Tobacco Control (FCTC), particularly criticising Article 5.3, which seeks to protect public health policy-making from their commercial interests, and why their allies seek to pressure and undermine the WHO.”65

The global tobacco control priority remains the implementation of comprehensive, evidence-based, well-enforced population level policies. As outlined in the FCTC these aim to reduce the uptake of smoking by young people and prompt smokers to quit. They include policies such as tobacco tax increases, bans on promotion, restrictions on availability, and the implementation of WHO FCTC Article 5.3. Any harm reduction approaches should be implemented as part of a broader strategy, including a comprehensive range of well enforced tobacco control policies.

The Tobacco Control Research Group states that:

“The tobacco industry, and its front groups, should not be treated as legitimate partners in any discussions on tobacco control policies and approaches, including harm reduction, or in research on NNTPs [novel nicotine and tobacco products].”52

For more information on how the tobacco industry works through its front groups and other allies see the page: Third Party Techniques.

Tobacco Endgame

In some countries (such as New Zealand and Canada) ‘endgame’ approaches to creating a tobacco- and nicotine-free future are increasingly being discussed, for example de-nicotinising tobacco products. Endgame approaches are diverse.6667 They may include a role for genuinely reduced risk products to be used as quitting aids and/or alternative products to cigarettes.68697071

TobaccoTactics Resources

The Next Generation Products page gives an overview of transnational tobacco companies’ interests and products, and links to more detailed pages for each company. The page contains a graphic overview of key tobacco company brands.

The following pages give more detail on the product types, and link back to tobacco company product pages:

See also Product Innovation as a tobacco company strategy.

List of pages in the category Harm Reduction.

Relevant Links

TCRG Research

For a comprehensive list of all TCRG publications, including TCRG research that evaluates the impact of public health policy, go to the Bath TCRG’s list of publications.

 

References

  1. R. O’Connor, S.J. Durkin, J.E. Cohen, et al, Thoughts on neologisms and pleonasm in scientific discourse and tobacco control, Tobacco Control 2021;30:359-360.
  2. Harm Reduction International, What is Harm Reduction? A position statement, website, undated, accessed July 2021. Available in multiple languages.[ref]Harm Reduction International, What is Harm Reduction? A position statement, website, undated, accessed July 2021. Available in multiple languages
  3. abR. Newcombe, High Time For Harm Reduction, Druglink, 1987;2. Available from Drugwise.org.uk
  4. abStratton K, Shetty P, Wallace R, Bondurant S, editors, Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction, Institute of Medicine, Washington, DC: The National Academies Press; 2001, doi:10.17226/10029
  5. abS. Lenton, E. Single, The definition of harm reduction, Drug and Alcohol Review, 1998;17(2):213-9. Published online 12 July 2009
  6. N. Gray, J.E. Henningfield, N.L. Benowitz NL et al, Toward a comprehensive long term nicotine policy, Tobacco Control, 2005;14:161-165
  7. J. Hartmann‐Boyce, S.C. Chepkin, W. Ye W, et al,  Nicotine replacement therapy versus control for smoking cessation, Cochrane Database of Systematic Reviews, 2018
  8. abC.E. Gartner, W.D. Hall, S. Chapman, B. Freeman, The PLoS Medicine Debate: Should the Health Community Promote Smokeless Tobacco (snus) as a Harm Reduction Measure? PLoS Medicine, 2007;4(7):1138-1141, doi:10.1371/journal.pmed.0040185
  9. Can electronic cigarettes help people stop smoking, and do they have any unwanted effects when used for this purpose? Cochrane science explainer, UK, April 2021
  10. J. Hartmann-Boyce, H. McRobbie, N. Lindson et al, Electronic cigarettes for smoking cessation, Cochrane systematic review, April 2021
  11. abcA. McNeill, L.S. Brose, R. Calder et al, Evidence review of e-cigarettes and heated tobacco products, 2018, A report commissioned by Public Health England, PHE February 2018
  12. P. Hajek, A. Phillips-Waller, D. Przulj D et al, A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy, New England Journal of Medicine, 2019;380(7):629-37.doi:10.1056/NEJMoa1808779
  13. abK. Stratton, L.Y. Kwan, D.L. Eaton eds, Public Health Consequences of E-Cigarettes, National Academies of Sciences, Engineering, Medicine, 2018. doi:10.17226/24952
  14. A.M. Glasser, L. Collins, J.L. Pearson et al, Overview of Electronic Nicotine Delivery Systems: A Systematic Review, American Journal of Preventive Medicine, 2017;52(2):e33-e66. doi:10.1016/j.amepre.2016.10.036
  15. abM. Jankowski, G.M. Brożek, J. Lawson et al, New ideas, old problems? Heated tobacco products – A systematic review. International Journal of Occupational Medicine and Environmental Health. 2019;32(5):595-634. doi:10.13075/ijomeh.1896.01433
  16. abE. Simonavicius, A. McNeill, L. Shahab, L.S. Brose, Heat-not-burn tobacco products: a systematic literature review, Tobacco Control, 2019;28(5):582-94. doi:10.13075/ijomeh.1896.01433
  17. G.A. Marlatt, Harm reduction: Come as you are, Addictive Behaviors, 1996;21(6):779-88.doi:10.1016/0306-4603(96)00042-1
  18. Canadian Centre on Substance Use and Addiction, Harm reduction: What’s in a name? Ottawa, CCSA, May 2008
  19. F.T Leone, K-H.Carlsen, D. Chooljian et al, Recommendations for the Appropriate Structure, Communication, and Investigation of Tobacco Harm Reduction Claims. An Official American Thoracic Society Policy Statement, American Journal of Respiratory and Critical Care Medicine, 2018;198(8):e90-e105.doi:10.1164%2Frccm.201808-1443ST
  20. C. Pisinger C, Why public health people are more worried than excited over e-cigarettes, BMC Medicine, 2014;12(1):226
  21. T.W. Ferkol, H.J. Farber, S. La Grutta et al, Electronic cigarette use in youths: a position statement of the Forum of International Respiratory Societies, European Respiratory Journal, 2018;51(5):1800278.doi:10.1183/13993003.00278-2018
  22. C. Franck, K.B. Filion, J. Kimmelman et al, Ethical considerations of e-cigarette use for tobacco harm reduction, Respiratory Research, 2016;17(1):53.doi:10.1186/s12931-016-0370-3
  23. D.T. Levy, K.M. Cummings, A.C. Villanti et al, A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products, Addiction, 2017;112(1):8-17.doi: 10.1111/add.13394
  24. B.J. Fox, J.E. Cohen, Tobacco harm reduction: A call to address the ethical dilemmas, Nicotine & Tobacco Research, 2002;4(Suppl_2):S81-S7.doi:10.1080/1462220021000032861
  25. A.B. Gilmore, G.E. Hartwell, E-cigarettes: threat or opportunity?, European Journal of Public Health, 2014, 24(4):532-3. doi:10.1093/eurpub/cku085
  26. O. Osibogun, Z. Bursac, W.E. Maziak, E-Cigarette Use and Regular Cigarette Smoking Among Youth: Population Assessment of Tobacco and Health Study (2013–2016), American Journal of Preventive Medicine, 2020;58(5):657-65. doi:10.1016/j.amepre.2020.01.003
  27. R. McMillen, J.D. Klein, K. Wilson et al, E-Cigarette Use and Future Cigarette Initiation Among Never Smokers and Relapse Among Former Smokers in the PATH Studyv, Public Health Reports, 2019;134(5):528-36. doi:10.1177%2F0033354919864369
  28. S.S. Soneji, H-Y. Sung, B.A. Primack et al, Quantifying population-level health benefits and harms of e-cigarette use in the United States, PLOS ONE. 2018;13(3):e0193328. doi:10.1371/journal.pone.0193328
  29. K.A. Cullen, A.S. Gentzke, M.D. Sawdey et al, e-Cigarette Use Among Youth in the United States, 2019, JAMA. 2019;322(21):2095-103.doi:10.1001/jama.2019.18387
  30. M.L. Goniewicz, N.J. Leigh, M. Gawron et al, Dual use of electronic and tobacco cigarettes among adolescents: a cross-sectional study in Poland, International Journal of Public Health, 2016;61(2):189-97.doi:10.1007/s00038-015-0756-x
  31. S. Soneji, J.L. Barrington-Trimis, T.A. Wills et al, Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis. JAMA Pediatrics, 2017;171(8):788-97.doi:10.1001/jamapediatrics.2017.1488
  32. R. Greenhill, L. Dawkins, C. Notley et al, Adolescent Awareness and Use of Electronic Cigarettes: A Review of Emerging Trends and Findings, Journal of Adolescent Health, 2016;59(6):612-9.doi:10.1016/j.jadohealth.2016.08.005
  33. S.L. Carroll Chapman, L-T. Wu, E-cigarette prevalence and correlates of use among adolescents versus adults: A review and comparison, Journal of Psychiatric Research. 2014;54:43-54.doi:10.1016/j.jpsychires.2014.03.005
  34. R. Grana, N. Benowitz, S.A. Glantz, E-cigarettes: a scientific review, Circulation, 2014;129(19):1972-86.doi:10.1161/circulationaha.114.007667
  35. The Union, Union Position Paper on E-Cigarettes and HTP Sales in LMICs, 3 March 2020, accessed June 2021
  36. A. Ayo-Yusuf, D. M. Burns, The Complexity of “harm reduction” with smokeless tobacco as an approach to tobacco control in low-income and middle-income countries. 16 February 2012, accessed June 2021
  37. C.O. Egbe, L. London, S. Kalideen, et al, The need to regulate electronic cigarettes amidst health concerns: Let’s follow the evidence, South African Medical Journal 2020;110(3):178-179. DOI:10.7196/SAMJ.2020.v110i3.14568
  38. abcdT. Dewhirst, Co-optation of harm reduction by Big Tobacco, Tobacco Control, 12 August 2020, doi: 10.1136/tobaccocontrol-2020-056059
  39. D. Mowls Carroll, R.L. Denlinger-Apte, S.S. Dermod, et al, Polarization Within the Field of Tobacco and Nicotine Science and its Potential Impact on TraineesNicotine & Tobacco Research, Volume 23, Issue 1, January 2021, pp 36–39, doi:10.1093/ntr/ntaa148
  40. abM. Parascandola, Lessons from the history of tobacco harm reduction: The National Cancer Institute’s Smoking and Health Program and the ‘less hazardous cigarette,’ Nicotine and Tobacco Research 7, 2005, 5: 779–789, doi:10.1080/14622200500262584
  41. J. Elias, P.M. Ling, Origins of tobacco harm reduction in the UK: the ‘Product Modification Programme’ (1972–1991), Tobacco Control, 2018;27:e12-e18
  42. abD.K. Hatsukami, D.M Carroll, Tobacco harm reduction: Past history, current controversies and a proposed approach for the future, Preventive Medicine, 2020, Apr 23:106099. doi: 10.1016/j.ypmed.2020.106099
  43. abM. Parascandola, Tobacco harm reduction and the evolution of nicotine dependenceAm J Public Health, 2011;101(4):632-641. doi:10.2105/AJPH.2009.189274
  44. abM. Zatoński, A. Brandt, ‘Divide and conquer? E-cigarettes as a disruptive technology in the history of tobacco control’ in Gruszczyński, Ł. (ed.) The Regulation of E-cigarettes: International, European and National Challenges, Edward Elgar Publishing, 2019
  45. A.M. Brandt, The cigarette century: The rise, fall, and deadly persistence of the product that defined America, Basic Books, 2007, abstract here
  46. R.N. Proctor,  Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition, Berkeley, CA: University of California Press, 2011
  47. abcdefSTOP, Addiction at any cost. Philip Morris International uncovered, 2020, available from exposetobacco.org
  48. abcdPeeters S, Gilmore AB. Understanding the emergence of the tobacco industry’s use of the term tobacco harm reduction in order to inform public health policy. Tobacco Control. 2015;24(2):182.
  49. S. Peeters S, A.B. Gilmore, Transnational Tobacco Company Interests in Smokeless Tobacco in Europe: Analysis of Internal Industry Documents and Contemporary Industry Materials, PLOS Medicine, 2013;10(9):e1001506.doi:10.1371/journal.pmed.1001506
  50. P. Lageweg, “Step-Changing New Categories: A very significant growth opportunity”, British American Tobacco Investor Day Presentation, BAT website, 14 March 2019, accessed June 2021
  51. M. Davies, B. Stockton, M. Chapman, T. Cave, The ‘UnSmoke’ Screen: The Truth Behind PMI’s Cigarette-Free FutureThe Bureau of Investigative Journalism, 24 February 2020, accessed June 202
  52. abTobacco Control Research Group, TCRG statement on novel nicotine and tobacco products, University of Bath, May 2021
  53. L.A. Bero, Tobacco industry manipulation of research, Public Health Reports, 2005;120(2):200-8.doi:10.1177%2F003335490512000215
  54. A.M. Brandt, Inventing conflicts of interest: a history of tobacco industry tactics, American Journal of Public Health, 2012;102(1):63-71.doi:10.2105%2FAJPH.2011.300292
  55. S. Lee, The Tobacco Industry’s Abuse of Scientific Evidence and Activities to Recruit Scientists During Tobacco Litigation,  J Prev Med Public Health, 2016;49(1):23-34.doi:10.3961%2Fjpmph.15.063
  56. A. Fallin, R. Grana, S.A. Glantz, ‘To quarterback behind the scenes, third-party efforts’: the tobacco industry and the Tea Party, Tobacco Control, 2014;23(4):322
  57. World Health Organisation, Tobacco Industry Interference with Tobacco Control, 2009
  58. abS.A. Glantz, FDA should not authorize Philip Morris International to market IQOS with claims of reduced risk or reduced exposure, Center for Tobacco Control Research and Education, 2020
  59. C. Pisinger, N. Godtfredsen, A.M. Bender, A conflict of interest is strongly associated with tobacco industry–favourable results, indicating no harm of e-cigarettes. Preventive Medicine. 2019;119:124-31.doi:10.1016/j.ypmed.2018.12.011
  60. Y. Hendlin, M. Vanora, J. Elias, P. Ling, Financial Conflicts of Interest and Stance on Tobacco Harm Reduction: A Systematic Review, American Journal of Public Health , 2019, 109, e1_e8.doi:10.2105/AJPH.2019.305106
  61. Y. Hendlin, M. Vanora, J. Elias et al, Assessing the tobacco harm reduction (THR) debate: a systematic review, Tobacco Induced Diseases, 2018;16(Suppl 1):A672.doi:10.18332/tid/84665
  62. J. Cohen, M. Zeller, T. Eissenberg et al, Criteria for evaluating tobacco control research funding programs and their application to models that include financial support from the tobacco industry, Tobacco Control, 2009;18(3):228.doi:10.1136/tc.2008.027623
  63. WHO Tobacco Free Initiative, Heated tobacco products (HTPs) market monitoring information sheet, WHO website, July 2018, accessed February 2020
  64. abWorld Health Organization, The Convention Secretariat calls Parties to remain vigilant towards novel and emerging nicotine and tobacco products, FCTC press release, 13 September 2019, accessed October 2019
  65. R. Malone, Finding ‘common ground’ on shifting sands: observations on the conflicts over product regulation, Tobacco Control 2021;30:119-120
  66. M. Laugesen, M. Glover, T. Fraser et al, Four policies to end the sale of cigarettes and smoking tobacco in New Zealand by 2020, New Zealand Medical Journal, 2010;123(1314):55-67
  67. F.S. van der Deen, N. Wilson, C.L. Cleghorn et al, Impact of five tobacco endgame strategies on future smoking prevalence, population health and health system costs: two modelling studies to inform the tobacco endgame, Tobacco Control, 2018;27(3):278
  68. R.E. Malone, Imagining things otherwise: new endgame ideas for tobacco control, Tobacco Control, Editorial, 2010;19(5):349
  69. T.T. Smith, D.K. Hatsukami, N.L. Benowitz et al, Whether to push or pull? Nicotine reduction and non-combusted alternatives – Two strategies for reducing smoking and improving public health, Preventive Medicine, 2018;117:8-14.doi:10.1016/j.ypmed.2018.03.021
  70. P.A. McDaniel, E.A. Smith, R.E. Malone, The tobacco endgame: a qualitative review and synthesisv, Tobacco Control, 2016;25(5):594
  71. C. Gartner, A. McNeill, Options for global tobacco control beyond the Framework Convention in Tobacco Control, Addiction, 2010;105(1):1-3. doi:10.1111/j.1360-0443.2009.02720.x
Go to Homepage