1. Personal tobacco product use and related behavioral patterns. Critical to assessing the health impact of conventional tobacco products and PREPs is the determination of actual products used, including product types and brands. It is also important to understand the impact of PREPs in terms of smoking initiation, quit attempts, maintained abstinence, and personal consumption patterns (Shiffman, 1999). In general, this can only be determined from sample surveys of relevant populations. Attitudes toward tobacco usage and knowledge of actual threats to health would also be important components of such a system.

  2. Disease outcomes. Current surveillance of tobacco-related illnesses through mechanisms such as vital records and disease registries provide important information. The development of additional types of registries, clinical record monitoring systems, and systems measuring aggregate health outcomes would add further useful information. Supplementary epidemiological studies of PREPs would enhance the ability to determine specific health outcomes. These studies would deal with use of various product lines and with potential confounders and effect modifiers of the associations. Surveillance and other long-term studies are necessary because of the duration of exposure before many chronic diseases appear. These adverse outcomes would include the health consequences that are expected based on the toxicological profile of the PREP, as well as those that are unexpected.


This section highlights existing systems of surveillance that monitor tobacco product consumption patterns, knowledge, attitudes, behaviors, and health consequences—elements that would inform the evaluation of PREP usage and impact (Giovino, 2000). The section emphasizes national and state level systems. It is possible that local or regional systems may add considerable useful information. Citations or web sites are provided for the reader who desires more detailed information.

Consumption of Tobacco Products and PREPS

The U.S. Department of Agriculture reports consumption data for the various types of tobacco products (U.S. Department of Agriculture, 2000; ERS, 2001). FTC also reports on the characteristics of cigarettes (e.g., length, filtered/non-filtered, mentholated/nonmentholated) sold in the United States (FTC, 2000a). At least one research unit (the Roswell Park Cancer Institute’s Department of Cancer Prevention, Epidemiology and Biostatistics) has begun to monitor the introduction of new products.

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