avoidable premature death in the developing world, as it is in developed countries today. In recognition of the difficulties of cessation, the WHO Framework Convention on Tobacco Control has been reviewing scientific information on harm reduction as part of its overall strategies.

However, despite the morbidity and mortality caused by tobacco and widespread knowledge by adults and adolescents of its adverse health effects, tobacco use continues. The biologically active component in tobacco that is primarily responsible for this is nicotine. Nicotine acts on several organs, including the brain. Nicotine is pleasurable to the user, and it is addictive. Thus, many but not all tobacco users find it very difficult to break their addiction and reduce the risk to their health. The continuing toll of tobacco use has prompted the public health community to consider anew harm reduction approaches for tobacco.

Tobacco harm reduction refers simply to the goal of reducing harm to health from tobacco use, including environmental tobacco smoke (ETS). Harm avoidance is achieved by never using tobacco products or having contact with ETS. Harm is minimized by quitting tobacco use and reducing exposure to ETS. For the purposes of this report—and as the term is commonly used in other disciplines—harm reduction refers to minimizing harms and decreasing total morbidity and mortality, without completely eliminating tobacco and nicotine use. This definition acknowledges that a significant proportion of individuals will continue to use tobacco for the foreseeable future. Harm reduction can be accomplished by decreasing the risk of an act (e.g., tobacco use), by decreasing the intensity per user, or by decreasing the prevalence. Chapter 2 includes a detailed discussion of harm reduction in other areas of public health concern and sets forth some general principles relevant to tobacco.

A multitude of policy strategies, such as increased taxes, contribute to the goal of harm reduction. However, this report focuses on substituting conventional tobacco use with either newly developed so called less harmful tobacco products or with pharmaceutical preparations used alone or concomitantly with decreased use of conventional tobacco products. The committee uses the terms harm-reducing or risk-reducing. The term “safer cigarette” has often been used historically and colloquially. The committee avoids the term “safer” in particular in order to avoid any impression that such products are safe. They are not. The U.S. cigarette manufacturers have recently publicly echoed the public health community’s assertion that that there is no safe cigarette (Philip Morris USA, 2000; R.J. Reynolds Tobacco Company, 2000). Despite any promised harm reduction, the use of tobacco harm reduction products poses greater risks than no tobacco exposure.

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