TABLE 1 Potential Reduced-Exposure Products




Modified tobacco

Reduced yield of selected toxicants

Advance™, low-nitrosamine tobacco cigarettes, Snus, reduced nitrosamine smokeless tobacco

Cigarette-like products

Less combustion than cigarettes

Premier™ (off market)



Pharmaceutical products

Nicotine replacement

Nicotine gum, patches, inhaler, nasal spray


Antidepressants that reduce nicotine craving

Bupropion SR, nortriptyline

Other medications

Nicotine antagonists, clonidine

  1. Are there surrogate indicators of this effect on health that could be measured in a time frame sufficient for product evaluation?

  2. What are the public health implications of tobacco harm reduction products?

The first three questions deal with the adequacy of current scientific methods to determine whether and to what extent these products reduce the risk of morbidity and mortality and the nature of the advice to give to citizens, health professionals, and others. The fourth question is important because it addresses the population impact of these products. That is, although a product might be risk-reducing for an individual’s health compared to conventional tobacco products, its use might not be harm-reducing for the population as a whole. The fourth question is also important because the answer lays the groundwork for educational, policy, and regulatory actions.

The committee reviewed the literature and assessed the nature and availability of the data needed to evaluate the feasibility of tobacco harm reduction. Its review encompassed the major disease categories linked by scientific evidence to tobacco consumption, including cancer, cardiovascular disease, respiratory disease, reproductive and developmental disorders, and others. The report is offered to relevant federal and state regulatory and policy bodies, Congress, scientists and health care professionals,

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