Source: Bulletin Board of Oral Pathology
Author: Dorothy Hatsukami et al.

To further the goal of eliminating smoking as the number one cause of preventable disease and death in the U.S., twenty six of the nation’s leading tobacco control researchers and policy experts today called for regulatory control of all tobacco products. They also called for policies that encourage current tobacco users to reduce their health risks by switching from the most to the least harmful nicotine-containing products.

This group of experts, who have devoted their careers to reducing tobacco use, met in a two-year process they called The Strategic Dialogue on Tobacco Harm Reduction (the Dialogue). Their vision: a world in which virtually no one uses cigarettes. Dialogue participants concluded that realizing that vision would have a profound impact on reducing death and disease from tobacco use.

The Dialogue process was led by Dorothy Hatsukami, Ph.D., director of the University of Minnesota’s Tobacco Use Research Center and Masonic Cancer Center’s Cancer Control and Prevention Programs, and Mitchell Zeller, a former associate commissioner of the U.S. Food and Drug Administration and currently a health policy expert with Pinney Associates.

The Dialogue members’ recommendations appear in the online version (posted February 25) of the peer-reviewed journal Tobacco Control. Their report recommends various ways to regulate tobacco products based on public health needs. It also recommends helping tobacco users who are unable or unwilling to quit to shift to the least harmful nicotine products. Prominent among the group’s recommendations are:

Regulation of all aspects of promotion, advertising, and labeling of tobacco products. Prohibition of claims touting reductions in exposure to harmful components in tobacco or smoke unless there is sufficient scientific evidence that risk has been reduced as well. Regulation of harmful compounds in all tobacco products. Accurate education of the public regarding the relative risks of different nicotine-containing products. Higher taxes on cigarettes. Expanded anti-tobacco advertising. Strong programs to encourage and support tobacco cessation

In addition, the Dialogue embraced the concept known as the “continuum of risk.” This principle unified Dialogue participants with differing views on more controversial issues, such as the appropriate role of oral tobacco products. The Dialogue acknowledged that cigarettes are the most harmful tobacco product and that, under the continuum, medicinal nicotine products such as nicotine gum and patches are less harmful than oral tobacco products.

These recommendations are made at a time when tobacco use remains the leading preventable cause of disease and death in the U.S. and costs our society almost $200 billion per year. Nearly 440,000 people will die this year alone in the U.S. from tobacco related illnesses. Around the world, an estimated one billion people will die prematurely from tobacco use this century, a ten-fold increase over the 20th century if current trends continue. Recent products offered by the tobacco industry claim reductions in exposure to toxic chemicals in tobacco smoke and oral tobacco. Some make implied or direct claims to reduce the risk of cancer or other diseases.
However, public health experts caution that these claims have not been scientifically substantiated. Such misrepresentations can lead to misperceptions about the safety of these products and result in greater tobacco use.

“Our report is a blueprint,” said Dialogue co-chair Dorothy Hatsukami. “It lays out the key elements of a science-based regulatory program and policies to shift current tobacco users away from cigarettes. With these policies and programs, we believe that the death toll from cigarette smoking and other tobacco use can be reduced dramatically.”

“Bold thinking is required to reverse the catastrophic projections for tobacco-caused deaths in this century,” said Dialogue co-chair Mitch Zeller. “Simply put, there is no ‘one size fits all’ method to quit or reduce smoking. The public health community has failed to provide appropriate guidance on all the evidence-based methods available so that smokers concerned about their health but who find themselves unable or unwilling to quit have options on how to quit smoking successfully.”

“Much is already known about the building blocks required to achieve the long-term vision and short-term policy objectives identified by the Dialogue,” said Cheryl G. Healton, Dr. P.H., president and CEO of the American Legacy Foundation(R), a sponsor of the Strategic Dialogue. “We have a unique public health opportunity right now to dare to envision a future world where almost no one smokes a cigarette,” she added.

Dialogue members also identified several issues requiring further research before policy changes could be recommended. These issues involve questions, such as whether reducing the nicotine content of cigarettes to non-addicting levels would likely lead to a reduction in smoking prevalence, and what are the key issues surrounding long-term use of safer nicotine-containing products?

The Dialogue was jointly funded by the American Legacy Foundation, the Robert Wood Johnson Foundation and the University of Minnesota Tobacco Use Research Center. Dialogue members met four times between December 2005 and August 2007.

A full roster of Dialogue participants is below.

Masonic Cancer Center, University of Minnesota is designated a Comprehensive Cancer Center by the National Cancer Institute for cancer research, treatment, and education. It is part of the University of Minnesota’s Academic Health Center. For more information visit or call:
www.cancer.umn.edu; 612-624-2620.

The American Legacy Foundation(R) is dedicated to building a world where young people reject tobacco and anyone can quit. Located in Washington, D.C., the foundation develops programs that address the health effects of tobacco use, especially among vulnerable populations disproportionately affected by the toll of tobacco, through grants, technical assistance and training, partnerships, youth activism, and counter-marketing and grassroots marketing campaigns. The Foundation’s programs include truth(R), a national youth smoking prevention campaign that has been cited as contributing to significant declines in youth smoking; EX(R), an innovative public health program designed to speak to smokers in their own language and change the way they approach quitting; research initiatives exploring the causes, consequences and approaches to reducing tobacco use; and a nationally-renowned program of outreach to priority populations. The American Legacy Foundation was created as a result of the November 1998 Master Settlement Agreement (MSA) reached between attorneys general from 46 states, five U.S. territories and the tobacco industry. Visit http://www.americanlegacy.org .

Strategic Dialogue on Tobacco Harm Reduction Participants*

Cathy Backinger, Ph.D., M.P.H., National Cancer Institute, Bethesda, MD
Neal Benowitz, M.D., University of California, San Francisco, CA
Lois Biener, Ph.D., University of Massachusetts, Boston, MA
David Burns, M.D., University of California, San Diego, CA
Pamela Clark, Ph.D., University of Maryland, College Park, MD (during
the Dialogue process Dr. Clark was with the Battelle Centers for Public
Health Research and Evaluation, Baltimore, MD)
Greg Connolly, D.M.D., M.P.H., Harvard School of Public Health, Boston,
MA
Mirjana Djordjevic, Ph.D., National Cancer Institute, Bethesda, MD
Thomas Eissenberg, Ph.D., Virginia Commonwealth University, Richmond, VA
Gary Giovino, Ph.D., University at Buffalo, SUNY, Buffalo, NY
Dorothy Hatsukami, Ph.D., University of Minnesota, Minneapolis, MN
(Dialogue co-chair)
Cheryl G. Healton, Dr. P. H., American Legacy Foundation(R), Washington,
D.C.
Stephen Hecht, Ph.D., University of Minnesota, Minneapolis, MN
Jack Henningfield, Ph.D., Pinney Associates, Bethesda, MD
Corinne Husten, M.D., M.P.H., Partnership for Prevention, Washington,
D.C.(during the Dialogue process Dr. Husten was with the Centers for
Disease Control and Prevention, Atlanta, GA)
Kimberly Kobus, Ph.D., University of Illinois, Chicago, IL
Scott Leischow, Ph.D., University of Arizona, Tucson, AZ
David Levy, Ph.D., Pacific Institute for Research & Evaluation,
Calverton, MD
Stephen Marcus, Ph.D., National Cancer Institute, Rockville, MD
Matthew Myers, J.D., Campaign for Tobacco-Free Kids, Washington, D.C.
Mark Parascandola, Ph.D., National Cancer Institute, Rockville, MD
Prabhu Ponkshe, Health Matrix Inc., McLean, VA
Peter Shields, M.D., Georgetown University, Washington, D.C.
Paul Slovic, Ph.D., Decision Research, Eugene, OR
David Sweanor, J.D., University of Ottawa, Ottawa, Ontario
Kenneth Warner, Ph.D., University of Michigan, Ann Arbor, MI
Mitchell Zeller, J.D., Pinney Associates, Bethesda, MD (Dialogue
co-chair)

*Dialogue members participated in their individual capacity.
Organizational affiliations are provided for informational purposes only.
The views expressed here are those of the authors only and do not represent any official position of the National Cancer Institute or National Institutes of Health. The Dialogue report does not take a position on any specific legislation.