The public health implications for regulating tobacco products

The FDA has the regulatory authority to implement tobacco product standards. Because nicotine is the primary reinforcing constituent in cigarettes, researchers have proposed implementing a very low nicotine product standard for cigarettes as a potential harm reduction strategy. Reducing the level of nicotine in cigarettes could enable more current smokers to quit by reducing nicotine dependence, decrease the number of adolescents who transition from cigarette experimentation to nicotine dependence, and allow those who want to continue smoking more of a choice to smoke. However, a low nicotine product standard in cigarettes may cause smokers to seek alternative nicotine sources to satisfy their nicotine addiction. Ideally, they would select nicotine replacement therapies but for those who are unwilling or unable to stop using tobacco they may choose other tobacco products to fill their nicotine void. Depending on which product(s) they select, switching to another tobacco product(s) could have a net positive public health impact. There is a continuum of harm for tobacco products. By selectively regulating other tobacco products, the FDA can shift consumers away from the most dangerous products and allow for the continued use of less harmful products. In a regulated cigarette environment, what are the potential public health risks and benefits of using other tobacco products? This essay will describe little cigars/cigarillos, snus, and electronic nicotine delivery systems (ENDS) as examples of tobacco products across the continuum of harm and provide recommendations on how the FDA can regulate these tobacco products in order to maximize the public health impact of a reduced nicotine product standard in cigarettes. Little cigars/cigarillos should be regulated in a manner similar to cigarettes in order to move smokers away from combustible products. Oral tobacco products and ENDS are likely less harmful products. If regulated effectively, they could be viable alternative nicotine sources. The FDA will need to carefully consider the potential benefits and negative health consequences for each of these products