Tobacco control strategies

Tobacco is the leading cause of preventable death worldwide, with most of this harm resulting from combustible cigarettes. Tobacco control is an arm of public health that aims to reduce the disease and premature mortality that results from tobacco use. In recent years, there has been a significant rise in alternative nicotine delivery systems that seek to deliver nicotine without tobacco combustion, resulting in significantly less harm than smoking tobacco. While the bulk of tobacco sales still come from cigarettes this trend has shifted in recent years as alternative nicotine delivery products has gained popularity in different markets, especially high income countries. Strategies for tobacco control can broadly be organized into three categories: (1) prohibition, (2) contraction, and (3) harm minimization. Prohibition strategies attempt to completely eliminate the sale of all tobacco products from the marketplace, and are rare, mostly because experience has shown they are unworkable. Contraction strategies include interventions aimed to reduce the overall size of the tobacco marketplace. Examples of contraction strategies include efforts to reduce the demand of tobacco products such as taxation, advertising bans, flavor bans, consumer education about product harms, and efforts to increase smoking cessation for users who want to stop using tobacco. Harm minimization strategies are not concerned with the size of the tobacco marketplace per se, but rather focus on reducing the harm caused by using tobacco by shifting consumers toward lower risk tobacco products. Thus, unlike prohibition or contraction strategies harm minimization accepts the basic premise of a continuum of risk for tobacco products with health gains coming about by shifting usage patterns away from very dangerous forms of tobacco to less harm products. Herein, we describe efforts to implement all three of these tobacco control strategies in different markets around the world.