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Endgame Strategies.

Although proposed endgame strategies for ending tobacco use vary, they share the following underlying assumptions (1) that the status quo burden from smoking is unacceptable and (2) that reducing smoking substantially will require something new, bold and fundamentally different from the tried-and-true (Warner, 2013). Some proposed endgame strategies include:

  • reducing the nicotine in cigarettes to non-addicting levels (Benowitz and Henningfield, 1994);
  • replacing combustion cigarettes with alternative products (harm reduction) (van der Eijk et al., 2013);
  • government agency control of the marketing of tobacco products where manufacturers simply produce products but do not conduct marketing (Borland, 2003);
  • a “sinking lid” supply side strategy (Wilson et al., 2013).

Currently there is not a consensus on the best endgame approach, nor precisely what the desired “end stage” should be (elimination of the use of combustion nicotine products? elimination of dependence on nicotine in any form?, elimination of the tobacco industry?) (Smith, 2013; Warner, 2013). It may be that an optimum policy relies upon the implementation of a combination of the potential strategies. For example, it is plausible that the net benefits of a “nicotine reduction in combustion products” strategy could be enhanced if it were pursued in tandem with a “make an array of adequate noncombustion substitutes available” strategy.

Benowitz NL, Henningfield JE. Establishing a nicotine threshold for addiction. The implications for tobacco regulation. N Engl J Med. 1994; 331: 123-125.

Borland R. A strategy for controlling the marketing of tobacco products: a regulated market model. Tob Control. 2003; 12: 374-382.

Smith EA. Questions for a tobacco-free future. Tob Control. 2013; 22(suppl 1): i1-i2.

Warner KE. An endgame for tobacco? Tob control. 2013; 22(suppl 1): i3-i5.

Wilson N, Thomson GW, Edwards R, Blakely T. Potential advantages and disadvantages of an endgame strategy: a ‘sinking lid’ on tobacco supply. Tob Control. 2013; 22(suppl 1): i18-i21. logo
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