1. AAPHP tobacco policy should be based on the best available scientific evidence.

2. Tobacco use is a major cause of illness and death in the United States.

3. Almost all tobacco attributable mortality in the USA is due to cigarette smoking.

4. While nicotine is the primary addictive substance in cigarette smoke, other factors substantially enhance the addictiveness of cigarettes. These factors include habituation to the cigarette handling ritual, psychological appeal based on advertising themes, the strength and speed of the nicotine hit, and other factors. This set of factors make cigarettes the most addictive of tobacco/nicotine products.

5. Substances in the cigarette smoke, other than the nicotine, inhaled deep into the lung, cause most of the tobacco attributable illness and death in the United States.

6. Smoke free tobacco/nicotine products, as available on the American market, while not risk free, carry substantially less risk of death and may be easier to quit than cigarettes.

7. Since susceptibility to tobacco/nicotine addiction is strongest in adolescence and early adulthood, measures to prohibit sale of tobacco/nicotine products without a physician prescription should be maintained and strengthened.

8. The healthiest option is to never initiate tobacco/nicotine use.

9. For those already using a tobacco/nicotine product, the best option is to quit.

10. Harm Reduction Smokers who have tried, but failed to quit using medical guidance and pharmaceutical products, and smokers unable or uninterested in quitting should consider switching to a less hazardous smoke free tobacco/nicotine product for as long as they feel the need for such a product. Such products include pharmaceutical Nicotine Replacement Therapy (NRT) products used, off label, on a long term basis , electronic e cigarettes, dissolvables (sticks, strips and orbs), snus, other forms of moist snuff, and chewing tobacco.

11. Harm reduction should be considered as an addition to current tobacco control policies and programming and should be done in a way that will minimize initiation of tobacco/nicotine use, maximize quit rates and assure that dual use does not increase potential harm to the user.

12. Mandated health related warnings on tobacco/nicotine products should be periodically reviewed to assure that each warning reflects a real life hazard posed by the product in question and is not misleading in any way.

13. AAPHP tobacco policy should be intended to reduce the burden of illness, death and property damage attributable to tobacco products in American society. In pursuit of this goal, AAPHP must consider the needs and risks of current tobacco users, those potentially exposed to tobacco smoke, and those at risk of initiating future use of tobacco/nicotine products.

14. The tobacco page of the AAPHP web site should be configured to serve as an informational resource to physicians, other health related organizations and the general public.

AAPHP Tobacco Documents

AAPHP 2008 Harm Reduction and Resolutions White Paper AAPHP 2008 Harm Reduction and Resolution White Paper

AAPHP 2010 Harm Reduction Update

AAPHP Statement on the State Regulation of E cigarettes This document is undergoing review at this time.

American Association of Public Health Physicians, Tobacco Control Task Force (AAPHP) Citizen Petition Document ID FDA 2010 P 0095 0001 Docket ID FDA 2010 P 0095 available at /#!documentDetail D FDA 2010 P 0095 0001 Also available here . A second related petition is available here FDA Petition Summary References to materials included as attachments to FDA Petitions Attachment Set A1 A40 For material from all other attachment sets and for additional information please contact Joel L. Nitzkin, MD at jln md

For additional background information relative to Tobacco Harm Reduction, plus brief narratives and bibliographic references to deal with the objections most commonly raised by opponents to Tobacco Harm Reduction, Dr. Nitzkin has posted this “Tobacco Harm Reduction A Public Health Perspective” based on a presentation he gave to a joint committee of the Oklahoma State Legislature, October 3, 2012. 2012NitzkinHarmReduction

Dr. Nitzkin’s lecture given at the AAPHP meeting at the June 2013 AMA House of Delegates meeting is available here Dr Nitzkin’s Lecture AAPHPSavingSmokers0608 The resolution that passed is available here

Other Tobacco Related Documents of Potential Interest to Readers

FDA determination to regulate E Cigarettes and other smokeless tobacco products

2011 Harm Reduction Update

Legislation H.R. 1256 Family Smoking Prevention and Tobacco
Control Act111th Congress 2009 2010 available at

Electronic cigarettes

Bbc news – australia cigarette plain packaging law upheld by court

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