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CLEARING THE SMOKE ASSESSING THE SCIENCE BASE FOR TOBACCO HARM REDUCTION Kathleen Stratton, Padma Shetty, Robert Wallace, and Stuart Bondurant, Editors Committee to Assess the Science Base for Tobacco Harm Reduction Board on Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by the Food and Drug Administration (FDA) prior to the March 2000 decision by the Supreme Court denying FDA comprehensive authority over tobacco products. The views presented in this report are those of the Institute of Medicine Committee to Assess the Science Base for Tobacco Harm Reduction and are not necessarily those of the funding agencies. Library of Congress Cataloging-in-Publication Data Clearing the smoke : assessing the science base for tobacco harm reduction / Kathleen Stratton ... [et al.], editors. p. ; cm. ISBN 0-309-07282-4 (alk. paper : case) 1. Smoking--Health aspects. 2. Smoking cessation programs. 3. Tobacco habit--Prevention. [DNLM: 1. Tobacco Smoke Pollution--prevention & control. 2. Biological Markers. 3. Environmental Exposure--adverse effects. 4. Neoplasms--etiology. 5. Nicotine--pharmacology. 6. Smoke--adverse effects. QV 137 C6225 2001] I. Title: Assessing the science base for tobacco harm reduction. II. Stratton, Kathleen R. RA645.T62 C56 2001 362.29'66--dc21 2001002837 ISBN 0-309-07282-4 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2001 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising th