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

Howstuffworks “10 little-known facts about e-cigarettes”

Britton discount cigarettes, 1314 w britton rd, oklahoma city, ok – restaurant inspection findings and violations, food safety

The electronic cigarette was introduced to the U.S. market in 2007 and offers the nicotine addicted an alternative to smoking tobacco. Most “e cigs” are similar enough in appearance to be mistaken for regular cigarettes, but one look inside and you’ll see the main difference E cigarettes don’t contain tobacco. Instead, there’s a mechanism that heats up liquid nicotine, which turns into a vapor that smokers inhale and exhale. Manufacturers and satisfied customers say that this nicotine vapor offers many advantages over traditional cigarette smoke. But regulatory agencies and some health experts aren’t sure. They’re asking questions about the possible side effects of inhaling nicotine vapor, as well as other health risks e cigarettes may pose both to users and to the public. Those calling for tight regulations on e cigarettes claim that these devices should be deemed illegal until the proper research trials have been conducted to prove that they’re safe.

Because they contain no tobacco, e cigarettes aren’t subject to U.S. tobacco laws, which means they can be purchased without proof of age, especially online. This raises concerns that e cigs may be particularly appealing to kids and may encourage nicotine addiction among young people. And while manufacturers of the e cigarette claim that it’s the cigarette you can “smoke” anywhere, regulatory agencies around the world are taking a close look at these gadgets and instituting a range of restrictions on their use.

Proponents of the e cigarette say they feel better using the device than they did when they were smoking tobacco cigarettes, and that because the e cigarette is reusable, it saves them money. Some praise the e cig for helping them quit smoking. But is the e cigarette as safe as its users including celebrities like Katherine Heigl believe? Is it a healthier option, or a riskier choice? And what does the FDA have to do with it? Before you consider taking up the e cigarette habit, read on to get the facts.