The Scientific Basis of Tobacco Product Regulation - World Health ...

2003; TobReg, 2004, 2007), TobReg recognized certain gaps in knowledge,
which indicate that a cautious approach is appropriate.
Research on and testing of smokeless tobacco products, their use, the consequences
of their use and the implications of different policies are essential,
so that policies can be set that will improve health and minimize unintended
consequences. The extent of the public health epidemic due to tobacco marketing
and use makes it essential to consider alternative approaches, to
address gaps in knowledge and to avoid taking actions that could worsen the
epidemic regionally or globally. General principles for research and testing
are given in the TobReg recommendations Guiding principles for the development
of tobacco product research and testing (TobReg, 2004). There are
both many uncertainties and numerous areas in which there is a strong scientific
foundation. For example, the conclusion that people who use only
smokeless tobacco products have lower overall risks for disease and premature
mortality than cigarette smokers can be reached with a high degree of
confidence. There is, however, considerable debate about the population impact
of promoting smokeless tobacco use for harm reduction in cigarette
smokers, and about the polices and marketing approaches that lead to improved
health rather than undermine health promotion efforts.
Resolution of these issues is complicated by the wide array of smokeless
tobacco products, marketing approaches and social, cultural and regional
factors that influence patterns of use. For example, substantial differences are
found in the patterns of use and the health consequences in South-East Asia
and Sweden (Foulds et al. 2003; Cnattingius, 2005) and in the USA (Department
of Health and Human Services, 1986; National Institutes of Health,
2006). The Scientific Committee on Emerging and Newly Identified Health
Risks (European Commission, 2008) concluded that “It is not possible to
extrapolate the patterns of tobacco use from one country where oral tobacco
is available to other countries due to societal and cultural differences.”
Thus, categories of products that meet specified standards and are marketed
under certain conditions in particular countries are more likely to benefit
public health than products that meet other standards and conditions. There
is no strong scientific basis for identifying product types or product performance
standards that could be promoted as substitutes for smoking, for the
forms of promotion that could be allowed or how cultural differences should
be addressed. Nevertheless, this information is necessary in order to make
significant progress beyond policies in which all tobacco products are considered
to have the same or similar risks. In order to guide short- and longterm
policy, research is needed:
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