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This paper aims to overview the need for tobacco harm reduction, the consumer products that facilitate tobacco harm reduction and the barriers to its implementation. The worldwide endemic of tobacco smoking results in the death of over seven million smokers a year. Cigarette quit rates are very low, from 3%–12%, and relapse rates are high, from 75%–80% in the first six months and 30%–40% even after one year of abstinence. In addition, some smokers do not desire to quit. Cigarette substitution in tobacco harm reduction is one strategy that may reduce the burden of morbidity and mortality.

This review examines the displacement of smoking through substitution of non-combustible low-risk products such as snus, heated tobacco products and e-cigarettes.

Toxicological testing, population studies, clinical trials and randomized controlled trials demonstrate the potential reductions in exposures for smokers. Many barriers impede the implementation of product substitution in tobacco harm reduction. These products have been subjected to regulatory bans and heavy taxation and are rejected by smokers and society based on misperceptions about nicotine, sensational media headlines and unsubstantiated fears of youth addiction. These barriers will need to be addressed if tobacco harm reduction is to make the maximum impact on the tobacco endemic.

This review provides the rationale for tobacco harm reduction, evaluates the current products available and identifies the barriers to implementation.

Despite substantial declines in cigarette smoking in England since the 1970s, around 20 per cent of the adult population still smokes. In Sweden, 10 per cent of adult males and 12 per cent of adult females smoke cigarettes, while snus use is prevalent among 19 per cent of adult males and 4 per cent of adult females. Traditional cessation‐only approaches may need to be supplemented with broader tobacco harm reduction measures to reduce smoking prevalence further. General practitioners (GPs) are well placed to give patients advice on tobacco harm reduction. This paper seeks to address these issues.

The authors administered an online survey to assess knowledge, perceptions and attitudes to tobacco and nicotine products to 220 GPs (100 in England and 120 in Sweden).

Most GPs (96 [96 per cent] England, 115 [98 per cent] Sweden) addressed smoking cessation with patients as part of their regular practice. Most GPs (87 [87 per cent] England, 102 [85 per cent] Sweden) felt extremely or fairly knowledgeable about the risks associated with cigarettes, but less so about nicotine in tobacco products and pharmaceutical nicotine. When asked to rank various products on a risk continuum, GPs rated cigarettes as riskiest and tobacco cessation and nicotine‐containing products as least risky. However, when asked to rank components of cigarettes based on their health risks, GPs ranked nicotine as the third riskiest (74 [74 per cent] England, 104 [87 per cent] Sweden), after tar and carbon monoxide, but before smoke or tobacco. When asked questions about a hypothetical nicotine replacement therapy (NRT) product that looks like a cigarette and is licensed for harm reduction, GPs perceived that sensory experience and tobacco harm reduction could be benefits to patients, but perceived appeal to children and risk for abuse could be drawbacks.

Most respondent GPs are well informed about the relative risks of nicotine and tobacco, but more research needs to be done to investigate their concerns over the long‐term substitution of cigarettes with alternative nicotine products.

This article aims to provide an informed overview of the current policy and upcoming e‐cigarette legislation, and their impact on the potential for harm reduction in the tobacco products arena in the USA. The article argues in favor of reasonable regulatory options supportive of harm reduction, and which take into consideration the realities of the emerging US e‐cigarette market.

The authors consider the recent refocus on harm reduction potential in the e‐cigarettes, which are growing in popularity but will be soon subject to potentially very restrictive regulation. This article provides an overview of selected, relevant provisions of the US tobacco product regulatory framework as it may soon apply to e‐cigarettes, not only for the benefit of the tobacco harm reduction debate, but also to global stakeholders, as well.

FDA needs strong leadership to avoid current political pressures to label all tobacco products as equally dangerous, vilify nicotine and deny a reasonable approach to harm reduction that promotes the benefits of reduced risk as a legitimate approach to better health. Admittedly, more research is needed before a final assessment can be made on the population‐level health benefits of e‐cigarettes.

This article provides an informed view of US e‐cigarette industry regulatory challenges by two industry regulatory experts, and an overview of possible e‐cigarette regulatory outcomes in the USA, in light of the US Food and Drug Administration announcement that such regulation is to be expected shortly.

Nicotine is widely known as a tobacco constituent and for its use as a tobacco cessation aid. The development of new devices for nicotine delivery in recent years has led to uncertainty among consumers regarding the health risks of nicotine relative to tobacco. The purpose of this study was to discover if current and former consumers of tobacco and tobacco harm reduction (THR) products could distinguish between “nicotine” and “cigarettes” and examined the preceding media dialogue to determine if conflicting messages by the media influence public perceptions.

A quantitative survey was administered online in Norway (NO), Japan (JP), the United Kingdom (UK) and the United States (US), while face-to-face computer-aided interviews were conducted with randomly selected samples in India (IN), Greece (GR) and South Africa (SA). Participants were between 18 and 69 years of age and either current users of tobacco and THR products or previous users who quit within the past five years. Questions assessed beliefs about harmfulness of nicotine. Nicotine and other products and substances were also independently rated for harmfulness on a scale of 1–10 and subsequently compared. In addition, the authors examined the media dialogue of top media outlets in four countries to assess the potential influence on people’s beliefs.

A total of 54,267 participants (NO: 1,700, JP: 2,227, UK: 2,250, USA: 2,309, IN: 41,633, GR: 1,801, SA: 2,359) were sampled with the percentage of women participants ranging from 14.8% (IN) to 53.8% (UK). Between 68.3% (men, IN) and 88.7% (men, USA) of current consumers believed nicotine is harmful. Current consumers who agreed with the statement that nicotine is the primary cause of tobacco-related cancer ranged from 43.7% (men, UK) to 78.0% (men, SA). In six countries nicotine was rated nearly as harmful as cigarettes and alcohol, while other substances such as sugar, salt or caffeine, were usually rated as less harmful.

A large proportion of consumers across all surveyed countries view nicotine and cigarettes similarly. Clearer communication on the harmful properties of both by the media is needed to help consumers make informed decisions about products across the continuum of risk. Messaging to consumers, especially via the media, propagates misinformation about the relative harms of tobacco and nicotine through reporting that is often incomplete and biased toward more negative aspects.

This study specifically assessed public perceptions of nicotine as opposed to products containing nicotine, which is the focus of previous studies. Apart from showing that consumers often incorrectly perceive nicotine and cigarettes as similar in terms of harmfulness, the authors highlight the need for more accurate and complete reporting by the media to clarify widespread misunderstandings and mitigate public uncertainty.

The marketing of alcohol and tobacco products and their related public policy implications have become controversial issues worldwide, due mainly to health‐related issues. Uses a telephone survey methodology to compare attitudes toward Olympic sponsorship by a leading US brewer with general attitudes toward the use of sports sponsorship to promote tobacco products. Results suggest that respondents have significantly different attitudes towards the two product categories and their use of sponsorship, accepting more readily the use of the Olympics to promote beer. Respondents’ self‐interest is also found to significantly affect the level of acceptance for the use of sport to promote alcohol or tobacco products, although in slightly different ways. The findings are discussed in relation to previous research, along with their managerial implications.

Briefly highlights the history of litigation against tobacco companies in the USA. Introduces the legal issues brought before the courts, the parties involved and the outcome of significant cases. This overview is followed by a guide to relevant legal research tools that are useful for exploring tobacco litigation in depth.

In Chapter 3, the author will problematise the youth smoking epidemic within SEA, in order to justify why the regional impacts of the tobacco trade on youths are worrisome. The author will present the major youth smoking trends in SEA, for the purpose of illustrating how the presence of tobacco products has adversely affected regional youths to a concerning degree. The author, next, will highlight the causes of the youth smoking epidemic, namely susceptibility and positive advertising. The author follows by emphasising the national and regional costs of youth smoking, by arguing how such a lifestyle results in negative consequences in relation to the delinquency itself. Lastly, the author will recommend policies for tobacco control that SEA governments should consider to contain the epidemic of youth smoking. It is noteworthy that all SEA governments have some degree of tobacco control policies in place. However, many lack the implementation of comprehensive national tobacco control strategic plans and tightened law enforcement endeavours to specifically target the problem of youth smoking. Therefore, the outputs of this chapter should contain scholarly values that are conducive to the betterment of policy-making.

Tobacco has exercised the interest of the nation since Elizabethan times, and the inhalation of its smoke for pleasure has become very widespread. It was not until the mid‐twentieth century, however, that its effects upon health were suspected. It is now widely accepted that tobacco smoke is implicated in a range of dangerous diseases, although the tobacco industry sometimes argues that the link is not proven. The arguments about the conflicting needs of a large, world‐wide industry and the health and prosperity of individuals and society are complex, and often influenced by conflicting vested interests. Government's involvement in the issues is further complicated by its reliance upon large tobacco revenues. The link between advertising and increased smoking, either by existing or new smokers, is not proved by research, although there are strong indications that it exists. The behaviour of most parties involved, including the tobacco companies, indicates that they share the belief of a link. Voluntary controls upon tobacco advertising have had some effect, in that, for example, advertising in the U.K. is no longer overtly directed at children, but various anti‐smoking lobbies believe voluntary control to be ineffective. The present British government has toyed wth the possibility of statutory control, but faces stiff opposition from back‐benchers and within the cabinet; it is also probably philosophically opposed to such measures. More research is needed into the link between advertising and smoking behaviour.

This article aims to explore the public evaluation of the ethics of marketing tobacco in Indonesia through the theoretical lens of normative ethics.

The present study adopted a symbiotic ethical approach which combined normative and positive ethical approaches. The data was collected in Yogyakarta, Indonesia, from six focus groups and thirty photo elicitation interviews with a total of 71 participants.

The thematic analysis has identified six main themes, economic contribution of the tobacco industry, harmful nature of tobacco products, tobacco marketing targeting vulnerable groups, covering the danger of smoking, intention and integrity of tobacco marketers and infringement of law and social norms. Adopting the theoretical lens of utilitarianism, deontology, contractarianism and virtue ethics, the analysis illustrates that most participants believed that tobacco marketing practices in Indonesia are unethical.

The findings of the study were disseminated in a public engagement event to stakeholders in Yogyakarta. The findings influenced the development of No Smoking Area monitoring instrument and the introduction of “Free from Tobacco Advertisement in No Smoking Area” policy in Sleman Regency, Yogyakarta.

Indonesia, with its lenient regulatory environment, provides a unique setting for investigating public evaluation of the ethics of tobacco marketing. This is one of the first studies that investigates public evaluation of tobacco marketing ethics in Indonesia through the theoretical lens of utilitarianism, deontology, virtue ethics and contractarianism.

Operations Management Quality Management.

The case can be used in a number of course contexts, including undergraduate and graduate courses in operations management and quality management.

Central Tobacco Plant (CTP) is a tobacco processing and packaging company, operating in the Central America and Caribbean region. This case focuses on a waste measurement exercise conducted in the cigarette production department of CTP, which was commissioned by George Edwards, the Secondary Manufacturing Department Manager. The reason for the exercise was the announcement that CTP could possibly face a plant audit, where a poor result could cause the shifting of manufacturing of some products, or, in the worst case scenario, all of it product lines, to one of the larger, and more efficient manufacturing plants in the Central America and Caribbean region. The waste measurement exercise is carried out as a three-week student–industry project by two students pursuing an MSc programme at the local university, who are mentored by both Edwards and by a university supervisor. At the end of the exercise, Edwards needs to consider the appropriateness of the current waste measurement system, the quantities of waste produced and opportunities to reduce waste.

The case has four primary learning objectives: to illustrate the role of performance measurement in process improvement, to explore the perspective of lean manufacturing in waste management, to apply basic quality tools in the analysis of a manufacturing process and to identify opportunities for process improvement.

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CSS 9: Operations and Logistics