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This Article Full Text Full Text (PDF) An erratum has been published All Versions of this Article: AJPH.2005.075499v1 96/11/1934    most recent Submit a response View responses View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (14) Citing Articles via Google Scholar Google Scholar Articles by Savitz, D. A. Articles by Lewin, F. Search for Related Content PubMed PubMed Citation Articles by Savitz, D. A. Articles by Lewin, F. Related Collections Health Policy Smoking Cessation Tobacco Control

David A. Savitz, PhD, Roger E. Meyer, MD, Jason M. Tanzer, PhD, DHC, Sidney S. Mirvish, PhD and Freddi Lewin, MD

At the time of the study, David A. Savitz was with the Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill. Roger E. Meyer is with the Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, and the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia. Jason M. Tanzer is with the Department of Oral Diagnosis, School of Dental Medicine, and the Department of Laboratory Medicine, School of Medicine, University of Connecticut Health Center, Farmington. Sidney S. Mirvish is with the Eppley Institute for Research in Cancer, University of Nebraska Medical Center, Omaha. Freddi Lewin is with the Department of Oncology, Karolinska Institute, Stockholm, Sweden.

Correspondence: Requests for reprints should be sent to David A. Savitz, PhD, Department of Community and Preventive Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1057, New York, NY 10029 (e-mail: david.savitz{at}mssm.edu).

Harm reduction strategies involve promoting a product that has adverse health consequences as a substitute for one that has more severe adverse health consequences. Smokeless tobacco low in nitrosamine content offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the potential for such products to serve as a gateway to more harmful tobacco products, public misinterpretation of "less harmful" as "safe," distraction from the public health goal of tobacco elimination, and ethical issues involved in advising those marketing these harmful products. We offer a research agenda to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.

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