Key Points

1. 1) Tobacco harm reduction (THR) is struggling to gain credibility and acceptance among the public health establishment.
2. 2) Those who are skeptical of the harm reduction potential of alternative tobacco products, such as e-cigarettes, worry about youth initiation, the role of big tobacco in research and production and the newness of the products themselves.
3. 3) THR advocates highlight emerging research that suggests electronic nicotine delivery systems (ENDS) may reduce health risks and increase quit rates for cigarette smokers. They also express concern that ENDS bans would undermine those benefits while contributing to overcriminalization.
4. 4) An integrated approach would acknowledge the overlaps between historically siloed issues, including: comorbidities among populations served; the goal of reducing health disparities; and the commitment to providing a practical public health solution that accepts and supports individual autonomy.