Abstract

In Australia in 2010 around 17% of adults still smoked cigarettes. In this paper we report work that we have done over the past 8 years assessing three types of strategies (hi, low and no tech) for reducing smoking prevalence under 10% by 2020 (a target recently set by the Australian government). The high tech strategies include: improving smoking cessation by screening smokers for polymorphisms that predict responses to pharmacological treatments; vaccinating smokers against the effects of nicotine; attempting to prevent nicotine dependence by screening the population for genetic susceptibility to nicotine dependence and vaccinating non-smoking children against the effects of nicotine. The low technology approach is nicotine harm reduction: encouraging smokers who are unable or unwilling to quit to switch to using non-smoked forms of tobacco such as pharmaceutical nicotine and low nitrosamine oral tobacco products. Among the leading no technology options is a de facto prohibition of smoked tobacco (e.g. by legislating to progressively reduce the nicotine content of cigarettes to zero over a decade). We compare the likely health impacts of these strategies and discuss the ethical and public policy implications that they raise.