Further work is necessary to fully translate these findings into treatment applications and recommendations to practicing clinicians. Nevertheless, the potential clinical implications of targeting this treatment-resistant group of smokers are clear and warrant further basic and applied research. Funding This research was sellckchem supported, in part, by grants CA57730 and DA016184 from the National Institutes of Health. Declaration of Interests None declared. Supplementary Material [Article Summary] Click here to view. Acknowledgments The authors extend their gratitude to Evelina Tapia and Elizabeth Miller for their role in collecting these data.
In summer 2006, the two largest U.S. cigarette manufacturers took the groundbreaking step of entering the smokeless tobacco arena.

Philip Morris announced the start of a test market of Taboka in Indianapolis, IN, and R. J. Reynolds announced test markets for Camel Snus in Portland, OR, and Austin, TX. Both of these products are modeled after the smokeless tobacco product used in Sweden and referred to as ��snus,�� the Swedish word for snuff. These products differ from traditional chewing tobacco, dip, and snuff in that (a) they are lower in tobacco-specific nitrosamines, a major carcinogen in tobacco; (b) they do not require spitting; and (c) they are packaged in small teabag-like pouches that are placed under the upper lip and can be relatively unobtrusive when in use. It is generally understood that one of the reasons for this movement of cigarette companies into the smokeless tobacco market is the proliferation of restrictions on where cigarettes can be smoked and the declining market for cigarettes in the United States (Levere, 2006).

At the same time, growing attention to methods of harm reduction has increased interest in lower nitrosamine smokeless tobacco as a product that, if taken up by smokers in lieu of smoking, could result in greatly reduced morbidity and mortality. There is substantial agreement in the public health community that the low-nitrosamine smokeless products are much less harmful than cigarettes (Levy et al., 2004; Luo et al., 2007; Savitz, Meyer, Tanzer, Mirvish, & Lewin, 2006). Nevertheless, there is a great deal of controversy about whether to disseminate information about the harm-reduction potential of switching from smoking to low-nitrosamine smokeless tobacco use. Many tobacco control professionals feel that to do so would result Cilengitide in a net increase in harm to the population (Hatsukami, Lemmonds, & Tomar, 2004; Tomar, 2007). They maintain that if health agencies promote the switch from cigarettes to smokeless tobacco, they may perpetuate tobacco use among smokers who would otherwise quit and remain tobacco free.