At the same time, emerging nicotine-delivery products, such as e-cigarettes, call for an updating of traditional tobacco control strategies to better address new opportunities and threats that they present. 7 9–16 However, a credible plan to minimise cigarette use has yet to be implemented. While some refer to an endgame for all tobacco, most appear to focus on cigarettes as a more realistic and most important target, since they cause the vast majority of harm. 6 Finland, New Zealand, Hong Kong and Ireland have already set the goal of reaching an endgame. The 2014 US Surgeon General Report recommended an endgame strategy for the tobacco epidemic. 6 7 Accordingly, tobacco control experts and national governments have begun considering what might be done to accelerate declines in tobacco-caused health harms and eventually eliminate all tobacco consumption (often termed an ‘endgame’). 3–5 Although many tobacco control policies, such as higher cigarette taxes, smoke-free public places, media campaigns, cessation treatment programmes and advertising restrictions, have already been implemented with substantial effectiveness, their pace in averting preventable deaths has been relatively slow and their potential to secure quick and substantial new smoking declines is limited. 1 2 Two of three long-term smokers will likely die prematurely of a smoking-attributable disease. Harms from cigarette smoking remain unacceptably high even though smoking prevalence in the USA has decreased markedly over the past 50 years.
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