Applications of biomarkers of exposure and biological effects in users of new generation tobacco and nicotine products: Tentative proposals.

Despite efforts to eliminate smoking, more than 1 billion people worldwide continue to use combustible cigarettes through choice or inability to quit. With an associated 8 million deaths, the provision of noncombustible tobacco and nicotine products that smokers will accept to replace combustible cigarettes can lessen harm. However, most of these products have entered the market only in the past 20 years. Therefore, particularly for some smoking-related diseases, epidemiological studies to test harm reduction potential are only now becoming feasible. For cancer and chronic obstructive pulmonary disease, around two decades of data might be required. In this article, we discuss how the use of biomarkers might be applied to supplement epidemiological research for regulators. We further discuss how health providers and insurers can keep up with the rapid changes in biomarker research and recognize these reduced risks.