Identification of these unintended consequences through specifically designed laboratory research studies, clinical trials, surveys, and postmarket surveillance will inform the development of risk management plans and help to minimize their impact. Below are the major unintended consequences that were described at the meeting and elsewhere sellckchem (Henningfield et al., 1998): Increased availability of black market products, which do not meet the reduced nicotine level Use of other unregulated tobacco in roll-your-own cigarettes pH modification strategies or addition of other additives by the consumer or manufacturers Product tampering (e.g., addition of nicotine to product) There may be effective ways to minimize unintended consequences by anticipating the needs of current users.

One option to consider is whether a slow change in lowering nicotine levels in tobacco would minimize market pressure for unregulated products. A second approach could be encouragement of the use of products that are relatively nontoxic but deliver nicotine in an equivalent dose to cigarettes, including the use of products that come closer to matching the speed with which cigarettes deliver nicotine to the lungs and the brain. Certain products have already been developed that might meet this need, but they need to be properly evaluated and regulated. A third (and not exclusive) approach is to investigate the potential for more effective enforcement policies to discourage the development of black markets. The advantages and disadvantages of each of these approaches warrant discussion.

Research Priorities and Types of Studies to Address Priorities Table 3 summarizes and further describes the four research priorities that were identified from the meeting and additional studies that might contribute to understanding moderating factors and surveillance needs. Types of studies that can be conducted to address these priorities are described next to each research question. These questions are more easily addressed now that research cigarettes with varying nicotine content are available through the U.S. National Institute on Drug Abuse. Table 3. Research Priorities and Types of Studies to Address Priorities Regulatory bodies will be responsible for determining how much evidence is needed to support a policy of reducing the levels of nicotine in cigarettes as a mandated regulatory measure.

That is, our research recommendations should not be construed as proposing that all of the questions need to be answered prior to adoption of such a policy. In fact, public health policies are often adopted on the basis of initial findings that support such an effort, AV-951 even though key issues remain to be resolved, for example, public health policies to control the spread of malaria, HIV AIDS, and influenza.