Tobacco is predicted to kill 1 billion humans in the 21st century if trends continue. Therefore, tobacco control is perhaps the most important public health issue today and for the foreseeable future. In 2009, the U.S. Food and Drug Administration was given authority to regulate tobacco. Traditionally, tobacco control has cantered around cessation policies. While smoking rates have declined slowly, they have now reached a plateau. Despite the well-known health risks and ubiquitous warnings, there are still hundreds of millions of addicted smokers, and the number is growing, in Asia especially. Cessation aids have a poor success record, with less than 15 percent abstinence rates at 1 year. Harm reduction (HR) strategies hold significant promise to reduce smoking-related disease and death. HR has been effectively used in other areas, e.g., HIV reduction through clean needles. Tobacco HR refers to products designed to provide nicotine, but at reduced risk of disease, since the lethal nature of smoking derives from inhaled tobacco smoke. In Sweden, men have taken up smokeless tobacco, and Sweden now has the lowest rate of lung cancer among developed nations and lower levels of oral cancer and other smoking-related diseases. This session provides new data on the Swedish experience, reviews HR policies and status in various regions and nations, and discusses why public health authorities still need encouragement to inform smokers about the relative risks of snuff versus cigarettes.