title: Postmarketing surveillance for "modified-risk" tobacco products.
abstract: BACKGROUND
  The U.S. Food and Drug Administration (FDA) acquired authority to regulate tobacco products in 2009. This authority will provide a structured process for manufacturers to introduce products that may have "modified-risk" for morbidity or mortality relative to traditional tobacco products, with postmarketing surveillance and studies a condition of marketing.
  
  
  METHODS
  A narrative review approach was taken. The author searched and integrated publicly accessible literature on tobacco product surveillance as well as drug and medical device postmarket activities currently performed by FDA.
  
  
  RESULTS
  FDA relies on active and passive methods for postmarket surveillance and can require specific studies and risk evaluation and mitigation strategies for certain products, including those with abuse liability. Past efforts at examining the individual and population effects of reduced harm tobacco products provide an example of integrating different data streams.
  
  
  CONCLUSIONS
  Postmarket surveillance can be viewed in terms of the Agent-Host-Vector-Environment model, and concepts from diffusion of innovations are relevant to understanding factors associated with the adoption of new products by the population. Given that active and passive surveillance approaches have different strengths and weaknesses, multiple approaches may be necessary to evaluate population-level effects. Assuring that required studies are properly conducted and reported and that data indicating significant public health harms are quickly recognized will be important going forward.
  
  
  CONCLUSIONS
  The advent of broad regulatory authority over tobacco provides opportunities for policy evaluation research. The research community can provide FDA with the independent science it needs to evaluate the public health impact of novel tobacco products.
authors.affiliation: Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA. richard.oconnor@roswellpark.org
authors.forename: Richard J
authors.initials: RJ
authors.lastname: O'Connor
mesh_terms: D054626:Consumer Health Information; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D033161:Government Regulation; D006306:Health Surveys; D006801:Humans; D011358:Product Surveillance, Postmarketing / Q000379:methods* / Q000592:standards; D012106:Research; D012907:Smoking / Q000331:legislation & jurisprudence*; D000074606:Smoking Prevention; D019460:Tobacco Industry / Q000331:legislation & jurisprudence*; D014481:United States; D014486:United States Food and Drug Administration; D062789:Tobacco Products