Not everyone is ready or able to quit immediately. Tobacco Harm Reduction addresses strategies that reduce disease risk while keeping the door open to complete cessation. We define the clinical frame: moving from high-toxicity combustion to lower-toxicant nicotine delivery; minimizing dual use; preventing youth uptake; and supporting transitions to abstinence when feasible. Assessment clarifies goals (quit now vs. reduce risk), prior quit history, nicotine dependence (time to first cigarette, nocturnal use), comorbidities (CVD, COPD, pregnancy, psychiatric conditions), and social context (household smokers, work breaks). We discuss the evidence around smoke-free nicotine options—nicotine replacement therapy used for reduction, and regulated non-combustible products in jurisdictions where permitted—and how to counsel about relative risk without overselling safety. Clinical tactics include structured “step-down” plans, pairing NRT with behavioral routines to displace morning and post-meal cigarettes, and setting rules that avoid compensatory overuse. For dual users, we prioritize complete substitution periods to extinguish combustible cues. Monitoring covers blood pressure, sleep, and psychiatric symptoms, with special attention to pregnancy and cardiovascular disease. Public health responsibilities remain central: strict age-verification, flavor policies, and marketing limits to deter youth initiation; clear messaging against DIY or illicit devices; and rapid response to safety alerts (e.g., lung injury syndromes). Equity matters: cost, access to regulated products, and culturally appropriate counseling. We keep relapse-learning loops active and celebrate risk-reducing milestones while revisiting readiness to quit at every visit. In settings with smoke-free campus or hospital policies, harm-reduction plans prevent covert smoking and ease transitions to cessation services. When practiced with transparency and guardrails, Tobacco Harm Reduction, the debate and data showcased at a tobacco harm reduction conference, and the clinical utility of smoke-free nicotine help patients reduce harm today and quit tomorrow.