Millions of adults around the world continue to smoke, often for the nicotine, which is known to be addictive. For many, quitting is a difficult journey.

Tobacco Harm Reduction (THR) offers a practical, science-led approach to support these individuals by providing access to alternative nicotine products that have a reduced-risk* profile compared to smoking.

THR aligns with broader public health goals by empowering adult smokers to make informed choices. Choices that reflect evolving science and a commitment to reducing risk, while respecting consumer autonomy.

Tobacco Harm Reduction offers an alternative for adult smokers who would otherwise continue to smoke. It supports the use of scientifically validated products with lower risk profiles than combustible cigarettes such as e-cigarettes, heated tobacco, and nicotine pouches that deliver nicotine without the combustion of tobacco, the main source of harmful toxicants in cigarette smoke.

The principle is simple: THR separates nicotine from cigarette smoke. When tobacco burns, it releases tar, carbon monoxide, and other harmful substances. Modern reduced-risk products avoid combustion altogether, helping adult smokers reduce health risks while still managing their nicotine needs.

Independent public health bodies have validated this. In its landmark 2015 review, Public Health England estimated that modern e-cigarettes are about 95% less harmful than smoking - a figure now widely cited by regulators and health bodies. However, PHE also cautioned that e-cigarettes are not entirely risk-free.

The Rationale for THR

Many adult smokers have tried to quit using nicotine patches, gums, medications, or counselling. For some, these methods work. But most relapse within a year (Tang et al., 1994). For those who find quitting too difficult or simply do not want to stop using nicotine, THR offers a more realistic path.

It plays two important roles:

Reducing risk: By switching from cigarettes to reduced-risk* products, adult smokers can significantly cut exposure to harmful chemicals, lowering the chances of smoking-related disease.

Helping transition: Many smokers use THR products as a stepping stone to quitting. First, they switch to reduced-risk* options, then gradually reduce nicotine use, or quit altogether. This step-by-step approach is often more successful than quitting abruptly (UK NHS: Vaping to quit smoking).

Notable health authorities have endorsed THR strategies. The Royal College of Physicians (UK) concluded in 2016 that THR could prevent millions of smoking-related deaths if widely adopted. Public Health England maintains that e-cigarettes are “substantially less harmful” than smoking and encourages their use in cessation programmes.

The U.S. National Academies of Sciences, Engineering, and Medicine also acknowledged in 2018 that e-cigarettes are likely far less harmful than combustible tobacco, though long-term effects require further study.

Risk Management and Underage Access Prevention

Critics worry that reduced-risk nicotine alternatives could be accessible to underage individuals. These concerns are valid, which is why strict age-verification systems, responsible marketing, and product safeguards are essential. Protecting minors is a shared responsibility and a key part of responsible harm reduction.

Studies such as Sun et al. (2023) have found no evidence of a gateway effect to smoking among underage or non-smokers, suggesting that with proper regulation, these products can help adult smokers transition without increasing youth uptake.

Countries like Sweden have implemented safeguards, including:

Strict age checks at retail outlets and online platforms

Marketing rules banning youth-targeted advertising and flavours

Clear product standards ensuring accurate nicotine content and safety

Ongoing monitoring of smoking and vaping trends to detect unintended effects early

Conclusion and Outlook

As nicotine use evolves, tobacco control strategies must evolve too. While quitting entirely remains the ideal outcome, many adult smokers struggle to achieve it.

Tobacco Harm Reduction provides a practical, science-backed alternative, offering reduced-risk options that, when combined with strong regulation and public education, can lower smoking-related disease rates, reduce healthcare costs, and lessen the health impact of tobacco use.

The Evolution of Smokeless Alternatives to Smoking

Reducing the harm caused by smoking has been a global health priority for decades, but smokeless alternatives are not new.

In 19th-century Sweden, snus, a moist, smokeless tobacco placed under the lip—became popular. Unlike cigarettes, snus delivers nicotine without burning tobacco, meaning no smoke, tar, or harmful chemicals. Its widespread use coincided with a sharp decline in smoking rates among Swedish men, from about 50% in the 1970s to just 5.3% in 2023 (WHO, Business Wire). Sweden is now close to meeting the WHO’s definition of a smoke-free society (5% smoking incidence), compared to an EU average of 24%.

In 2003, Chinese pharmacist Hon Lik, motivated by his father’s battle with lung cancer, developed the first modern e-cigarette.

This innovation marked a turning point, delivering nicotine without combustion and opening the door to new reduced-risk products.

Milestones in Tobacco Harm Reduction Innovation

Late 1800s: Introduction of Swedish snus

2003: Launch of the first modern e-cigarette in China

2014–2016: Heated tobacco products introduced in Japan and Europe

2020s: Growth of nicotine pouches and advanced inhalation devices

Each innovation expanded the THR toolkit, offering diverse options tailored to smoker preferences.

Regulatory Landscapes
Governments vary widely in regulating smokeless nicotine products:

UK: Integrates e-cigarettes into NHS cessation programmes, encouraging vaping as a quitting aid.

Sweden: Allows snus and other reduced-risk* alternatives under strict controls, contributing to low smoking and lung cancer rates.

Japan: Restricts vaping liquids but permits heated tobacco products under safety guidelines.

USA: Enforces FDA oversight of e-cigarettes, with flavour restrictions to reduce youth appeal.

These frameworks show that balanced regulation can enable adult smokers to access reduced-risk products while safeguarding youth and non-smokers.

Public understanding of nicotine is also shifting from viewing all nicotine use as equally harmful to recognising a continuum of risk. Combustible cigarettes pose the highest risk, while non-combustible products such as heated tobacco, vapour devices, oral nicotine pouches, and nicotine replacement therapies are generally considered far less harmful.

Conclusion

From the early use of snus in Sweden to today’s advanced vapour and oral nicotine pouches, the evolution of tobacco harm reduction reflects a global effort to reduce smoking’s health impact.

By applying evidence-based, balanced regulation, countries including Nigeria can harness innovation to guide adult smokers away from combustion and toward reduced-risk alternatives.