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 and 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 and choice.
Tobacco Harm Reduction (THR) 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 harmfultoxicants found 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. But modern reduced-risk* products avoid combustion altogether, helping adult smokers reduce the health risks related to cigarette smoking, while still managing their nicotine needs.
Independent public health bodies such as Public Health England (PHE) have also validated this. In its landmark review (Public Health England 2015) estimated that modern e-cigarettes are about 95% less harmful than smoking. This is a figure that is now widely cited by regulators and health bodies. However, PHE has also said that it should be noted that this does not mean e-cigarettes are entirely risk-free.
The Rationale for THR
Many adult smokers have tried to quit using tools like nicotine patches, gums, medications, or counselling. For some, these methods work. But the reality is that most people who try to quit, relapse within a year (Tang et al, 1994). For those who find quitting completely too difficult or simply don’t 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 like e-cigarettes, heated tobacco, or nicotine pouches, adult smokers can significantly cut their exposure to harmful chemicals – reducing the chances of smoking-related disease.
Helping transition: Many adult smokers use THR products as a stepping stone to quitting. First, by switching to reduced-risk options, then gradually reducing their nicotine use, or even quitting altogether. This step-by-step approach is often more successful than trying to quit all at once (UK NHS: Vaping to quit smoking).
Notable health authorities have also begun to endorse THR strategies. The Royal College of Physicians (UK) issued a comprehensive report in 2016 concluding that THR could prevent millions of smoking-related deaths if widely adopted (Royal College of Physicians 2016). Further, Public Health England maintains that e-cigarettes are “substantially less harmful” than smoking and encourages their use in national cessation programmes (Public Health England 2015).
The National Academies of Sciences, Engineering, and Medicine (USA) acknowledged that while long-term effects require further study, e-cigarettes are likely to be far less harmful than combustible tobacco (National Academies of Sciences, Engineering, and Medicine 2018).
Risk Management and underage access prevention
Some critics worry that offering reduced-risk nicotine alternatives could make these products more accessible to underage individuals. These concerns are valid and deserve attention. That’s why strict age-verification systems, responsible marketing practices, and product safeguards are essential to ensure reduced-risk products remain available only to adults.
Protecting the underaged is a shared responsibility—and a key part of how harm reduction can work responsibly. More so, a few studies have indicated no evidence of a gateway effect to smoking for underage or non-smokers (Sun et al, 2023), suggesting that with the right regulations in place, these products can help adult smokers transition without increasing youth uptake
To address these risks, many countries such as Sweden for example (Smokefree Sweden, 2023), have put various safeguards in place, including:
• Strict age checks at retail outlets and online platforms
• Marketing rules that ban underage-targeted advertising and flavours
• Clear product standards to ensure accurate nicotine content and safety
• Ongoing monitoring of smoking and vaping trends to catch any unintended effects early
While there are continuous efforts to enhance them, these measures help to ensure that Tobacco Harm Reduction remains focused on adult smokers only.
Conclusion and outlook
As nicotine use continues to evolve, tobacco control strategies must evolve with it. While quitting entirely remains the ideal outcome, it’s a goal that many adult smokers may find difficult to reach. Tobacco Harm Reduction (THR) offers a practical and science-backed alternative – providing adult smokers with reduced-risk* options. By combining these alternatives with strong and evidence-based regulation as well as public education, health systems could potentially contribute to lowering smoking-related disease rates, reduce healthcare costs, and—most importantly—reduce the health impact of these products if fully adopted.
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The author Dr. Puddicombe is the Scientific Engagement Manager at BAT West & Central Africa. He is a medical doctor and a Fellow of the Academy of Public Health.
References
1.World Health Organization. (2021). WHO report on the global tobacco epidemic, 2021: addressing new and emerging products. World Health Organization. https://iris.who.int/handle/10665/343287.
2.Public Health England. 2015. “E-Cigarettes around 95 Percent Less Harmful than Tobacco, Estimates Landmark Review.” GOV.UK, August 19, 2015. https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review
3.Royal College of Physicians. 2016. Nicotine without Smoke: Tobacco Harm Reduction. London: Royal College of Physicians.
4.National Academies of Sciences, Engineering, and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington, DC: National Academies Press.
5.Tang JL, Law M, Wald N. How effective is nicotine replacement therapy in helping people to stop smoking? BMJ. 1994 Jan 1;308(6920):21-6. doi: 10.1136/bmj.308.6920.21. Erratum in: BMJ 1994 Mar 5;308(6929):626. PMID: 8179658; PMCID: PMC2539178.
6.U.K. National Health Service (NHS), Vaping to quit smoking. Available at: https://www.nhs.uk/better-health/quit-smoking/vaping-to-quit-smoking/
7.Sun R, Méndez D, Warner KE. Association of Electronic Cigarette Use by US Adolescents With Subsequent Persistent Cigarette Smoking. JAMA Netw Open. 2023;6(3):e234885. doi:10.1001/jamanetworkopen.2023.4885. Association of Electronic Cigarette Use by US Adolescents With Subsequent Persistent Cigarette Smoking – PubMed.
8.Smoke Free Sweden 2023. The Swedish experience: A roadmap to a smoke free society. https://www.smokefreesweden.org.
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