Misconceptions around nicotine
Nicotine, a naturally occurring alkaloid found in tobacco plants, is addictive and not risk free, however, it is not the primary cause of smoking-related diseases. In fact, it has been scientifically substantiated that the primary health risks associated with smoking stem from the combustion of tobacco. Burning tobacco releases thousands of chemicals, many of which are harmful and are primarily responsible for the majority of smoking-related diseases, including lung cancer, cardiovascular disease, and chronic obstructive pulmonary disease. Nonetheless, the misconception that nicotine is a major cause of smoking-related disease has led to policies that may not effectively address the root of the problem associated with smoking.
The role of nicotine in harm reduction policies
To devise policies which can effectively combat smoking-related diseases, it is crucial to distinguish between the risks associated with nicotine and those caused by tobacco combustion. Policies should be informed by scientific evidence and recognize the potential of harm reduction strategies. By doing so, adult smokers can be better supported in their journey to stop smoking for good and ultimately achieve better public health outcomes. Indeed, nicotine is a crucial part of the harm reduction equation: it is not enough to offer less harmful products, they also need to be an acceptable substitute to cigarette smoking—in other words, they should deliver nicotine, as well as a satisfactory taste and sensory experience that help adult smokers who would otherwise continue to smoke to fully transition to better alternatives.
The role of smoke-free products
Thanks to science and innovation, there are now different ways of consuming nicotine that do not involve burning tobacco and have been scientifically substantiated to be less harmful than smoking. Because of their lower risk of harm compared with cigarettes, these alternatives can significantly contribute to smoking decline and harm reduction efforts. However, for this to be effective, it is important that tobacco control policies are designed to support these products as viable alternatives to cigarettes. In fact, some countries that have embraced this science-based approach have seen notable declines in smoking rates and improvements in public health outcomes.
Policy examples from different countries
The contrasting effects of policy decisions are evident in Australia and New Zealand, where Australia's restrictive approach to smoke-free products stands in contrast to New Zealand's science-based policies. Both countries began their journey from the same starting point and followed a similar initial approach to policy, namely, regulating all tobacco and nicotine products restrictively.
However, over time, New Zealand diverged from this approach by providing a regulatory path to the sale and use of smoke-free products. This includes the adoption of different health warnings for e-vapor and heated tobacco products, compared with cigarettes, to allow more communication about “significantly less harmful products” for adult smokers. The result is that, according to some recent research, New Zealand’s adult daily smoking rate declined at a much faster rate than Australia’s.
We can see similar results when comparing Sweden, where snus have been allowed for sale for decades, with the rest of the EU, where snus are subject to a general ban. While Sweden has seen a dramatic decline in smoking prevalence between 2006 and 2023 (the most recent year for which data is available), smoking prevalence in other EU member states has declined by a lower rate over the same period.
Developing science-driven tobacco control policies
As we have seen, in order to effectively reduce smoking-related diseases, it is important that policies are informed by scientific evidence and enable harm reduction strategies. This science-based approach can help adult smokers to transition away from cigarettes and countries to achieve better results in reducing smoking rates and improving public health.
