Review Examines the Effects of Tobacco Harm Reduction Products – Including E-Cigarettes


Lindsey Stroud

AVA Synopsis:

The authors seek to provide a comprehensive review to emphasize “the need for tobacco harm reduction.” The authors focus on the effects of substituting harm reduction products, including snus, heat-not-burn, and vapor products, for smoking.

The review examines literature of each tobacco harm reduction product, as well as barriers to harm reduction – including bans, regulations and taxes. Further, the review examines recent alarmism, including misperception and misinformation brought for by media sensationalism.

The authors conclude that “to reduce smoking and to save millions of lives, tobacco harm reduction in the form of cigarette substation with low-risk products appears to be a promising path.” The authors do caution though, that “tobacco harm reduction is in sore need of more research if this public health strategy is to make a meaningful impact on the tobacco epidemic.”


The paper provides a comprehensive review of the available evidence of the impact of tobacco harm reduction. It also offers detailed insight to negative misperception of use of these products.


Purpose: This paper aims to overview the need for tobacco harm reduction, the consumer products that facilitate tobacco harm reduction and the barriers to its implementation. The worldwide endemic of tobacco smoking results in the death of over seven million smokers a year. Cigarette quit rates are very low, from 3%–12%, and relapse rates are high, from 75%–80% in the first six months and 30%–40% even after one year of abstinence. In addition, some smokers do not desire to quit. Cigarette substitution in tobacco harm reduction is one strategy that may reduce the burden of morbidity and mortality.

Design/methodology/approach: This review examines the displacement of smoking through substitution of non-combustible low-risk products such as snus, heated tobacco products and e-cigarettes.

Findings: Toxicological testing, population studies, clinical trials and randomized controlled trials demonstrate the potential reductions in exposures for smokers. Many barriers impede the implementation of product substitution in tobacco harm reduction. These products have been subjected to regulatory bans and heavy taxation and are rejected by smokers and society based on misperceptions about nicotine, sensational media headlines and unsubstantiated fears of youth addiction. These barriers will need to be addressed if tobacco harm reduction is to make the maximum impact on the tobacco endemic.

Originality/value: This review provides the rationale for tobacco harm reduction, evaluates the current products available and identifies the barriers to implementation.

Further Reading:

The Counterfactual, The past is not the future – what lies ahead for tobacco and nicotine?, 2020

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