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Despite substantial declines in cigarette smoking in England since the 1970s, around 20 per cent of the adult population still smokes. In Sweden, 10 per cent of adult males and 12 per cent of adult females smoke cigarettes, while snus use is prevalent among 19 per cent of adult males and 4 per cent of adult females. Traditional cessation‐only approaches may need to be supplemented with broader tobacco harm reduction measures to reduce smoking prevalence further. General practitioners (GPs) are well placed to give patients advice on tobacco harm reduction. This paper seeks to address these issues.

The authors administered an online survey to assess knowledge, perceptions and attitudes to tobacco and nicotine products to 220 GPs (100 in England and 120 in Sweden).

Most GPs (96 [96 per cent] England, 115 [98 per cent] Sweden) addressed smoking cessation with patients as part of their regular practice. Most GPs (87 [87 per cent] England, 102 [85 per cent] Sweden) felt extremely or fairly knowledgeable about the risks associated with cigarettes, but less so about nicotine in tobacco products and pharmaceutical nicotine. When asked to rank various products on a risk continuum, GPs rated cigarettes as riskiest and tobacco cessation and nicotine‐containing products as least risky. However, when asked to rank components of cigarettes based on their health risks, GPs ranked nicotine as the third riskiest (74 [74 per cent] England, 104 [87 per cent] Sweden), after tar and carbon monoxide, but before smoke or tobacco. When asked questions about a hypothetical nicotine replacement therapy (NRT) product that looks like a cigarette and is licensed for harm reduction, GPs perceived that sensory experience and tobacco harm reduction could be benefits to patients, but perceived appeal to children and risk for abuse could be drawbacks.

Most respondent GPs are well informed about the relative risks of nicotine and tobacco, but more research needs to be done to investigate their concerns over the long‐term substitution of cigarettes with alternative nicotine products.

Nicotine is widely known as a tobacco constituent and for its use as a tobacco cessation aid. The development of new devices for nicotine delivery in recent years has led to uncertainty among consumers regarding the health risks of nicotine relative to tobacco. The purpose of this study was to discover if current and former consumers of tobacco and tobacco harm reduction (THR) products could distinguish between “nicotine” and “cigarettes” and examined the preceding media dialogue to determine if conflicting messages by the media influence public perceptions.

A quantitative survey was administered online in Norway (NO), Japan (JP), the United Kingdom (UK) and the United States (US), while face-to-face computer-aided interviews were conducted with randomly selected samples in India (IN), Greece (GR) and South Africa (SA). Participants were between 18 and 69 years of age and either current users of tobacco and THR products or previous users who quit within the past five years. Questions assessed beliefs about harmfulness of nicotine. Nicotine and other products and substances were also independently rated for harmfulness on a scale of 1–10 and subsequently compared. In addition, the authors examined the media dialogue of top media outlets in four countries to assess the potential influence on people’s beliefs.

A total of 54,267 participants (NO: 1,700, JP: 2,227, UK: 2,250, USA: 2,309, IN: 41,633, GR: 1,801, SA: 2,359) were sampled with the percentage of women participants ranging from 14.8% (IN) to 53.8% (UK). Between 68.3% (men, IN) and 88.7% (men, USA) of current consumers believed nicotine is harmful. Current consumers who agreed with the statement that nicotine is the primary cause of tobacco-related cancer ranged from 43.7% (men, UK) to 78.0% (men, SA). In six countries nicotine was rated nearly as harmful as cigarettes and alcohol, while other substances such as sugar, salt or caffeine, were usually rated as less harmful.

A large proportion of consumers across all surveyed countries view nicotine and cigarettes similarly. Clearer communication on the harmful properties of both by the media is needed to help consumers make informed decisions about products across the continuum of risk. Messaging to consumers, especially via the media, propagates misinformation about the relative harms of tobacco and nicotine through reporting that is often incomplete and biased toward more negative aspects.

This study specifically assessed public perceptions of nicotine as opposed to products containing nicotine, which is the focus of previous studies. Apart from showing that consumers often incorrectly perceive nicotine and cigarettes as similar in terms of harmfulness, the authors highlight the need for more accurate and complete reporting by the media to clarify widespread misunderstandings and mitigate public uncertainty.

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.

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

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.

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

Health promotion strategies often attempt to change people’s behavior through targeting their risk perceptions. These perceptions may, however, be moderated by other factors. This study therefore aimed at investigating the trustworthiness and consistency of risk information, as well as respondent perceptions of the adequacy of amount received among a representative sample of former smokers, and how this information is related to gender, age, education level and whether using nicotine or not.

The respondents are part of a seven-year follow-up of former smokers in Sweden. Initially, 1400 respondents were contacted, whereof 705 (response rate 50%) answered a Web-survey. The majority (85 %) was still nicotine-free but some made use of nicotine in different forms. The data analysis includes descriptive statistics and logistic regressions.

Most respondents trusted risk information whether offered by the public authorities or came from other sources such as media, and generally perceived that there was an adequate amount. However, there were some differences between the products, where quite a few distrusted information on Nicotine Replacement Therapies (NRTs) and some perceived the information on snus and NRTs as contradictory and too little.

Knowledge about how former smokers perceive information regarding negative aspects of cigarette use may facilitate more effective risk communication with current smokers, and it may also be important for communicating information about other nicotine products to those who are trying to or who already have quit smoking.

The purpose of this paper is to review the barriers in the dissemination of effective smoking cessation treatments and services globally. Offering tobacco users help to stop using tobacco is a key demand reduction measure outlined under Article 14 of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC). Implementing Article 14 can reap great dividends for the billion plus tobacco users around the world and their families, friends and societies.

A review of the status of the global implementation of Article 14 using available literature on smoking cessation products, services and national guidelines. Discussing innovative approaches being currently explored in South Asia that can lead to faster adoption and implementation of Article 14 globally.

Major gaps remain in cessation products’ availability and resource allocation for cessation services globally. Current licensed products are falling short on delivering and sustaining smoking cessation. Innovation in cessation products and services needs to build on learnings in nicotine pharmacokinetics, behavioural insights from consumer research and tap into 21st century tools such as mobile based apps. National implementation of FCTC’s Article 14 needs to follow guidelines that encourage integration into existing health programmes and health-care practitioners’ (HCPs) upskilling.

Smoking cessation is a desirable health outcome and nicotine replacement products are a means of achieving cessation through tobacco harm reduction. E-cigarettes are sophisticated nicotine replacement products. Innovation is urgently needed to fill the gaps in smoking cessation products and services, and for converting global policy into local practice. In low- and middle-income countries (LMICs), HCPs’ knowledge, attitudes and practice regarding tobacco use and cessation may hold the key to rapidly scaling up cessation support and delivery to achieve FCTC objectives sooner. Additionally, HCPs can play an important role in offering smoking cessation support in existing national health programmes for TB, cancer screening and maternal and child health. Also, widely prevalent smartphone devices may deliver smoking cessation through telemedicine in LMICs sooner, leapfrogging the hurdles of the existing health-care infrastructure.

This article examines the relationship between tobacco control and tobacco harm reduction, illuminating the differences and similarities between them.

Drawing on published sources, the author conducts a critical analysis of the prevailing discourses on tobacco control and tobacco harm reduction.

Although tobacco control and tobacco harm reduction differ in their views on the resolutions to the tobacco “problem”, they manifest similar underlying assumptions about the nature of “the smoker” and are equally silent on the topic of pleasure.

This article emphasises the need for tobacco harm reduction to take pleasure seriously and highlights the limitations of approaches focused exclusively on risk and harm reduction.

This paper aims to provide a brief summary of the effectiveness and efficacy of tobacco harm reduction (THR). THR is the substitution for cigarettes of low‐risk alternatives, including Swedish or American‐style smokeless tobacco, pharmaceutical nicotine products, and electronic cigarettes. The paper then very briefly summarizes the current social and political situation regarding THR.

This paper is a review of the evidence.

The risk from smoke‐free tobacco/nicotine products is so low as to be unmeasurable. For most smokers, adopting THR is a lower risk option than to trying to become nicotine abstinent. THR products have been widely adopted in some populations, providing great public health benefits. There is currently an explosion of interest in electronic cigarettes. However, THR is a threat to the business model of the tobacco control industry, and so they are fighting hard to discourage it. Because they cannot admit their real motives for discouraging THR, anti‐THR activism is an entirely dishonest enterprise.

Tobacco harm reduction is the greatest untapped public health initiative in the developed world. It is more promising than further attempts to promote tobacco/nicotine abstinence. The future inevitably includes a large portion of the population using low‐risk tobacco/nicotine, but anti‐THR efforts might keep people smoking in the short run.

While most of the content of this paper is well known to experts on THR, many ostensible experts on health, as well as other opinion leaders and policy makers, are unaware of the truth.

The purpose of this paper is to examine the importance of tobacco differentiation attributes (i.e. nicotine and tar content, length, flavor and thickness) in market performance and loyalty levels of brands.

The study adopts a stochastic approach to measure brand loyalty at the attribute level using the Dirichlet model as a benchmark tool. Data based on the Juster Probability Scale were collected from a sample of n=155 young smokers in Iceland.

Product differentiation strategies operate differently. Light nicotine and tar content encourages smokers to switch across brands and within family brands, resulting on improved market performance and loyalty levels. Length and thickness‐related differentiation are slightly better than non‐differentiation in inducing loyalty, but worse in improving performance.

Two types of categorization prevail in the category: first, a family brand‐based, mainly relevant for large brands; and second, an attribute‐driven, apparent for small family brands. Two types of switching behaviors can also be considered: first within family brands, switching among product attributes for the larger brands; and second within product attributes, switching among family brands for smaller brands.

These findings have profound implications for the development of anti‐smoking policy in terms of the exact functioning of product differentiation as part of the tobacco industry's strategy. Public health policy makers can benefit in their fight against nicotine consumption by taking public policy counter‐measures (e.g. completely banning or regulating production of “light” nicotine and tar content brands) that can limit the anticipated success of differentiation strategies of the tobacco industry.

Not much research has been done on loyalty within the tobacco category, possibly due to the ethical considerations accompanying managerial suggestions about smoking. The contribution of the present work lies in the provisions of evidence‐based insights to help brand managers and other stakeholders (e.g. public health policy makers) to take informed decisions.

Nicotine is consumed by one in five of the global adult population, mostly by smoking tobacco cigarettes. Modern electronic cigarettes came onto the market from around 2007 and have considerable potential to improve population health by displacing tobacco smoking. The purpose of this study is to map the use of e-cigarettes, but this is difficult due to absence of data sources for many countries.

The global number of vapers was estimated to be 68 million in 2020. New data in 2021 offered an opportunity to update that estimate. The method of assumed similarity was used for countries with missing data. The average prevalence of vaping was calculated for each World Health Organization region, World Bank income classification group and the legal status of e-cigarettes in each country. The number of vapers was calculated for the adult population. The estimate was refined by adjusting for changes in market value size and the actual year of surveys.

Population prevalence data on e-cigarette used were available for 48 countries. We estimate that there were 82 million vapers worldwide in 2021: 9.2 million in the Eastern Mediterranean region; 5.6 million in the African region; 20.1 million in the European region; 16.8 million in the Americas; 16.0 million in the Western Pacific region; and 14.3 million in South-East Asia.

Global, regional and national estimates of the numbers of vapers are important indicators of trends in nicotine use, and monitoring the uptake of vaping is important to inform international and national policy.

In Norway, snus (low nitrosamine smokeless tobacco) is allowed to compete with cigarettes for market share, and over the past decades the prevalence of snus users has increased as the prevalence of smokers has decreased. The author has aimed to sum up the findings from research that has tried to identify the role of snus in smoking cessation and how availability to snus in Norway has affected the magnitude of concomitant use of snus and cigarettes.

Relevant results from Norwegian studies are presented, and, if possible, compared to findings from studies conducted in other countries.

Snus is reported by ever‐smokers to be the most preferred method for quitting, and former smokers make up the largest segment of Norwegian snus users. The quit rate for smoking is consistently observed to be higher for snus users than for smokers who have no experience of use of snus. Moreover, those using snus are more likely to have quit smoking completely or considerably reduced their cigarette smoking than users of medicinal smoking cessation products. The increase in snus use among men in Norway has not been paralleled by an increase in dual use of snus and cigarettes.

The results observed in Norway might not be extrapolated to other countries that do not have the same history of use of snus.

The replacement of cigarettes by snus has been the most typical pattern of use in Norway, and the availability of snus may have been beneficial to public health.

Besides neighbouring Sweden, Norway is the only country in the eurozone with a tradition of snus use. Knowledge about the pattern of snus use in these countries is relevant for policymakers when deciding the legal status of snus in the EU.