Countries that adopt smoke-free alternatives like e-cigarettes, heated tobacco and nicotine pouches are experiencing sharper declines in cigarette smoking than those with tougher restrictions, according to international studies and historical records.
A recent large-scale study in JAMA Network Open indicates that nicotine pouches are increasingly being used by Americans as a bridge away from more harmful tobacco habits.
Using U.S. Census Bureau data from more than 110,000 adults (2022–2023), Rutgers Health researchers found that while nicotine pouches aren’t yet widely adopted, they are emerging as a meaningful alternative for those aiming to quit combustible tobacco or e-cigarettes.
The research led by Cristine Delnevo, director of the Rutgers Institute for Nicotine and Tobacco Studies, shows that daily nicotine pouch use is most prevalent among recent quitters, who are about four times more likely to use them than current smokers.
The study indicates that nicotine pouches contribute to harm reduction, even though they are not marketed as cessation products. “For people who smoke or use other nicotine products and don’t want to stop using nicotine, switching completely from the more harmful product and moving down the risk continuum with nicotine pouches is likely good for public health,” Delnevo said.
Nicotine pouches and other smoke-free products deliver nicotine without combustion, the process tied to smoking. A 2025 toxicological review by aerosol chemist Reinhard Niessner, published in the U.S. National Library of Medicine, found that e-cigarettes, heated tobacco, and nicotine pouches release far fewer harmful and potentially harmful constituents (HPHCs) because they avoid combustion.
In the study “The potential of smoke-free products to reduce harm for smokers: What does the toxicological evidence say?”, Niessner explains that smoking-related diseases stem mainly from toxins produced during tobacco combustion, not from nicotine itself. A lit cigarette generates around 6,500 chemicals—100 of them highly toxic—whereas smoke-free alternatives avoid combustion and thus prevent the formation of these hazardous substances.
Because e-cigarettes, heated tobacco, and nicotine pouches do not involve burning, they produce far lower levels of HPHCs.
A study published in Oxford Academic in February 2024 by Brighton and Sussex Medical School found that smokers who viewed vaping as less harmful than smoking were more likely to have made a permanent switch six years later.
The clearest example is Sweden, which Damian Sweeney, chair of New Nicotine Alliance Ireland, calls a compelling “proof of concept.” Although overall nicotine use in Sweden mirrors the EU average, most consumers rely on snus or nicotine pouches, driving smoking prevalence down to just 5 percent—the lowest in the union.
Representatives of the World Vapers Alliance (WVA) says that millions of lives could benefit if regulators gave greater weight to the experiences of those who have successfully moved away from combustible tobacco.
This view was affirmed by a March 2025 survey by the Tholos Foundation and Dynata involving 515 nicotine pouch users in Spain, which found that two-thirds adopted the products as a way to quit smoking.
The Global State of Tobacco Harm Reduction report finds that smoke-free nicotine products are far safer than cigarettes. In the UK, where they are promoted as lower-risk options, smoking prevalence dropped from 24 percent in 2005 to 10.8 percent in 2025.
University of Queensland researchers found that smoking rates in New Zealand fell by 10 percent annually between 2016 and 2023—double the 5 percent yearly decline recorded in Australia’s stricter regulatory environment.
Former WHO Tobacco-Free Initiative program manager Derek Yach highlighted Japan, South Korea and Norway as further examples of successful transitions.
“Let’s put all our focus on getting harm reduction out there. If so, a decade from now, we will be able to cut the billion smokers and users of tobacco by 50 percent, maybe even more,” Yach said, adding that the global goal should be to “all be Swedes” when it comes to smoking statistics within the next 20 years.
University of Catania biochemistry professor Giovanni Li Volti stated that nicotine itself is not linked to recurrent stroke or poor cardiovascular health, pointing out that the existence of nicotine replacement therapy demonstrates its accepted medical use.
By enacting the Vape Law in 2022, the Philippines established a comprehensive legal framework for tobacco harm reduction, positioning itself as a regional example in Southeast Asia.
A joint report by former WHO officials Tikki Pang and Derek Yach, economist Chris Snowdon of the Institute for Economic Affairs, and Clearing the Air co-founder Peter Beckett cautioned that neglecting harm reduction could cost millions of lives.
They estimated that adopting these measures could save more than 14 million lives across 23 countries by 2060.
