Reducing the harm caused by smoking has been a global health priority for decades, but the idea of providing adult smokers with smokeless alternatives isn’t new.
In fact, it started long before modern vaping devices came onto the scene. One of the earliest examples comes from Sweden, where, in the 19th century, a product called snus, a moist, smokeless form of tobacco placed under the lip, became popular.
Unlike cigarettes, snus delivers nicotine without burning tobacco, meaning that there is no smoke emitted. Thus, there are no tar or other harmful chemicals contained in cigarette smoke.
Over time, the widespread use of snus has coincided with a sharp decline in daily smoking rates among Swedish men; from approximately 50% in the 1970s (World Health Organization, 2019) (WHO) to 5.3% smoking incidence in 2023, (Business Wire, 2025) leaving Sweden very close to meeting the definition of a smoke-free society, achieved at 5% smoking incidence, according to the WHO, in contrast with an EU average of 24% (Eurobarometer 2024).
In 2003, Chinese pharmacist Hon Lik, motivated by his father’s battle with lung cancer, developed the first modern e-cigarette. His invention marked a turning point in the global effort to reduce the harm caused by smoking. By delivering nicotine without burning tobacco, this innovation opened the door to a new generation of products designed to help adult smokers switch to alternatives with lower risk profiles. (Kim JY, 2020).
Milestones in Tobacco Harm Reduction innovation
Late 1800s: Introduction and commercialisation of Swedish snus.
2003: Launch of the first modern e-cigarette in China.
2014 – 2016: Market introduction of heated-tobacco products (HTPs) in Japan and select European countries.
2020s: Rapid growth in popularity of nicotine pouches (tobacco-free oral nicotine) and next-generation inhalation devices with advanced temperature controls.
Each successive innovation has expanded the THR toolkit, providing a spectrum of options tailored to diverse smoker preferences (Royal College of Physicians 2016).
Regulatory Landscapes
As with all nouveau products, it is important for government authorities to determine and prescribe strict, evidence-based guardrails to prevent youth access and facilitate the responsible sale of nicotine products to adult consumers only. Countries around the world take very different approaches to regulating smokeless nicotine products—and much of that depends on how well they understand THR as a public health strategy. Some governments have adopted more progressive policies that strike a balance: making reduced-risk alternatives available to adult smokers, while putting strong rules in place to prevent misuse.
United Kingdom (UK): Integrates e-cigarettes into the National Health Service’s smoking-cessation programmes, recognising their role in helping adult smokers quit (Public Health England, 2018). As a result, the UK government actively includes e-cigarettes in its National Health Service Stop Smoking Campaign, encouraging local services to support adult smokers who choose vaping as a quitting aid.
Sweden: Allows snus and other reduced-risk* alternatives under strict quality controls, contributing to one of Europe’s lowest smoking and lung cancer rates. (Smoke Free Sweden 2023)
Japan: Prohibits most vaping liquids but permits heated tobacco products to flourish under consumer-safety guidelines. (Royal College of Physicians, 2024).
United States: Implements stringent FDA oversight of e-cigarettes, with flavour restrictions aimed at reducing youth appeal. (Royal College of Physicians, 2024).
These varied frameworks yield instructive lessons: balanced regulation can enable adult smokers to access reduced-risk* products, while safeguarding underage access and non-smokers from unintended exposure.
Generally, public understanding of nicotine is changing from the one-dimensional view that “all nicotine use is equally harmful” to a continuum-of-risk model. At the highest end of that risk spectrum are combustible cigarettes, which release toxic chemicals when burned. The level of risk decreases along the continuum towards non-combustible products such as heated tobacco products, vapour products, oral nicotine pouches and nicotine replacement therapies, which are generally considered to pose the lowest relative risk.
Conclusion
From the early use of snus in Sweden to today’s advanced vapour and oral nicotine pouches, the evolution of tobacco harm reduction reflects a global effort to reduce the health impact of smoking. By learning from past models and applying evidence-based and balanced regulatory frameworks, countries, including Nigeria, can harness innovation to guide adult smokers away from combustion, toward potentially reduced-risk alternatives.
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.Royal College of Physicians. 2016. Nicotine without Smoke: Tobacco Harm Reduction. London: Royal College of Physicians.
2.Kim JY. Directions and Challenges in Smoking Cessation Treatment. Tuberc Respir Dis (Seoul). 2020 Dec;83(Supple 1):S1-S5. doi: 10.4046/trd.2020.0150. Epub 2020 Dec 2. PMID: 33261242; PMCID: PMC7837376. https://pmc.ncbi.nlm.nih.gov/articles/PMC7837376/ .
3.Business Wire, 2025. Sweden’s Smoke-Free Model Is Already Saving Lives Worldwide, Says New Report
4.The Eurobarometer survey on Attitudes of Europeans towards tobacco and related products, 2024, https://europa.eu/eurobarometer/surveys/detail/2995.
5.Public Health England. 2018. Evidence Review of E-Cigarettes and Heated Tobacco Products. Updated March 2, 2018. https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review/evidence-review-of-e-cigarettes-and-heated-tobacco-products-2018-executive-summary.
6.World Health Organization. 2019. WHO Report on the Global Tobacco Epidemic, 2019: Offer Help to Quit Tobacco Use. Geneva: WHO.
7. Smoke-Free Sweden 2023. The Swedish experience: A roadmap to a smoke-free society. https://www.smokefreesweden.org.
8. Royal College of Physicians, .2024. E-cigarettes and harm reduction: An evidence review (p. 106). Royal College of Physicians. e-cigarettes-and-harm-reduction_full-report_updated_0.pdf.
9. Royal College of Physicians, .2024. E-cigarettes and harm reduction: An evidence review (p. 105). Royal College of Physicians. e-cigarettes-and-harm-reduction_full-report_updated_0.pdf.
10.E-cigarettes Market, 2024. https://market.us/report/e-cigarettes-market/