Effective public health strategies are most successful when they combine the latest scientific discoveries with regulatory measures.
IN a world where health-conscious choices are becoming the norm, many people are swapping indulgent comfort foods for lighter, more nutritious alternatives. Even the beloved crispy, juicy fried chicken now has healthier substitutes, like air-fried or baked versions.
Similarly, some smokers are turning to less harmful alternatives to traditional smoking. Products like heated tobacco products (HTPs), e-cigarettes, and snus allow users to continue consuming nicotine without the harmful effects of burning tobacco.
The burning process produces over 6,000 chemicals – of which 100 have been identified by public health agencies as potential causes of smoking-related diseases,1 in addition to dangerous tar.
While critics contend that there isn’t enough evidence to conclusively prove the safety of these alternatives, it’s important to note that the World Health Organization (WHO)2 recognises harm reduction as a key element of tobacco control in its Framework Convention on Tobacco Control (FCTC). This acknowledgment suggests that reducing harm – rather than insisting solely on complete cessation – can be a valid part of the solution.
Although quitting entirely is ideal, for some individuals switching to a less harmful alternative represents a positive step forward.
Enhancing regulatory synergy
Regulatory frameworks often lag behind rapid technological and scientific advancements, particularly in emerging fields like tobacco harm reduction. For public health strategies to be truly effective, regulations must evolve alongside new scientific evidence. This ensures that policies remain relevant and that safer alternatives are both accessible and rigorously controlled.
Ongoing research also plays a crucial role in identifying emerging health risks, discovering better treatments, and developing more efficient solutions. Without integrating new evidence, public health policies risk overlooking key issues or missing opportunities to improve outcomes.
Countries like Japan and Sweden offer compelling examples of how incorporating scientific findings into tobacco control can yield significant public health benefits.
Rather than focusing solely on eliminating tobacco use, these nations have embraced safer alternatives as part of a comprehensive strategy to reduce smoking-related health risks.
In Sweden, for instance, the widespread use of snus—a smokeless tobacco product—has contributed to lower smoking rates among men by providing a safer alternative.3 Although the Swedish approach is different from that of Japan, both strategies illustrate the value of integrating harm reduction into national tobacco control policies.
Real-world evidence from Japan: Heated tobacco products in action
In Japan, strong regulatory support and public education campaigns have contributed to a marked decline in smoking rates.
The Japanese government has supported the widespread adoption of heated tobacco products, such as IQOS,4 through measures allowing smokers to switch to less harmful alternatives.
Data from Global Action to End Smoking5 indicate that demand for cigarettes dropped by 56%, from 82.1 packs per capita in 2010 to 36.2 packs in 2022. Overall tobacco and nicotine product use decreased from 18.5% in 2016 to 15.4% in 2023, with cigarette smoking specifically falling from 17.6% to 11.8% during the same period.
According to PMI Science6, a long-term study conducted in Japan over the past five years has tracked adult tobacco use habits and revealed that heated tobacco products have largely replaced traditional cigarettes without increasing overall tobacco consumption. The findings suggest that smoke-free alternatives may play a significant role in reducing the harm associated with smoking, said Philip Morris International Regulatory Consumer Research manager Dr Karina Fischer.
This ongoing, representative cross-sectional study – designed in line with the Japan National Health and Nutrition Survey and approved by the Hakata Clinic Institutional Review Board – has surveyed between 4,000 and 7,000 Japanese adults annually since 2016.
The data clearly show that while the prevalence of cigarette smoking has declined, heated tobacco product usage has risen correspondingly. Nearly all users of these alternatives are former cigarette smokers, with less than 0.1% of adult never-users initiating heated tobacco use.
Moreover, combined use of cigarettes and heated tobacco products has diminished substantially, further underscoring the potential of these alternatives to drive harm reduction.
Breaking the chain of combustion
Extensive research confirms that while nicotine is addictive, the primary dangers of smoking arise from the combustion process. Traditional cigarettes burn tobacco at high temperatures (400°C to 800°C), producing smoke laden with tar, carbon monoxide, and numerous harmful chemicals that contribute to diseases such as lung cancer, heart disease and chronic respiratory conditions.
In contrast, alternatives such as heated tobacco products and e-cigarettes operate at significantly lower temperatures, thereby reducing the generation of harmful chemicals. Studies indicate that such heated tobacco products can lower the levels of dangerous compounds by as much as 90% to 95% compared to conventional cigarettes,7 marking a significant advance in offering smokers safer choices.
Governments can enhance public health by supporting these innovations through regulatory measures that balance safety with accessibility. This might include streamlined approval processes, clear safety guidelines and public education campaigns that effectively communicate the benefits of transitioning away from combustion-based smoking.
The experiences of Japan and Sweden underscore that integrating harm reduction strategies into tobacco control frameworks can lead to notable decreases in smoking-related health issues.
With evidence suggesting that a substantial number of adult smokers are switching to less harmful alternatives, policymakers may consider whether greater support for these innovations could complement traditional cessation efforts – rather than viewing complete cessation as the only acceptable outcome.
1 https://www.pmi.com/our-science/tobacco-harm-reduction/what-is-tobacco-harm-reduction
2 https://pmc.ncbi.nlm.nih.gov/articles/PMC9293728/
4 https://www.pmiscience.com/en/research/literature-reviews/why-did-cigarette-sales-decline-in-japan-/
5 https://globalactiontoendsmoking.org/research/tobacco-around-the-world/japan/
6 https://www.pmiscience.com/en/news-events/news/heated-tobacco-products-public-health-harm-reduction/
7 https://www.pmiscience.com/en/smoke-free/harm-reduction/
