Sunday, July 14, 2024
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Managing nicotine without smoke

YPKP Indonesia would like to attach the Preventive Medicine Journal about managing nicotine without smoke to save lives now: Evidence for harm minimization


An array of noncombustible nicotine products (NNPs) has emerged and has disrupted the marketplace. Saving lives more speedily will require societal acceptance of locating a “sweet spot” within a three-dimensional framework where NNPs are simultaneously:

  1. Less toxic
  2. Appealing (can reach smokers at scale)
  3. Satisfying (adequate nicotine delivery) to displace smoking.

For this harm minimization framework to eliminate smoking, a laser focus on “smoking control” (not general tobacco control) is needed. By adopting these economically viable NNPs as part of the solution, NNPs can be smoking control’s valued ally.

Reaffirming Harm Minimization and Smoking Control as the New Tobacco Control

Charting a new course in tobacco control via harm reduction must be seriously considered. Innovations in technology and accelerating adoption of NNPs have taken the “tobacco control” community, policymakers and cigarette companies by storm and surprise. As Michael Russell, a pioneering tobacco control scientist, put it, “People smoke for nicotine but they die from the tar.”138 The safest course is to stop smoking or, better, never to start. When a harmful behavior cannot be eliminated, it is necessary to reduce its adverse health consequences to the greatest extent possible among any users of nicotine or tobacco containing consumer products. As stated several times, a critical organizing harm minimization principle is that policy, regulation, science and advocacy should be evidence-based and aligned proportional to the degree of product harm.


  1. Harm reduction can both protect youth and speedily save millions of smokers lives
  2. Products that do not burn tobacco are substantially less harmful than deadly smoke
  3. E-cigarettes do help smoker’s switch or quit smoking especially if used daily
  4. Youth use of e-cigarettes is experimental and not a gateway to lifetime smoking
  5. If over 10 years smokers switch to vaping then 6+ million deaths will be averted

Read full manuscript : Here to open PDF file.


factasia - tobacco harm reduction
Figure 1. Products along the harm minimization continuum
. Adapted from Nutt et al., 201435 and reproduced from Abrams et al., 201824 The figure depicts four panels representing classes of products ranging from exceptionally low harm to exceptionally high harm. Panel 1 (left) depicts no use and thus no exposure. Panel 2 (left middle) depicts the class of nicotine delivery products without any tobacco (e-cigs/e-vapor products and nicotine replacement therapies – NRTs). Products containing tobacco are depicted as noncombusted or smokeless (panel 3, right middle) and combusted or smoked (panel 4, right). Panels 2 and 3 constitute the broader supra-ordinate category of noncombusted nicotine products (NNPs).


Figure 2. Multidimensional framework for nicotine containing products, considering (1) harmfulness, (2) appeal, and (3) dependence. Reproduced from Abrams et al., 201824 The top, back, right corner depicts the most popular (appealing), highly satisfying (dependence), and toxic space (combusted products), whereas no use at all is zero on all three axes. The bottom, front, left space depicts products that have low toxicity but little appeal or satisfaction (e.g., nicotine replacement therapies – NRTs). Minimizing risk while making a net population health impact requires products to successfully compete with and replace smoking. Thus, the sweet spot, where ANDS or NNP’s products might fall, is depicted by high appeal and satisfaction but low toxicity along with products such as Swedish-type snus, which has successfully displaced cigarettes in Sweden.facta asia thrFigure 3. Markov state transition model of cigarette and non-combusted nicotine products (NNPs), or alternativenicotine delivery systems (ANDS) use. Adapted from Cobb et al., 201567 and reproduced from Abrams et al., 201824 Directed arrows represent transitions, whereas looped arrows at each state represent maintenance of that state. Traditional youth prevention and smoking cessation strategies reinforce the states of noncurrent and former use depicted by green circles, and complementary new harm minimization strategies facilitate movement away from deadly combusted tobacco smoking to substantially less harmful alternative NNP/ANDS products (blue arrow).

Read full manuscript : Here to open PDF file.

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