Quit cigarette smoking completely or switch to a less harmful nicotine product. Options include electronic cigarettes, oral nicotine or smokeless tobacco, heated tobacco products (heat-not-burn) or pharmaceutical products (e.g. inhalers, lozenges, patches and nicotine gum).

Yes. Four elements of evidence suggest that e-cigarettes are effective in helping people to quit smoking:

• Evidence from randomised controlled trials, notably Hajek et al. [21], which showed vaping to be about twice as effective as NRT.
• Observational studies (examining what happens when people use e-cigarettes) for example, Jackson et al, “Use of e-cigarettes and varenicline are associated with higher abstinence rates following a quit attempt in England. “
• Population data (unusually rapid reductions in smoking prevalence and cigarette sales), for example, Zhu S-H et al.
• Thousands of testimonials by users who have struggled to quit using other methods. See, for example, CASAA testimonials.

For all practical purposes, e-cigarettes show a 95-99% reduction in harm, compared to cigarettes. Exposure to nicotine itself is not especially harmful and mostly under the control of the user through ‘titration’ – smoking or vaping in a way that provides the desired nicotine dose.

Consuming nicotine is not totally risk-free, and can lead to dependence. However, its benefits far outweigh the risk of smoking. Nicotine has similar effects to caffeine found in coffee. There is no evidence that nicotine causes any substantial risk for cancer, and the risk for cardiovascular disease is minimal. It’s the smoke, not the nicotine that is responsible for nearly all premature death and disease. Most people can consume nicotine safely – with nicotine replacement therapy (NRT) such as gum, inhalers, lozenges, sprays or patches. However, pregnant women should avoid nicotine as it may have a negative effect on foetal development.

In those countries where THR is recognised and proportionate, risk-based regulation is in place, significant net public health gains have been demonstrated. For example, in the United Kingdom, electronic cigarettes have become the method of choice to quit smoking. In Sweden, a significant number of people replaced smoking cigarettes with ’snus’ (a Swedish smokeless tobacco product). Smoking prevalence has decreased to as low as 6%, whereas the average in the EU is still around 26%.

THR faces many barriers in its efforts to reduce harm and save lives. Most barriers start with misperceptions and disproportionate tobacco regulation. For example, non-differentiation between combustible and non-combustible nicotine products causes confusion among consumers. Misleading media reports exacerbate the misperceptions.