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COP10 ends with a missed opportunity for harm reduction. Despite calls, no workgroup was established. Emphasis on Article 18's environmental impact. Advocates stress inclusion and science-based policies for COP11.

**Day 5**

COP10 wrapped up on February 10th, with the member states mainly focusing on FCTC Article 18, concerning the protection of the environmental impact of combustible tobacco cultivation, manufacture, consumption and waste disposal. A missed opportunity was the failure of COP10 to appoint a workgroup on "tobacco harm reduction strategies", an integral part of Article 1(d) of the FCTC. The governments of several Caribbean countries urged parties to formally appoint such a workgroup, to "learn from the best practices of proven public health-oriented measures".

Similarly, COP10 failed to facilitate genuine multi-stakeholder engagement. Again, the "invisible" stakeholder group at COP10 was the 1,1 billion adult cigarette smokers worldwide. While the inclusion of youth groups in COP10 should be welcomed, Sweden, which is on the cusp of becoming smoke-free, has shown that it is possible to prevent young people from starting to smoke while also helping adults find a safer path away from traditional smoking.

COP10 was again about exclusion and non-differentiation of tobacco risk and harm. Yet, combustible tobacco-related disease, disability and premature death remain by far the world's most significant health problem, killing 8 million people per year. As Sweden has shown, sensible tobacco harm reduction measures have the ability to save millions of lives. For COP11, let's continue to advocate for inclusion, engagement and proper science-based risk differentiation, for responsible and effective policymaking.

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Delon Human's FCTC COP10 Insights

COP10 closes without appointing a harm reduction workgroup, despite calls for multi-stakeholder engagement. Focus on Article 18 environmental protection.

Missed Opportunities and Calls for Inclusion: Reflections on COP10's Focus on Tobacco Harm Reduction

World Health Day 2022

THR: A Historic Opportunity for Our Health & Our Planet

Seize COP10 delay for tobacco control innovation. Learn from Sweden and the UK, exemplary in harm reduction.

**For Immediate Release**

**Experts recommend to seize the COP 10 delay as a catalyst for tobacco control innovation**

**21st November, 2023 Stockholm, Sweden** – The Framework Convention on Tobacco Control must use the delays to its Tenth

Conference of the Parties (COP10) to consider smoke-free success stories like that of Sweden, leading experts have said.

Since the delay to COP10 was announced last week, Dr. Delon Human, leader of the Smoke Free Sweden movement, has emphasised the urgency of the moment: "_This is a critical time for the WHO to consider the compelling evidence and to do their own research on countries such as Sweden that have successfully implemented harm reduction strategies._"

Sweden, with its smoking prevalence nearing the 'smoke-free' threshold of 5%, serves as a model for effective tobacco control.

_"The Swedish approach has saved thousands of lives annually. If other countries adopted similar strategies, the potential for saving millions of lives is immense. It's about providing safer options, not just imposing bans,_" commented Anders Milton, a renowned Swedish public health expert.

Similarly, in the UK, where the NHS endorses vaping for smokers unable to quit, there has been a consistent decline in smoking rates. In 2021, the proportion of current smokers in the UK was 13.3%, equating to 6.6 million people, showing a [significant decrease](https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2021) of 6.9 percentage points compared with 2011​.

"_The rescheduling of COP10 should prompt a focused analysis of the tobacco control strategies implemented in countries like Sweden and the UK, or even Japan which is seeing lower smoking rates because of heated tobacco products use. Examining their substantial reductions in smoking rates through harm reduction methods will provide practical insights._" added Dr. Human.

Building on the need for detailed analysis, Dr. Human proposed an innovative approach to enhance global understanding of effective tobacco control. "_Hosting a future FCTC conference in Sweden would be a strategic move, offering global health leaders direct exposure to the successful implementation of Tobacco Harm Reduction (THR) policies, alongside traditional tobacco control._"

This proposal aims to showcase Sweden's pioneering approach to tobacco control, where a combination of accessible reduced-risk products and informed public education has led to one of the lowest smoking rates in Europe. A conference in Sweden would provide a tangible, real-life context for discussions, allowing policymakers to observe and learn from a country that has effectively balanced regulatory frameworks with public health objectives.

\*\*\*\*\*\*\*

**Notes to editors:**

About COP10

The Tenth session of the Conference of the Parties (COP10) to the WHO Framework Convention on Tobacco Control was supposed to take place from 20 to 25 November 2023, in Panama City, Panama. It is currently postponed and no location or dates are known for the moment.

About Smoke Free Sweden

Smoke Free Sweden is a campaign which encourages other countries to follow the Swedish model when it comes to Tobacco Harm Reduction. Sweden is about to become the first 'smoke-free' European country in 2023, with a smoking rate of below 5 percent. This is a huge achievement, and will be 17 years ahead of the 2040 EU target. This can be attributed to Sweden's open attitude towards alternative products.

For more information on Sweden's successful approach to becoming a smoke-free nation, please visit www.smokefreesweden.org.

Contact

Jessica Perkins

jessica@healthdiplomats.uk

www.smokefreesweden.org

COP10 twitter-03.png

Press Release: Experts recommend to seize the COP 10 delay as a catalyst for tobacco control innovation

Experts urge using COP10 delay for tobacco control innovation, citing Sweden and the UK as successful models.

COP 10 Delay Sparks Innovation in Tobacco Control

Leading harm reduction experts debunk the notion that vaping is a gateway to smoking, advocating for evidence-based harm reduction strategies

Recent claims by Otago University in New Zealand that vaping is a gateway to smoking have been disputed by leading global harm reduction experts Roberto Sussman, Konstantinos Farsalinos, and Gerry Stimson. These experts have highlighted the importance of harm reduction strategies in reducing the negative health impacts of smoking.

According to Dr. Roberto Sussman, "There is no evidence that vaping is a gateway to smoking. In fact, [studies have shown that vaping can be an effective tool for smoking cessation](https://www.cochrane.org/news/latest-cochrane-review-finds-high-certainty-evidence-nicotine-e-cigarettes-are-more-effective)." Dr. Konstantinos Farsalinos adds, "The vast majority of vapers are former smokers who have successfully quit smoking thanks to vaping."

Gerry Stimson, a public health expert and advocate for harm reduction, emphasizes that "Harm reduction [strategies like vaping are essential in reducing the negative health impacts of smoking](https://www.tobaccoharmreduction.net/thr). We need to focus on providing smokers with safer alternatives to cigarettes, rather than demonizing harm reduction strategies like vaping."

As Dr. Sussman notes, "We need to focus on harm reduction strategies that work, rather than relying on outdated and inaccurate claims about vaping being a gateway to smoking." Dr. Farsalinos adds, "The evidence is clear: [vaping can be an effective tool for smoking cessation and harm reduction](https://www.tobaccoharmreduction.net/benefits)."

Nancy Loucas, Executive Coordinator of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates ([CAPHRA](https://caphraorg.net/)), who compiled these comments, also disputed the recent claim by [Otago](https://www.otago.ac.nz/) [University](https://www.otago.ac.nz/) that vaping is a gateway to smoking. In her view, the recent claim by Otago University is not supported by the evidence and could discourage smokers from trying vaping as a tool for smoking cessation.

According to recent data, the smoking incidence rates in New Zealand have fallen significantly over the past 5 to 10 years. The current smoking rate of New Zealand adults is 8% in 2021/2022, which has decreased from 16.5% in 2015 and from 27% in both men and women in 1993. Vaping has played a significant role in the reduction of smoking rates in New Zealand over the past 5 to 10 years.

According to research published in the [NZ Medical Journal](https://journal.nzma.org.nz/journal-articles/an-evaluation-of-a-new-zealand-vape-to-quit-smoking-programme), the current vaping rate in New Zealand is 8.3% of adults being categorized as daily e-cigarette users, up from 6.2% in the previous year.

"We need to [focus on harm reduction strategies that work](https://www.tobaccoharmreduction.net/thr-products), rather than relying on outdated and inaccurate claims about vaping being a gateway to smoking. The evidence is clear: vaping can be an effective tool for smoking cessation and harm reduction," Ms. Loucas said.

Read more on [Tobacco Harm Reduction](https://media.thr.net/strapi/d5b691d7b57a532da30f41f52dd63dcc.pdf). Follow us on [Twitter](https://twitter.com/Tobaccoharmred1) and [LinkedIn](https://www.linkedin.com/company/tobaccoharmreduction-net/).

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Leading harm reduction experts dispute claim that vaping is a gateway to smoking.

Harm reduction experts challenge the claim that vaping leads to smoking, emphasizing evidence of vaping's effectiveness in smoking cessation

Leading Experts Dispute Vaping as a Gateway to Smoking: Focus on Harm Reduction Strategies

Seize the Chance: Speak Out Against Restrictive Vaping Policies in Australia by March 24, 2022. Advocate for Harm Reduction and a Safer Future!

This is an opportunity for vapers to be heard before the anti-vaping policy is locked in for the rest of the decade.

The draft strategy lacks urgency. It sets a very modest goal of <**10%** adult daily smoking by 2025. In sharp contrast, [**New Zealand**](https://www.health.govt.nz/system/files/documents/publications/hp7801_-_smoke_free_action_plan_v15_web.pdf) recently set a target of <**5%** daily adult smoking by 2025 for all population groups including Maori and Pacifica groups. Vaping is a key element of this plan.

Please make a submission before the deadline of **24 March 2022**. More information about making a submission can be found [**HERE**](https://www.health.gov.au/initiatives-and-programs/national-tobacco-strategy#:~:text=The%20draft%20National%20Tobacco%20Strategy%202022%E2%80%932030%20is%20being%20developed,closes%20on%2024%20March%202022.). 

***“The main element missing from the draft Strategy is tobacco harm reduction, ie the use of safer nicotine alternatives such as vaping, heated tobacco products, Swedish snus and nicotine pouches for smokers who are unable to quit with other methods”***

Vaping is supported by the [**Royal Australian and New Zealand College of Psychiatrists**](https://www.ranzcp.org/news-policy/policy-and-advocacy/position-statements/e-cigarettes-and-vaporisers) and [**Royal Australian College of General Practitioners**](https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/supporting-smoking-cessation) for smokers who are unable to quit with conventional strategies. However, the draft strategy *ignores their advice*. In Australia it is easier to purchase a deadly cigarette than a far safer alternative.

Continuing the traditional 'quit or die' approach will result in a continuing sluggish decline in Australian smoking rates and another embarrassing failure to reach the smoking target. Smokers are being thrown under the bus. **We need to do better**.

![Aus Post.png](https://media.thr.net/strapi/8b9027a880eeeb6fd98d3c7f6971b901.png)

Australian Government Department of Health and aged care logo for Tobacco Harm Reduction

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The Australian Department of Health is seeking feedback on how to reduce smoking in the draft National Tobacco Strategy 2022-2030.

Raise Your Voice for Safer Alternatives: Advocate Against Restrictive Vaping Policies in Australia by March 24, 2022. Let's Prioritize Harm Reduction!

Advocate for Tobacco Harm Reduction in Australia Before It's Too Late!

Oral Nicotine Delivery Systems such as vaping, nicotine pouches, and snus represent the next generation of smokeless, tobacco-free nicotine products.

Over the last two decades, vaping, nicotine pouches and a range of other less harmful products have completely transformed the nicotine space. Oral Nicotine Delivery Systems, or ONDS, represent the next generation in smokeless, tobacco-free nicotine products.

Scientific evidence surrounding the benefits of nicotine pouches and snus has been mounting. A recent [study](https://pubmed.ncbi.nlm.nih.gov/32466721/) from the [Karolinska Institute in Sweden](https://ki.se/en), which involved 400,000 participants and covered 9-million-person years, has shown that there is no association between snus use and oral cancer. A separate [study](https://www.linkedin.com/pulse/systematic-review-confirms-harmful-health-outcomes-from-cother-hajat/) conducted by the physician and epidemiologist, [Dr. Cother Hajat](https://uk.linkedin.com/in/cother-hajat-b912261a) shows that we should not classify all oral tobacco or nicotine products in the same risk camp, and that snus confers no excess risks for oral and many other cancers, cardiovascular disease, and chronic lung diseases. When taking the scientific evidence into consideration, it comes as no surprise that the US Food and Drugs Administration (FDA) has [authorised](https://www.fda.gov/news-events/press-announcements/fda-grants-first-ever-modified-risk-orders-eight-smokeless-tobacco-products) Swedish Match's snus as being appropriate for the protection of public health under its modified risk tobacco product (MRTP) guidance.

Regulators and international organisations continue to group [oral nicotine products](https://oralnicotine.com/oral-nicotine/what-is-it) with combustible tobacco products, ignoring [the evidence of their positive impacts](https://oralnicotine.com/publications). The WHO's [latest report](https://www.who.int/publications/i/item/9789240061484) on oral health fails to distinguish between [snus and toxic smokeless tobacco products](https://oralnicotine.com/oral-nicotine/benefits) and raises unscientific concerns about the [potential negative effect of nicotine from vaping on oral cancer.](https://oralnicotine.com/publications)

Sweden assumes the [Presidency of the Council of the European Union](https://www.consilium.europa.eu/en/council-eu/presidency-council-eu/) in January 2023, so right now is the perfect time to look at the role snus has played in allowing them to become the European leader in smoking cessation.

Sweden has the lowest smoking rate in the EU at [6%](https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/living-conditions-and-lifestyle/andtg/tobacco/), compared to the EU average of 23%. As a result of this, Sweden has the lowest tobacco mortality rate in Europe. Snus has been at the centre of the reduction measures, but in recent years, nicotine pouches and e-cigarettes have proven to be [useful additional tools for Swedish smokers aiming to quit.](https://oralnicotine.com/oral-nicotine/benefits) The progressive, pro harm-reduction Swedish model is clearly distinct from the tobacco control policies proposed by other EU Member States. Ensuring that [less harmful alternatives to smoking, such as nicotine pouches and vapes](https://www.tobaccoharmreduction.net/thr-products), are accessible will be paramount to ensure that other countries can replicate Sweden's success.

At [Tobaccoharmreduction.net](https://www.tobaccoharmreduction.net/) and the [Oral Nicotine Commission](https://oralnicotine.com/about-us), we have developed an advocacy instrument, which addresses public misconceptions surrounding tobacco harm reduction.


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The Swedish harm reduction approach reduces smoking rates

In a special episode for World Mental Health Day, Michelle Minton explores the connections between addiction, mental health, and tobacco control in a series of enlightening discussions. Dive into the video clips for valuable insights.

[**THR.net**](https://www.tobaccoharmreduction.net/thr) sat down with [**Michelle Minton**](https://twitter.com/michelleminton) of the [Reason Foundation](https://reason.org/) for the latest #WomenInTHR episode, in honour of [**World Mental Health Day in October**](https://www.mentalhealth.org.uk/our-work/public-engagement/world-mental-health-day). We discussed the topics listed below (click on each one to watch the clips):

> [Addiction and nicotine](https://www.youtube.com/watch?v=P70-EoQaKt8&t=1s)

> [Mental Health Disorders and The Benefits of Nicotine](https://www.youtube.com/watch?v=cyMOZXOu4jQ)

> [Anti Smoking Campaign Effects On Youth](https://www.youtube.com/watch?v=--axrVx7W4Q&t=249s)

> [Narratives Prevent People From Objectively Looking At The Evidence](https://www.youtube.com/watch?v=YOIk19p_Kso)

> [The Quit or Die Approach in Tobacco Control](https://www.youtube.com/watch?v=tYzi15IEUBw)

> [Work and research into nicotine](https://www.youtube.com/watch?v=xhlAml08MeU) 

> [The unspoken benefits of tobacco and nicotine](https://www.youtube.com/watch?v=3vCkdpV-m2k) 

Click on [**this link here**](https://www.youtube.com/channel/UCyHKweBxXVzcskK-HOo8PEg/featured) to access our YouTube channel with mini clips for small and digestible videos.

Click below to watch the part called > “[**Mental Health Disorders and The Benefits of Nicotine**](https://www.youtube.com/watch?v=cyMOZXOu4jQ)”


Michelle Minton Women in Tobacco Harm Reduction Coffee Chat

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Latest #WomenInTHR webinar with Michelle Minton now on YouTube

Michelle Minton of the Reason Foundation delves into the complex relationship between nicotine, mental health, and tobacco control.

Michelle Minton Discusses Nicotine and Mental Health

Women in THR: Coffee Chat with Michelle Minton | Mental Health Diagnosis & Nicotine

Implementing the Philippine nicotine products Regulation Act will save lives, says harm reduction advocates


![Clarisse Virgino (1).png](https://media.thr.net/strapi/f6e0f098db4b2b5d758009ad57d020e1.png)


"Any concerns about youth vaping are well covered in last year's landmark vape law. The Philippines has more than enough regulations and safeguards now in place, without a Senator trying to relitigate everything," says Nancy Loucas, Executive Coordinator of CAPHRA ([Coalition of Asia Pacific Tobacco Harm Reduction Advocates](https://caphraorg.net/)).

Her comments follow the Senate recently adopting a resolution denouncing the sale and marketing of e-cigarettes and other vape products towards the youth. It saw [Senator Pia](https://en.wikipedia.org/wiki/Pia_Cayetano) [Cayetano](https://en.wikipedia.org/wiki/Pia_Cayetano) deliver a speech where she claimed vape flavours and designs draw young people to the products.

Last year, smokefree advocates around the world celebrated the Philippines passing the Republic Act 1190, otherwise known as the 'Vaporized Nicotine and Non-Nicotine Products Regulation Act'.

Regulation of the importation, manufacture, sale, packaging, distribution, use and communication of vaping products such as e-cigarettes and heated tobacco products (HTPs) became law on 25 July 2022.

At the time advocates said the law strongly protects minors, helps to eradicate blackmarkets, ensures safety standards, and critically delivers adult accessibility to viable alternatives for smokers desperate to quit.

"Without doubt, the legislation and regulations are aimed at protecting youth, despite it not being expressly stated in the statute. For example, there are provisions that expressly provide prohibition on selling to minors.

She says there is also a provision where it is expressly stated that flavour descriptors that unduly appeal to minors are prohibited. This includes candy, fruits, desserts, and cartoon graphics.

Late last year, following the passing of the vape law, the Department of Trade and Industry (DTI) issued the Implementing Rules and Regulations (IRR).

"It's the DTI's mandate and responsibility to implement the new vaping laws. The Philippines doesn't need any more Senate speeches and resolutions. It just needs the regulator and retailers to work together to ensure young people are protected as was clearly intended," says Nancy Loucas.

Clarisse Virgino, Philippine representative to the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), agrees that any issues pertaining to the vape law now lie with the DTI.

"This is not a Senate issue but an issue around implementation. We must let the DTI do its job and positively work with the industry and retailers to make sure they're educated and compliant. Many parties, including consumer advocates, worked on the vape law in good faith. Let's continue that good faith," says Ms Virgino.

She says despite political argument at the edges the Philippines now leads the charge in Tobacco Harm Reduction (THR) among its Asian neighbours.

"Our country has endured a terrible smoking epidemic for decades, with nearly 90,000 Filipinos dying annually from smoking-related diseases. We've now adopted a successful THR strategy which will see smoking rates fall. Ours is landmark and leading legislation. It just needs time to bed in.

"The 2022 vape law will deliver real results and help eradicate smoking. Our focus now must be to ensure 16 million Filipino smokers have a viable path to switch to safer nicotine products," says Clarisse Virgino.

For a free digital media repository on tobacco harm reduction in Asia Pacific

- including media releases, images, and graphics - please visit [https://apthrmedia.org](https://apthrmedia.org/)

**About CAPHRA**

The Coalition of Asia Pacific Tobacco Harm Advocates is a regional alliance of consumer tobacco harm reduction advocacy organizations. Its mission is to educate, advocate and

represent the right of adult alternative nicotine consumers to access and use of products that reduce harm from tobacco use.

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Time to support Filipino vape law, not relitigate it

The 10th edition of GFN celebrated a decade of progress in tobacco harm reduction. Experts discussed challenges, opportunities, and evidence-based approaches to nicotine use

**13 June 2023**

*Written by: Joseph Magero*

In Warsaw this June, [The Global Forum on Nicotine (GFN)](https://gfn.events/) celebrated its 10th edition, with a packed program reflecting on the last decade in safer nicotine use. The event brought together over 400 researchers, public health professionals, policymakers, and advocates to share scientific findings and insights.

This year's theme centered on reflecting on the challenges and successes of tobacco harm reduction over the past decade and sought to identify the priorities for advocates, academics, scientists, policymakers, manufacturers, and distributors in the future.

As usual, the GFN tackled controversial subjects head-on, in respectful debates involving all stakeholders. Public health advocates who attended the forum emphasized evidence-based approaches to nicotine use and policy-making. They revisited the key milestones of the last ten years, assessed today's complex political, regulatory, and scientific environment, and discussed the challenges and opportunities of the future.

Dr. Alex Wodak, a retired physician, hosted a session on reducing the environmental impacts of tobacco harm reduction. The panel included Dr. Colin Mendelsohn, a medical practitioner, academic, and researcher in smoking cessation and tobacco harm reduction for 40 years; who said that 'disposable vapes cause environmental harm but far less than cigarette butts.'

Clive Bates, former Director of Action on Smoking and Health (UK), sought testimonies from the audience on how the last decade can influence and inform the next. Delegates expressed concern as the W.H.O. makes preparations for the [10th session of the Conference of the Parties](https://fctc.who.int/who-fctc/governance/conference-of-the-parties/tenth-session-of-the-conference-of-the-parties) to the [W.H.O F.C.T.C.](https://fctc.who.int/who-fctc/overview) in Panama City later this year. They called on the World Health Organization (W.H.O) to stop its opposition to the tobacco harm reduction approach and insistence on banning less harmful alternative products, and instead rely on scientific research to support evidence-based policymaking.

Experts were particularly worried about the W.H.O F.C.T.C.'s push for a ban on [vapes and other smoke-free alternatives](https://www.kcl.ac.uk/news/vaping-substantially-less-harmful-than-smoking-largest-review-of-its-kind-finds), which would deprive smokers, especially those from L.M.I.C.s, of [the most effective means to quit cigarette smoking](https://www.cochrane.org/news/latest-cochrane-review-finds-high-certainty-evidence-nicotine-e-cigarettes-are-more-effective). 'It is absolutely clear that consumers across the world are demanding lower-risk alternatives,' said Dr. Sud Patwardhan, co-founder of the Centre for Health Research and Education ([CHRE](https://chre-uk.com/)).

As GFN 2023 finally came to an end, the comprehensive discussions provided invaluable insights into the facilitators and barriers to smoking cessation and transitioning to low-risk tobacco and nicotine products. The take-home message was, by relying on scientific evidence, we can make more informed, rational, and evidence-based choices that are grounded in the best available knowledge and understanding of the world around us.

This year's winner of the prestigious 2023 [Michael Russell Award](https://gfn.events/michael-russell/awards/) was Professor Gerry Stimson.

Follow us on [Twitter](https://twitter.com/Tobaccoharmred1) and [LinkedIn](https://www.linkedin.com/company/tobaccoharmreduction-net/).

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Global Experts Convene in Warsaw For The Global Forum on Nicotine

The 10th edition of GFN celebrated a decade of progress in tobacco harm reduction. Experts discussed challenges, opportunities, and evidence-based approaches to nicotine use.

Global Forum on Nicotine (GFN) 2023: Reflecting on Safer Nicotine Use

A new study in Addiction highlights significant harm reduction by switching from smoking to vaping or dual use, based on a secondary analysis of 1,299 participants across multiple countries.

A [**new study**](https://onlinelibrary.wiley.com/doi/10.1111/add.16063) published in **Addiction** (by [**the society for the Study of Addiction**](https://www.addiction-ssa.org/)) has found significant harm reduction when switching from smoking to vaping or dual use. Following a [**systematic review**](https://ebn.bmj.com/content/14/3/64), this [**secondary analysis**](https://www.indeed.com/career-advice/career-development/secondary-analysis) incorporated nine studies from Greece, Italy, Poland, the United Kingdom and the United States. It features **1,299 adult participants** who smoked combustible cigarettes (CC), switched completely from smoking CC to electronic cigarettes (EC), or who switched to using both CC and EC (dual users). 

In a **secondary analysis**, researchers work with previously collected existing data (secondary data) to perform a new study. This allows researchers to work with large data sets, as they can work with data from multiple studies. A **systematic review** uses all the existing research and also secondary research (research on research). A high-quality **systematic review** is one of the most reliable sources of evidence to guide clinical practice, as it delivers a meticulous summary of the available primary research in response to a research question.

Measurements for the study were conducted using **carbon monoxide (CO) and other biomarkers**. [**Biomarkers (biological markers**)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078627/) are biological molecules found in body fluids or tissues that signal a normal or abnormal process or a condition or disease. Measuring biomarkers enabled the researchers to indicate how biomarkers of harm change based on participants’ smoking/vaping behaviour. 

The study found exhaled CO (eCO) to be lower in participants who switched to EC completely than those who smoke CC or are dual users. eCO was also significantly lower in dual users than in CC only participants. 13 biomarkers were measured to compare EC versus CC – of these, 12 were lower in the EC groups. 25 biomarkers were measured when comparing EC to CC and dual use – of these, the results were lower for EC groups for 12 measures and for dual use groups for 5 measures. 

This secondary analysis confirms that exclusive EC use is associated with lower levels of biomarkers of harm than the exclusive use of CC or dual use. This supports the broad scientific consensus that the greatest health improvements come from ceasing the use of CC completely, and that (although not completely without risk) EC is a reduced-risk alternative that offers harm reduction benefits. An analysis such as this study not only informs debates concerning the potential harms and benefits of dual use but also illustrates the changes a smoker might expect if they switched completely to ECs or dual use.

Access [**www.tobaccoharmreduction.net**](https://www.tobaccoharmreduction.net/thr) to learn more about tobacco harm reduction.

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New study finds that switching from smoking to vaping or dual use significantly reduces potential harm

A recent study in Addiction highlights significant harm reduction in transitioning from smoking to vaping or dual use.

Switching to Vaping or Dual Use: Study Shows Significant Harm

In this interview, Dr. Marewa Glover, a prominent Māori behavioral scientist, discusses her advocacy for tobacco harm reduction and Indigenous sovereignty.

We sit down with [**Dr. Marewa Glover**](https://twitter.com/marewaglover), Director at the [Centre of Research Excellence: Indigenous Sovereignty & Smoking](https://coreiss.com/home). Dr. Glover is a Māori (New Zealand indigenous) behavioural scientist with over 30 years' experience in public health. She has written over [100 scientific papers](https://coreiss.com/publications) and is well known for her compassionate insight and **advocacy on tobacco harm reduction**. Dr. Glover was appointed as Tobacco Section Editor for the international [Harm Reduction Journal](https://harmreductionjournal.biomedcentral.com/about?gclid=Cj0KCQiAiJSeBhCCARIsAHnAzT_WapZOUObnh1u7UnkPUv6q6UOEHk9amGdjk0_66yR17cgn5cF4k3MaAqLaEALw_wcB) in 2019.

Click [here](https://www.youtube.com/watch?v=AsYMs8QLHCQ) to watch the **full episode** or on the topics below from the episode:

[Current Work](https://www.youtube.com/watch?v=etYzWcExHw0)

[SNUS was Never Illegal](https://www.youtube.com/watch?v=r3IATv2hIoE)

[NZ has Highest Priced Tobacco Relative to Income](https://www.youtube.com/watch?v=N0jC7wPGtyw)

[The Lack of Cessation Advice in NZ for Women](https://www.youtube.com/watch?v=s-PUOz8cDQc)

[There's No Good Basis to Deny Pregnant Women THR](https://www.youtube.com/watch?v=NLlpg7Ifpc8)

Click [HERE](https://www.tobaccoharmreduction.net/resources) to read more about tobacco harm reduction **RESOURCES.**

Click [HERE](https://www.tobaccoharmreduction.net/thr) to read our home page and access our **THR E - BOOK.**

Meet DR. MAREWA GLOVER in latest #WomeninTHR episode

Explore the insights of Dr. Marewa Glover, a Māori scientist advocating tobacco harm reduction and Indigenous sovereignty.

Dr. Marewa Glover: Championing Tobacco Harm Reduction 

Women in THR: Coffee Chat with Dr Marewa Glover | Full Webinar

World No Tobacco Day 2024 promotes innovative, evidence-based strategies to reduce smoking. The article highlights successful harm reduction methods and calls for WHO support in leveraging modern nicotine products for global smoking reduction.

World No Tobacco Day 2024 calls for a renewed commitment to innovative and evidence-based strategies to end smoking. By embracing modern approaches and leveraging scientific research, we can move closer to a smoke-free world, saving millions of lives.

Each year, on 31 May, the World Health Organization (WHO) and the health community worldwide join forces to raise awareness about the harms of smoking. [World No Tobacco Day](https://www.who.int/campaigns/world-no-tobacco-day/2024) (WNTD) brings to light the devastating health effects of tobacco use, drawing attention to the tobacco epidemic, which results in 8 million deaths every year.

According to [2022 data](https://www.who.int/news/item/16-01-2024-tobacco-use-declines-despite-tobacco-industry-efforts-to-jeopardize-progress#:~:text=Globally%20there%20are%201.25%20billion,1%20in%203%20in%202000.), worldwide, at least 37 million young people aged 13–15 years use some form of tobacco. In the WHO European Region, 11.5% of boys and 10.1% of girls aged 13–15 years are tobacco users (4 million).

Whilst smoking rates have fallen significantly in some countries over the last few years, they have remained stubbornly [high](https://www.who.int/news-room/fact-sheets/detail/tobacco) across the globe. Currently, the WHO Southeast Asian Region has the highest percentage of the population using tobacco at 26.5%, while the European Region is not far behind at 25.3%.

Notably, countries that have embraced harm reduction strategies, like the [UK](https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/) and [Sweden](https://smokefreesweden.org/), are close to declaring themselves "smoke-free" — defined as having fewer than 5% smokers in the population.

**_Should the W.H.O. Embrace Innovation?_**

New strategies to prevent and control cigarette consumption are highly needed. It’s a stark truth that smoking is addictive and not easy to quit, but the W.H.O. should diligently advocate for evidence-based methods that might help smokers quit.

The goal of evidence-based research has always been to provide reliable and valid evidence that can inform policies, practices, and interventions based on scientific evidence rather than on anecdotal evidence, personal experience, or opinion.

International evidence such as the [Cochrane Review](https://www.cochrane.org/news/latest-cochrane-review-finds-high-certainty-evidence-nicotine-e-cigarettes-are-more-effective) and Swedish studies demonstrates that the most successful methods of quitting smoking involve modern alternative nicotine products such as regulated electronic cigarettes, cytisine, varenicline, and other modern nicotine products such as Nicotine Replacement Therapies as well as nicotine pouches and heated products.

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World No Tobacco Day 2024: Support Innovative Strategies to End Smoking

Support innovative, evidence-based strategies to end smoking on World No Tobacco Day 2024. Learn how modern methods can help reduce tobacco use globally.

Discover how biomarkers are challenging conventional wisdom in tobacco control. Researchers Derek Yach and Gerhard Scherer introduce a groundbreaking approach to evaluating the harm reduction potential of tobacco alternatives like e-cigarettes. 

[A new research paper](https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.3567) is challenging a long-standing belief in the tobacco control community. For too long, potentially less harmful alternatives like e-cigarettes have been dismissed due to "lack of evidence." Now, researchers Derek Yach and Gerhard Scherer present a promising tool that could change this narrative: biomarkers.

"The reluctance to accept less harmful nicotine products, such as e-cigarettes, has always been rooted in the fear of the unknown and the desire for long-term evidence. Our research now showcases a robust method to bridge this knowledge gap sooner than previously imagined," said Derek Yach, one of the authors of the study.

Biomarkers are measurable substances in our bodies – present in fluids, tissues, and cells. They give information about our exposure to certain compounds and potential physiological effects. The use of these biomarkers could revolutionise the way we evaluate the harm reduction potential of new generation tobacco and nicotine products (NGPs). Instead of waiting for decades to understand the long-term effects of these products, we can rely on these indicators for quicker assessments.

"The future of public health depends on us embracing modern methodologies. Biomarkers offer a real-time snapshot of exposure levels, eliminating the traditional waiting period of 40-50 years to understand the effects of new products on our health," Gerhard Scherer, the research co-author commented.

A critically important application of this technology is in the life and health insurance industry. Currently, most insurers do not recognise the drastically reduced risk posed by smokefree alternative nicotine products, in comparison with combustible cigarettes.

“Insurers and their clients stand to gain by better quantifying and reducing smoking risk, using new technology such as biomarkers”, remarked Derek Yach.

With over a billion people globally facing health risks due to combustible cigarette consumption and a staggering eight million deaths linked to such cigarettes annually, the urgency for safer alternatives cannot be understated. NGPs like e-cigarettes and heated tobacco products hint at a future with reduced harm from tobacco. This study could be the key to unlocking that future.

[Watch the webinar here](https://www.youtube.com/watch?v=sWxc8Lrg0S0&ab_channel=TobaccoHarmReduction) on the breakthrough research paper, held Wednesday 13 September 10 AM EST.


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Revolutionizing Tobacco Control: Biomarkers Pave the Way for Safer Alternatives

Discover how biomarkers are revolutionizing tobacco control, providing a quicker and safer way to assess alternatives like e-cigarettes. Learn more here.

Biomarkers: A Game-Changer for Assessing Harm Reduction in Tobacco Alternatives.

Discover the unique risks smoking poses to women's health on Women's Day. Learn why harm reduction and cessation are crucial for everyone's well-being.

While it is well known that smoking contains many, severe health risks, we wanted to take this Women’s Day as an opportunity to highlight some risks that are unique to women - and why it is so important for everyone to embark on a harm reduction or cessation journey.

1\. [Cancer](https://women.smokefree.gov/quit-smoking-women/what-women-should-know/smokings-impact-on-women): While smoking in general increases the risk of various cancers, it is particularly associated with an increased risk of cervical cancer. Additionally, smoking is the leading cause of lung cancer in women, and there are more cases of young female smokers (30-49) developing lung cancer than male smokers.

2\. [COPD](https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_women_smoking_508.pdf): Women who smoke, within certain age groups, are up to 38 times more likely to develop chronic obstructive pulmonary disease (COPD) than never-smokers. COPD also kills more women than men and develops more severely in women at an earlier age.

3\. [Cardiovascular Disease](https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_women_smoking_508.pdf): When compared to men who smoke, women smokers over 35 are more likely to die from heart disease.

4\. [Reproductive Health](https://women.smokefree.gov/quit-smoking-women/what-women-should-know/smokings-impact-on-women): Aside from the known complications that arise from smoking while pregnant, smoking can also lead to pain and irregularity during periods, a decrease in estrogen levels and an increase in the risk of infertility. Smoking may also worsen menopausal symptoms in women, including an increased risk of early menopause and related health issues.

5\. [Bone Health](https://www.lung.org/quit-smoking/smoking-facts/impact-of-tobacco-use/women-and-tobacco-use#:~:text=Women%20who%20smoke%20may%20develop%20more%20severe%20COPD%20earlier%20in%20life.&text=Women%20who%20smoke%20also%20have,for%20developing%20coronary%20heart%20disease.): Relatedly, post-menopausal women who smoke may have decreased bone density and an increased risk of hip and spine fractures.

Amidst all these negative health consequences, the good news is that it is never too late to quit. You can use this Women’s Day as an opportunity to encourage yourselves and the women in your life to prioritise their health and quit smoking by using [tobacco harm-reduction](https://www.tobaccoharmreduction.net/thr) strategies. These strategies, which help offset the varied and gendered consequences of tobacco smoking, are an important tool on the journey to smoking cessation.

You can learn more about tobacco harm reduction here: <https://www.tobaccoharmreduction.net/thr>

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Smoking and Gender: Health Risks of Tobacco for Women

Explore how smoking affects women's health uniquely on Women's Day. Prioritize harm reduction and cessation for a healthier future for all.

Women's Day: Smoking Risks & Harm Reduction

Dr. Lars Ramström argues that snus, a tobacco alternative, has dramatically cut tobacco deaths in Sweden and could save 2.9 million EU lives. He emphasizes reevaluating snus's risks to combat smoking.

In a recent commentary piece titled "[Snus: A Lifesaver in Sweden – And Beyond,](https://www.qeios.com/read/FUX4PH)" Dr Lars Ramström sheds light on the impactful role of snus in significantly reducing tobacco-related fatalities in Sweden. Highlighting Sweden's potential to become the first European Union country to achieve a smoking rate below 5%, a benchmark set by the World Health Organization for being 'smoke-free,' Dr Ramström emphasises the importance of alternative smoking products. Snus, a less harmful tobacco product, has been instrumental in this achievement.

Dr Ramström's analysis compares mortality rates in Sweden with those in countries where snus is less available, revealing that snus has saved approximately 4,000 lives annually among Swedish men. This finding underscores the necessity for health authorities to clearly differentiate the risks associated with cigarettes and snus. Misleading perceptions about snus's dangers may hinder the shift away from cigarette smoking.

Supporting Dr Ramström's insights, [research from Smoke-Free Sweden](https://smokefreesweden.org/wp-content/themes/smokefreesweden/assets/pdf/reports/Report%20The%20Swedish%20Experience%20EN.pdf) illustrates Sweden's lower cancer incidence and mortality rates compared to its European neighbours—41% and 38% lower, respectively. The ["Saving Lives Like Sweden"](https://smokefreesweden.org/wp-content/themes/smokefreesweden/assets/pdf/reports/Report_SAVING%20LIVES%20LIKE%20SWEDEN.pdf) report by Smoke-Free Sweden proposes that adopting Sweden's approach to tobacco harm reduction could potentially save 2.9 million lives across the EU. This evidence suggests that by promoting safer alternatives like snus, we could pave the way for a healthier future for millions of smokers worldwide.

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Snus is key to lowering tobacco-related death rates, says Swedish health expert

Explore how snus is pivotal in reducing tobacco deaths in Sweden, as Dr Lars Ramström highlights its role in achieving a smoke-free status.

Despite public health campaigns, nicotine myths persist. Learn how tobacco harm reduction (THR) strategies, like Sweden's approach, can save millions of lives by embracing safer nicotine alternatives.

Despite decades of public health campaigns highlighting the dangers of smoking, misconceptions and misinformation about nicotine persist. Contrary to popular belief, nicotine itself does not cause cancer and plays a minimal role, if any, in tobacco-related diseases. It's time to dispel these myths and acknowledge the potential of tobacco harm reduction (THR) strategies in saving millions of lives.

It is essential to recognise that there will always be individuals who choose to consume nicotine, much like those who consume caffeine. It is known that humans have used nicotine for [more than 12,000 years](https://www.bbc.co.uk/news/world-us-canada-58884119); it is foolhardy for modern policymakers to believe that they can be the ones to eradicate it.

Smokefree Sweden’s new report, [_No Smoke, Less Harm_](https://www.tobaccoharmreduction.net/en/article/introduction-to-the-report-no-smoke-less-harm), illustrates that rather than demonising nicotine, the focus should shift towards reducing the harm associated with its consumption. Sweden serves as a prime example of how THR can mitigate tobacco-related diseases despite similar levels of nicotine consumption compared to other European countries. By embracing smoke-free nicotine products, Sweden has significantly lower rates of tobacco-related illnesses and premature deaths.

Compared to the rest of the European Union (EU), Sweden boasts 44 percent fewer tobacco-related deaths, a 41 percent lower cancer rate, and 38 percent fewer deaths attributable to any cancer. If Sweden’s approach to reducing the use of combustible products rather than a puritan war against consumption of nicotine is replicated across the EU, many millions of lives could be saved in just a few years.

Consumers are increasingly understanding this concept, while governments have mostly not. Those who have successfully moved away from smoking using snus, vaping products, and other safer alternatives are constantly frustrated and confused as to why the huge benefits that they have experienced are not being recognised by legislators.

The concept of harm reduction is not new. It's about enabling consumers to use potentially harmful substances in less risky ways, thereby preventing the devastating health consequences.

This principle, encapsulated in the motto "No Smoke, Less Harm," should inform the global approach to tobacco control policy. It's time for institutions like the World Health Organization (WHO) – which has long endorsed harm reduction for drug use - to formally integrate THR as the fourth pillar of tobacco control, alongside taxation, regulation, and education.

Harm reduction products offer a perfect alignment of business, economic, and public health goals without the state having to do anything but allow them to be sold to adults who would otherwise smoke.

To achieve meaningful progress in tobacco harm reduction, several actions must be taken. First and foremost, EU and WHO member states must adopt a risk-proportionate regulatory framework that distinguishes between smoked and smoke-free nicotine products. This approach recognises the varying levels of risk associated with different nicotine delivery methods and allows consumers access to safer alternatives.

Furthermore, combating nicotine misinformation is paramount. Misconceptions about the risks of nicotine can deter smokers from transitioning to safer alternatives. It's crucial to actively eliminate false narratives and provide accurate information about the relative risks of different nicotine products.

Research plays a pivotal role in building the evidence base for tobacco harm reduction. All stakeholders, including governments, research institutions, and industry, should invest in rigorous scientific studies to evaluate the safety and efficacy of THR strategies. By gathering robust evidence, public health policies can be better informed and consumers will be empowered to make smart and life-saving choices about their health.

At the heart of THR lies an ethical imperative: the recognition of consumers' fundamental human right to health. Individuals have the right to access accurate information and safer alternatives to smoking. By respecting this right, policymakers can support THR initiatives that prioritise public health and individual autonomy.

Lastly, monitoring and evaluation are essential components of effective tobacco harm reduction strategies. WHO and member states must step up efforts to track the impact of THR interventions, including changes in smoking prevalence, tobacco-related diseases, and public perceptions of nicotine use.

We have overwhelming data now to show that harm reduction works. The Swedish experience has shown conclusively that abstinence only policies are vastly inferior to those which meet the consumer where they are instead of where governments wish them to be. There is no longer any meaningful justification for pursuing futile policies to restrict nicotine use instead of accepting that, like coffee, there will always be those who consume it.

The real public health enemy is smoking combustible tobacco, not nicotine.

Embracing THR is not only a pragmatic approach to reducing the burden of tobacco-related diseases but also a moral imperative. By fundamentally differentiating between smoked and smoke-free products and adopting risk-proportionate regulatory frameworks, millions of lives can be saved. It just takes enlightened policymakers to recognise that, not bury their heads in the sand like the WHO.

It's time to prioritise THR awareness and adoption, dismantle nicotine misconceptions, and uphold consumers' right to health. A future can be built where tobacco-related diseases are relegated to the past, and every individual has the opportunity to lead a healthier, smoke-free life, if only influential organisations adhere to a simple, progressive mantra.

No smoke. Less harm.


_Martin Cullip is an International Fellow at The Taxpayers Protection Alliance's Consumer Center and is based in South London, UK._

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No Smoke, Less Harm: A Path to Saving Lives

Discover the truth about nicotine and its role in tobacco harm reduction. Learn how embracing safer alternatives can save millions of lives and improve public health.

Dispelling Nicotine Myths: Embrace Tobacco Harm Reduction to Save Lives

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Dr Konstantinos Farsalinos’ multidimensional report on vaping flavours titled “**The case for flavours in tobacco harm reduction to save lives**” examines the science, consumer insights, risks and regulatory considerations relating to vaping flavours. 
 
The review concludes that **restrictions on vaping flavours would risk seriously reducing the life-saving potential of these innovative products.**
 
Click [HERE ](https://media.thr.net/strapi/0cbd3b34cef86dad0032528c324d2f7b.pdf) to read the full report, or [HERE](https://media.thr.net/strapi/e43d913841406aa46d3684a9ae4eeb48.pdf) to read the Executive Summary.









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In Favour of Flavour - A Key Report On How Flavours in Tobacco Harm Reduction Save Lives

Ahead of the EU elections, health experts urge policymakers to adopt Sweden’s successful tobacco harm reduction strategies. Implementing these methods could save nearly 3 million smokers in the EU, emphasizing the need for science-based policy decisions.

**Stockholm, Sweden**

On the eve of this year’s European elections, international health experts are rallying behind a call to action for MEP candidates and policymakers: incorporate Sweden’s tobacco harm reduction strategies into the new mandate. With the revision of the Tobacco Products Directive on the agenda, the elections are an historic opportunity to enact life saving changes for smokers across the entire Union.

In 2023, the European Parliament recognised in its report on non-communicable diseases the role that products such as e-cigarettes play in smoking cessation. By implementing this recommendation into policy actions as part of the upcoming revision of Tobacco Products Directive, EU policymakers have an unprecedented opportunity to save the lives of almost 3 million smokers across Europe.

In recent decades, Sweden has quickly transformed into a leader in tobacco harm reduction. While Swedes consume similar levels of nicotine compared to their European counterparts, the country has a 21% lower tobacco-related death rate, as well as a 36% lower lung cancer death rate. This is linked to the common availability of less harmful, nicotine alternatives such as e-cigarettes and snus.

Meanwhile, European neighbours are lagging. Some governments, including Belgium and the Netherlands are taking steps to ban less harmful products, including nicotine pouches or vaping flavours.

Commenting on the upcoming elections, Dr Delon Human, leader of Smoke Free Sweden said: 
 _“As millions of voters across the EU take to the polls over the coming days, we encourage the newly elected policymakers to take a step back from ideology and understand the science of tobacco harm reduction, which has been a successful strategy for saving lives in Sweden. ​​_

_“Every day we delay this important conversation and we take no action, lives will be lost.”_

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Urgent call for EU policymakers ahead of EU elections: replicate Smoke Free Sweden

Urgent call for EU policymakers ahead of elections: replicate Sweden’s successful tobacco harm reduction strategies to save lives across Europe.

On September 28th, a new **Asia Harm Reduction Alliance** platform was launched, to bring together consumers, policymakers, and harm reduction experts in the health care community in the Asia Pacific and the Middle East region. 

The new website, along with a [**Twitter page**](https://twitter.com/HRA_asia) and [**YouTube Channel**](https://www.youtube.com/channel/UC_IPnHiXfRrRBBlhBPmZgAA), will provide advocates with up-to-date information on tobacco, alcohol, and drug health policy, scientific research, and news.

Dr. Marewa Glover, Director, Centre of Research Excellence: Indigenous Sovereignty & Smoking, New Zealand, is featured on the site as one of the champions of the platform, along with six other health experts. Dr. Marewa Glover quotes: 

*“**There are compassionate and more cost-effective ways to reduce smoking prevalence. One of these is to encourage switching to a low-risk alternative. The use of e-cigarettes (vaping) has been found to be more effective than nicotine replacement therapy in enabling people to quit smoking**”*

To read more and visit the website, [**click here**](https://asiaharmreductionalliance.net/).

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New Platform Revealed: The Asia Harm Reduction Alliance 

Malaysian webinar reveals misconceptions about THR products and the need for proper regulation to promote harm reduction.

On the 22nd June, a [**webinar** ](https://www.youtube.com/watch?v=RnSgB5AxPfU&t=307s)hosted by thr.net took place. Moderated by [**Dr. Delon Human**](https://www.tobaccoharmreduction.net/dr-delon-human) and [**Jessica Perkins**](https://www.linkedin.com/in/jessica-perkins-963a4b32/) from ****tobaccoharmreduction.net****, the panel featured leading medical expert [**Dr. Konstantinos Farsalinos**](https://twitter.com/FarsalinosK), [**Professor Sharifa Ezat Wan Puteth**](https://www.linkedin.com/in/sharifa-ezat-wan-puteh-b2b05b196/), President of the Malaysian Society for Harm Reduction and [**Professor Neil McKeganey**](https://twitter.com/McKeganey1), director of the Centre for Substance Use Research at the University of Glasgow.


“Many Malaysian smokers are seeing ecigs, and other non-combustible nicotine alternatives as their fire escape. We need to promote evidence-based regulation that gives comfort to consumers to switch from the most harmful to the least harmful alternatives." - said [**Dr Delon Human**](https://twitter.com/HumanDelon). 


The 3 eminent academics discussed the need for regulation of tobacco harm reduction (THR) products in Malaysia, and misconceptions about alternative nicotine products and flavours.


**Key misconceptions and the role of health practitioners**


The **[Kantar survey](https://media.thr.net/strapi/57d0472d80a9339de39153e6793d973b.pdf)** showed that many adults in Malaysia are misinformed about the relative risk of THR products such as vaping. More than a third of Malaysians perceive them as more harmful or as harmful as cigarettes. “These figures underline the importance of health practitioners to encourage the efforts of smoking cessation”, argued [Professor Neil McKeganey](https://twitter.com/McKeganey1).


However, the survey shows that just **4%** of people who **vape** said that they were encouraged to do so by a health practitioner. This also stems from the fact that many of them do not understand the relative risks of vaping or the fact that nicotine itself does not cause cancer. 


All the speakers agreed that there is a huge role to be played by health practitioners in advising smokers to switch to less risky products, such as vaping. But in order to do that, misconceptions about reduced-risk products need to be dispelled. 


[**Professor Sharifa Ezat**](https://www.linkedin.com/in/sharifa-ezat-wan-puteh-b2b05b196/) spoke about THR encountering resistance from regulators and policymakers, since it’s a relatively new concept and the risk perception is skewed by exaggerated and fear-mongering media reports. 


The survey also found that **52% of Malaysian smokers** perceive vaping to be less harmful than smoking cigarettes. On this basis, **86%** said that vaping should be made available to smokers as a *less harmful* product and **90%** believe that **vaping should be actively promoted as a less harmful** alternative to smoking cigarettes.


The good news from the survey, however, is that those who have actually managed to switch to vaping, did so in order to cut down on smoking or quit completely (**49%**). 


**The use of flavours in vaping**


The [**Kantar survey**](https://media.thr.net/strapi/57d0472d80a9339de39153e6793d973b.pdf) showed that nearly a third of respondents (**61%**) who **vape** used **fruit flavours**, hence the use of flavours is a powerful way for people to cut down on or quit smoking entirely. [**Dr Farsalinos**](https://twitter.com/FarsalinosK) commented on the issues of flavours, and highlighted that if products do not taste good, smokers will unlikely want to use them to quit smoking. What can prevent e-cigarette users from relapsing back into cigarettes, is to provide a variety of flavours for them to choose between - keeping the e-cigarette experience more interesting. 


**We need to provide practical solutions through risk - based regulation**


In **[Malaysia](https://twitter.com/Tobaccoharmred1/status/1539529585695539202)** today, e-cigarette products are unregulated, which on the one hand means that users can easily access products that can help them to switch or quit smoking; but on the other hand it provides poor quality manufacturers the opportunity to use potentially dangerous ingredients - causing harm to consumers. 


The [**Kantar study**](https://media.thr.net/strapi/57d0472d80a9339de39153e6793d973b.pdf) saw that consumers are willing to embrace regulation of THR products, and the members of the panel agree that regulation is necessary to avoid having any substandard items on the market that could be dangerous to people’s health. However, as proven by other countries, bad regulation can cause people to switch back to smoking or never switch to vaping in the first place.


Success can only be achieved through proper information, knowledge and favourable legislation. [**Professor McKeganey**](https://twitter.com/McKeganey1) said that what will be important for any future legislation of THR products in Malaysia is that it increases the accessibility, availability and safety of these products compared to cigarettes. 


This webinar was the start of a much-needed debate in **Malaysia on tobacco harm reduction**. It highlighted how consumers feel about it and where it can go next. 


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NEW WEBINAR - MALAYSIA: ON THE PATH TO LIFE - SAVING ALTERNATIVES. A CALL FOR REGULATION TO PROTECT CONSUMERS

Explore findings from Malaysia's THR webinar addressing tobacco harm reduction, misconceptions, and the role of health practitioners.

Malaysia's THR Webinar: Insights & Misconceptions

WHO's new tobacco cessation guidelines support over 750 million users in quitting. Recommendations include nicotine replacement therapy (NRT), varenicline, bupropion, cytisine, and digital interventions.

_Guidelines aim to support more than 750 million tobacco users worldwide who wish to quit all forms of tobacco._

The World Health Organization ([WHO](https://www.who.int/)) released the first-ever [clinical treatment guidelines](https://www.who.int/news/item/02-07-2024-who-releases-first-ever-clinical-treatment-guideline-for-tobacco-cessation-in-adults) on July 2nd. The guidelines aim to help over 60% (750 Million) of the world’s 1.3 million smokers quit the deadly habit. In its tobacco cessation guideline, WHO proposes a comprehensive range of measures, including behavioural support provided by healthcare providers, digital cessation interventions, and pharmacological treatments.

The World Health Organization recommends varenicline, nicotine replacement therapy ([NRT](https://www.tobaccoharmreduction.net/thr-products)), bupropion, and cytisine as effective treatments for people who want to quit smoking.

- Bupropion is an FDA-approved non-nicotine antidepressant. It is currently used for smoking cessation to help smokers quit.
- Cytisine, a partial agonist of nicotinic acetylcholine receptors, has the same molecular structure as nicotine and varenicline. It also has similar pharmacological effects. Cytisine minimises the urge to smoke and reduces the severity of nicotine withdrawal symptoms.
- Varenicline is a nicotine-free pill that works differently compared to other cessation drugs. Although you will need a prescription to buy it, it can be an effective drug for those who have not been able to kick the habit of using other drugs before.

In these guidelines, the UN health agency also recommends counselling, individual, group, or phone counselling, and digital interventions like text messaging, smartphone apps, and internet programs.

A complementary proposition, [Tobacco Harm Reduction](https://www.tobaccoharmreduction.net/) (THR), can be an additional tool for helping with smoking cessation.

View the WHO clinical treatment guidelines for tobacco cessation [here](https://www.who.int/publications/i/item/9789240096431).

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WHO Endorses NRT In First-Ever Tobacco Cessation Guidelines

WHO releases first-ever tobacco cessation guidelines, endorsing NRT and other treatments to help over 750 million tobacco users quit.

Contribute to the UK government's vital survey on smoke-free alternatives. Your insights shape policies, ensuring accurate risk communication. Be a part of informed decision-making for a smoke-free generation. Your voice matters!

The UK government has recently released an important survey and they want to hear from you!

Your ability to save lives doesn’t solely rely on actions but on accurate risk communication and informed choices. Developing policies that guide a nation's future should be grounded in providing precise and comprehensive information to consumers regarding smoke-free alternatives and their comparative risks. 

The UK government's online survey offers each individual or organisation the opportunity to step forward, share their insights, and be a part of the [decision-making process](https://www.gov.uk/government/consultations/creating-a-smokefree-generation-and-tackling-youth-vaping/creating-a-smokefree-generation-and-tackling-youth-vaping-your-views). Your voice holds weight in advocating for policies that prioritise accurate risk communication.

Global advocate, Clive Bates, has started providing his perspectives and responses to the survey. Bates’ article is also a great resource to understand more about the survey and what it entails. 

Read [Clive Bate’s overview commentary](https://clivebates.com/uk-smoking-and-vaping-policy-consultation-my-draft-response/).

The survey is available [HERE](https://consultations.dhsc.gov.uk/en/65201ed1f3410a69990d3081) until 6 December 2023.

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Engage and Influence: Make Your Voice Heard in UK Government Surveys

Shape UK policy on smoke-free alternatives! Contribute insights to the government's survey by Dec 6. Your voice guides informed decision-making.

Shape UK's Future: Join Smoke-Free Survey for Informed Policies

The 8th WHO report on tobacco and new products faces scrutiny from a sector expert for alleged flaws and links to Bloomberg Philanthropies' policy influence.

The World Health Organization’s recently released 8th report on the global tobacco epidemic relating to new and emerging products,  is deeply flawed and unscientific according to a tobacco sector expert. This thought-provoking assessment also explains why the report is raising concern about the influence that Bloomberg Philanthropies exerts on WHO policy.

Concern over unscientific stance in WHO's 8th report on global tobacco epidemic

An industry expert critiques the WHO's 8th report on tobacco and new products


Controversial WHO Report on Emerging Tobacco Products

In a change that will favour vaping consumers today, Italy has **adjusted its tax on e-liquids** for the fourth time in four years. 

The tax rate on e-liquids containing nicotine will decrease from €0.175 (U.S. equivalent: $0.19) per millilitre to €0.13, and the zero-nicotine e-liquid tax will fall from €0.13/mL to €0.08. The new, lower tax rates are in line with the levels set in 2021 (these levels had seen an increase in January 2022). 

Italy has experienced a turbulent history when it comes to vaping products. In 2014, the Government made vapes as expensive as cigarettes, which meant that 75% of the ‘thriving’ vape industry had been wiped out. The tax was the highest in the EU, which almost doubled the price of e-liquid. This meant that vapers were now seeking the black market and some returned to smoking. 

However, in 2019 the vaping community applied pressure to the Parliamentary legislators and they finally reduced the tax rate by 80%, to a far more reasonable €0.08 per mL for e-liquids containing nicotine, and €0.04 for nicotine-free e-juices. However, last year the legislators increased the tax yet again, only to (finally) reduce them today. 

**References**

1. Vaping 360: [https://vaping360.com/vape-news/113815/italy-will-reduce-e-liquid-tax-april-1st/](https://vaping360.com/vape-news/113815/italy-will-reduce-e-liquid-tax-april-1st/)

![2 hands for Italy post.jpg](https://media.thr.net/strapi/87c2bcc76eacff986d85a3a64b8fedc0.jpg)


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Today (April 1st 2022) - Italy reduces tax on e-liquids 

Discover how flavors aid tobacco harm reduction. The latest 2023 research by Dr. K. Farsalinos highlights flavors' role in smoking cessation.

A [new and updated revision of the "Case for Flavours in Tobacco Harm Reduction"](https://media.thr.net/strapi/34d52398d9056adece15e8bda5172870.pdf?updated_at=2023-08-29T12:28:33.423Z) by Dr. [Konstantinos Farsalinos](mailto:kfarsalinos@gmail.com), originally published in 2022, has been newly released for 2023.

The latest report contains updated studies on flavours, showcasing the most recent and up to date research, including the findings of a longitudinal study on non - tobacco vs tobacco flavours, and the effects on smoking abstinence. The study also describes how vaping non-tobacco flavours was not associated with youth smoking initiation but was associated with increased adult smoking cessation.

Read the [full report](https://media.thr.net/strapi/34d52398d9056adece15e8bda5172870.pdf?updated_at=2023-08-29T12:28:33.423Z) to learn more about how flavours save lives in tobacco harm reduction.

[Click here](https://www.tobaccoharmreduction.net/updates/flavours) to access more content on flavours on [THR.net](https://www.tobaccoharmreduction.net/thr).

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UPDATED - THE CASE FOR FLAVOURS IN TOBACCO HARM REDUCTION, TO SAVE LIVES BY DR KONSTANTINOS FARSALINOS

Discover the updated report by Dr. K. Farsalinos on the role of flavors in reducing tobacco harm. New studies show flavors' impact on smoking cessation. Learn more.

Flavours in Tobacco Harm Reduction: Latest Research 2023

CAPHRA endorses NZ's harm reduction stance, praising Smokefree Act repeal. Emphasis on adult choices, vaping regulation. Coordinator Nancy Loucas aligns with economist Eric Crampton.

The Coalition of Asia Pacific Harm Reduction Advocates ([CAPHRA](https://twitter.com/caphraorg)) today expressed its support for the New Zealand Government's decision to repeal elements of the Smokefree Environments Act.

“The decision, part of the NZ First 2023 Coalition Agreement, is seen by CAPHRA as a balanced approach to tobacco control that focuses on harm reduction rather than outright prohibition,” said Nancy Loucas, a public health policy expert and passionate advocate for tobacco harm reduction and executive coordinator of CAPHRA.

"CAPHRA applauds the government's decision to prioritise [harm reduction strategies](https://www.tobaccoharmreduction.net/thr)," said Ms Loucas. "We believe that vaping and other harm reduction tools can play a significant role in helping smokers quit, and we are pleased to see the government recognising this."

The organisation also shares the government's concerns about the potential for a black market to develop if the sale of tobacco is overly restricted.

"A regulated market is always preferable to an unregulated one, where product safety cannot be guaranteed," Loucas added.

CAPHRA supports the government's plan to reform the regulation of vaping, smokeless tobacco, and oral nicotine products.

"These products can be part of a comprehensive harm reduction strategy," Loucas said. "We also support the government's decision to ban single use disposable vaping products, which are often of lower quality and can be more harmful than reusable devices."

The organisation agrees with the government's plan to increase penalties for illegal sales of tobacco and vaping products to those under 18. "These products should only be available to adults who can make informed decisions about their use," Loucas stated.

CAPHRA also supports the government's decision to tax only smoked products. "This approach recognises the harm reduction potential of smokeless products and vaping devices," Loucas said.

CAPHRA's views align with those of Eric Crampton, a well-known economist and commentator on public policy in New Zealand. "We are in agreement with Mr. Crampton's views on this issue," Loucas noted.

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CAPHRA supports NZ Government's decision to repeal elements of the Smokefree Environments Act

CAPHRA supports NZ's harm reduction. Applauds Smokefree Act repeal, prioritizing adult choices, regulating vaping. Coordinator Nancy Loucas aligns with economist Eric Crampton.

Asia Pacific Backs NZ's Harm Reduction: Applauds Smokefree Act Repeal

Explore the worldwide movement to aid 780 million smokers in quitting tobacco in 2024. Learn about evidence-based methods, dispel misconceptions, and access crucial cessation support for a healthier, smoke-free life.

With the new year right around the corner, quitting smoking will once again feature as a popular resolution among the world's 1 billion smokers.Millions of smokers worldwide want to quit tobacco for good. In fact, according to the World Health Organization, about [780 million smokers](https://www.who.int/news/item/08-12-2020-who-launches-year-long-campaign-to-help-100-million-people-quit-tobacco) worldwide say they want to quit, but only 30% of them have access to the tools that can help them do so.

Irrespective of how long you have smoked, quitting will benefit your health in both the immediate and long-term future. Quitting has been shown to lower risks of lung and other smoking-attributable cancers such as coronary artery disease, stroke and chronic obstructive pulmonary disease (COPD) while improving lung function and symptoms.

Whilst going '[cold turkey](https://en.wikipedia.org/wiki/Cold_turkey)' may seem like the quickest and easiest option, [research](https://excommunity.becomeanex.org/t5/Mayo-Clinic-Blog/Does-Cold-Turkey-Work-Best/ba-p/985030) suggests that for most people, it's unlikely to be effective in the long term.Dr. Hays, a renowned expert in tobacco use and dependence, [states](https://excommunity.becomeanex.org/t5/Mayo-Clinic-Blog/Does-Cold-Turkey-Work-Best/ba-p/985030) that 'Out of 100 smokers trying to quit cold turkey, about three to five will succeed past six months.  While some smokers can and do quit cold turkey, 95% or more are unsuccessful.'

Indeed, willpower is important when quitting cigarettes, but it's easier when combined with some extra cessation support.With the W.H.O. having [stated](https://www.who.int/news-room/commentaries/detail/quit-tobacco-to-be-a-winner) that over 70% of the 1.3 billion smokers worldwide lack access to the tools they need to quit successfully,the gap in access to cessation services is clear for all to see.

Adopting an approach to minimise the harm caused by smoking should be guided by the fact that the adverse health effects caused by tobacco smoking are not triggered by [nicotine](https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4575), but by toxic chemicals released during combustion (burning). Switching completely to electronic cigarette use is [less harmful](https://www.nhs.uk/better-health/quit-smoking/vaping-to-quit-smoking/) than continuing to smoke. Non-combustible alternative nicotine products (e-cigarettes, nicotine pouches, lozenges, snus, heat-not-burn products) can serve as options and aid adult smokers to quit smoking successfully in 2024.

With cessation support and will power, a smoke-free lifestyle is within reach. This 2024, the New Year falls on a Monday, a perfect opportunity to embark on your quitting journey.

For more cessation support to quit smoking, join the [online community.](https://twitter.com/Tobaccoharmred1)

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New Year's Resolution – Quit Smoking in 2024!

Discover the global push to help 780 million smokers quit in 2024. Uncover effective strategies, debunk myths, and find the support needed for a successful smoke-free journey.

2024 Resolution: Quitting Smoking for a Healthier Tomorrow

Sweden approaches historic milestone of being Europe’s first ‘smoke-free’ country, says new report.

*Public Health Experts Urge Countries Around the World to Follow the Swedish Example*

**STOCKHOLM, Sweden, Mar 14, 2023**

**PUBLIC health experts launched a major new report today (TUESDAY) to mark Sweden approaching the historic milestone of becoming Europe's first 'Smoke Free' country.**

**Sweden is on course to drop below a 5% tobacco smoking prevalence rate in the coming months. This is the level below which the country will be considered officially 'Smoke Free'.**

**No other country in the European Union is even close to replicating this achievement and none are currently on track to even achieve it by the EU's target of 2040, in 17 years time.**

**The country's groundbreaking strategy to minimize the harmful effects of tobacco smoking and save lives is detailed in a new report entitled "** **The Swedish Experience: A roadmap for a smoke-free society** **," presented [today](https://www.youtube.com/watch?v=S-5SCNad53s) at an international research seminar in Stockholm.**

According to the report's authors, Sweden's approach, which combines tobacco control methods with harm minimisation strategies, could save 3.5 million lives in the next decade if other EU countries adopt similar measures.

"Quitting smoking like Sweden saves lives," says Dr. Anders Milton, one of the report's authors. "It has annually saved more than 3,400 lives in Sweden. If all other EU countries did as Sweden did, 3.5 million lives could be saved in the coming decade, in the EU alone."

**Combination of tobacco control with harm minimization**

The Swedish model combines recommendations in the WHO Framework Convention for Tobacco Control (FCTC), including reducing the supply and demand of tobacco, banning smoking in certain places, but it adds an important element: accepting smoke-free products as less harmful alternatives.

"It's about combining tobacco control with harm minimisation," explains Dr. Delon Human, another of the report's authors. "There are no risk-free tobacco products, but e-cigarettes, for example, are 95% less harmful than cigarettes. It is far better for a smoker to switch from regular cigarettes to e-cigarettes or nicotine pouches than to continue smoking."

**Public health benefits for individual and society**

The benefits of Sweden's strategy are enormous, with the country having the lowest percentage of tobacco-related diseases in the EU and a 41% lower incidence of cancer than other European countries. The report also describes how the percentage of smokers in Sweden has dropped from 15 percent to 5.6 percent of the population in 15 years, putting it on track to achieve smoke free status 17 years ahead of the EU's 2040 target

"Sweden has a very successful tobacco strategy that should be exported," says Professor Karl Fagerström, who also authored the report..

"It would be of enormous benefit to the world if more countries did as Sweden did with measures that reduce supply and demand while having differentiated tax rates that give smokers financial incentives to switch from cigarettes to less harmful alternatives," Dr. Fagerström added.

**About the report**

The report was commissioned by Health Diplomats, an international organization working to improve access to healthcare, encourage innovation and the use of harm reduction to minimize the negative impact of alcohol, food, nicotine and drugs.

[The full report is available here: ](https://media.thr.net/strapi/a2e4589c40fabbdfaae76bc7e1e3128e.pdf)

**Some of the report's conclusions and suggestions for implementation in other countries.**

1. Recognize smoke-free products as less harmful and that they pose significantly less risk than smoking. Encourage smokers to switch from cigarettes to less harmful alternatives.

1. Provide fact-based information. It is clear that there are no risk-free tobacco products. But, for example, e-cigarettes are 95% less harmful than cigarettes. Of course, it is better for a smoker to switch from regular cigarettes to e-cigarettes, although it is not without risk.

1. Policy decisions that make smoke-free alternatives more accessible than cigarettes. For example, differentiated taxes give smokers financial incentives to switch from cigarettes to less harmful alternatives.

**About the report's authors:**

Dr. Anders Milton, formerly chairman of the Swedish Medical Association, the Swedish Red Cross and the World Medical Association.

Prof. Karl Fagerström, docent and internationally recognized expert in addiction research and smoking cessation.

Dr. Delon Human, physician specializing in global public health issues. Former advisor on public health issues to, among others, three WHO directors-general and the UN secretary-general.

Swedish version:

**Ny expertrapport visar: Sverige snart rökfritt – Sveriges framgångsrika strategi räddar liv och bör gå på export**

**Sverige blir rökfritt 2023\*. Därmed blir landet först i EU att nå rökfrihet, något inget annat EU-land är i närheten av. I en ny rapport som presenteras i [dag](https://www.youtube.com/watch?v=S-5SCNad53s) redogörs för Sveriges framgångsrika strategi för att minimera tobaksrökningens skadeverkningar och därmed rädda liv. Om övriga EU-länder gjorde som Sverige gjort skulle miljontals liv kunna räddats under det kommande decenniet – bara i EU.**

Rapporten "_The Swedish Experience: A roadmap for a smoke free society"_ presenterades i dag på ett internationellt forskarseminarium i Stockholm. I rapporten uppmanar författarna andra länder att ta efter Sveriges framgångsrika strategi, som kombinerar metoder för tobakskontroll med skademinimeringsstrategier.

- Att sluta röka som Sverige räddar liv. Det har årligen räddat fler än 3 400 liv i Sverige. Om alla andra EU-länder gjorde som Sverige skulle 3,5 miljoner liv kunna räddas under det kommande decenniet, bara i EU, säger dr Anders Milton, en av rapportens författare.

**Kombitation av tobakskontroll med skademinimering**

En viktig del i den framgångsrika svenska strategin är att man proaktivt implementerat det som Världshälsoorganisationen (WHO:s) ramkonvention för tobakskontroll föreslår: att införa en rad åtgärder för att minska utbud och efterfrågan av tobak, liksom skademinimeringsåtgärder.

- I grunden handlar det om att kombinera åtgärder för tobakskontroll, som att förbjuda rökning på vissa platser, med att acceptera rökfria produkter som mindre skadliga. Det finns inga riskfria tobaksprodukter. Men exempelvis är e-cigaretter 95% mindre skadliga än cigaretter. Självklart är det bättre för en rökare att byta från vanliga cigarretter till e-cigaretter eller vitt snus, även om det inte är riskfritt, säger dr Delon Human, en av rapportens författare.

**Folkhälsovinster för individ och samhälle**

I rapporten redogörs för hur andelen rökare i Sverige på 15 år gått från 15 procent till 5,6 procent av befolkningen. Folkhälsovinsterna är enorma. Bland annat har Sverige lägst andel tobaksrelaterade sjukdomar av alla EU-länder och 41 procent lägre förekomst av cancer än andra europeiska länder.

- Sverige har en mycket framgångsrik tobaksstrategi som bör gå på export. Det skulle vara till enorm nytta för världen om fler länder gjorde som Sverige med åtgärder som minskar utbud och efterfrågan samtidigt som man exempelvis har differentierade skattesatser som ger rökare ekonomiska incitament att byta från

cigaretter till mindre skadliga alternativ, säger professor Karl Fagerström, en av rapportens författare.

**Några av rapportens slutsatser och förslag för implementering i andra länder.**

1. **Erkänn rökfria produkter som mindre skadliga** och att de utgör en betydlig mindre risk än rökning. Uppmuntra rökare att byta från cigaretter till mindre skadliga alternativ.

1. **Ge faktabaserad information som skapar acceptans.** Det är tydligt att det inte finns riskfria tobaksprodukter. Men exempelvis är e-cigaretter 95% mindre skadliga än cigaretter. Självklart är det bättre för en rökare att byta från vanliga cigarretter till e-cigaretter, även om det inte är riskfritt.

1. **Politiska beslut som gör rökfria alternativ mer tillgängliga än cigarretter.** Till exempel differentierade skatter som ger rökare ekonomiska incitament att byta från cigaretter till mindre skadliga alternativ.

**Om rapporten**

Rapporten har tagits fram på uppdrag av Health Diplomats, en internationell organisation som arbetar för att förbättra tillgången till hälso- och sjukvård, uppmuntra innovation och användning av skademinskning för att minimera den negativa effekten av tobak, alkohol, livsmedel och droger.

[Hela rapporten finns här:](https://media.thr.net/strapi/838c66b26020a0a75d7d7d931d34ecbf.pdf)

**Om rapportens författare**

**Dr Anders Milton,** tidigare bland annat ordförande för Svenska Läkarförbundet, Svenska Röda Korset och World Medical Association.

**Prof. Karl Fagerström** , docent och internationellt erkänd expert inom beroendeforskning och rökavvänjning.

**Dr Delon Human,** läkare specialiserad på globala folkhälsofrågor. Tidigare rådgivare om folkhälsofrågor till bland annat tre WHO-generaldirektörer och FN:s generalsekreterare.

\*Det europeiska natverket for tobaksforebyggande arbete (ENSP) och Varldshalsoorganisationen (WHO) anser att lander ar officiellt "rokfria" nar mindre an 5 procent av den vuxna befolkningen roker tobak.

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SWEDEN’S STUNNING SMOKE FREE SUCCESS PROVIDES A ROAD MAP THAT COULD SAVE LIVES OF MILLIONS - MAJOR NEW REPORT

Sweden's Smoke-Free Success Provides Global Road Map

As the EU elections approach, it's crucial for leaders to focus on Tobacco Harm Reduction (THR). This article explores how adopting THR policies can significantly reduce smoking-related deaths across Europe.

**As the EU elections begin, we want leaders who pay attention to Tobacco Harm Reduction. But what does that mean? Let’s find out together.**

In a year marked with elections worldwide, June 2024 sees the onset of the 4-day EU elections. With 720 parliamentary members to be elected across 27 member states by around 370 million Europeans, this is an election marked with potential and promises. In fact, in the lead-up to the elections, many parties have shared many different promises on smoking, tobacco control and harm reduction. Tobacco use remains one of the leading causes of preventable diseases and deaths across Europe, making it imperative for candidates and policymakers to address how they plan to combat this ongoing crisis.

**Why is it important for parties to focus on harm reduction?**

Despite decades of tobacco control measures, smoking rates in many EU countries remain alarmingly high. Tobacco use is responsible for nearly [700,000 deaths](https://www.theparliamentmagazine.eu/partner/article/growing-calls-for-eu-to-reconsider-antismoking-policies-and-embrace-the-swedish-approach-to-beat-smoking) annually within the EU and traditional tobacco control strategies, such as taxation, advertising bans, and public smoking restrictions, have not been sufficient to curb smoking prevalence significantly.

[Tobacco Harm Reduction](https://www.tobaccoharmreduction.net/thr) (THR) is an approach that aims to minimise the health risks associated with tobacco use by encouraging smokers to switch to less harmful alternatives. These alternatives include [electronic cigarettes (vapes), heated tobacco products, nicotine pouches](https://www.tobaccoharmreduction.net/thr-products), and snus. Unlike combustible cigarettes, these products do not involve the burning of tobacco, which is the primary source of harmful toxins and carcinogens.

**What are some aspects of harm reduction that EU leadership can invest in?**

1\. Include THR in Tobacco Control Policies: It is time for the EU to officially embrace THR as a tool for, not a target of, tobacco control.

2\. Promote Risk-Proportionate Regulations: This includes recognising the [risk continuum](https://ahra.info/thr-risk-continuum/) and embracing [reduced-risk](https://www.tobaccoharmreduction.net/thr-products) products to help smokers quit.

3\. Encourage Public Education and Awareness: Widespread misconceptions surrounding THR products, such as e-cigarettes, continue to gain traction. It falls on our leaders to support education campaigns on the reduced-risk benefits and the proven successes of these alternative products.

4\. Support Innovation and Research: As a science-backed organisation, we value and strive to showcase the latest research. Investing in this sphere can help reduce risk even further and significantly change the EU’s public health landscape when it comes to smoking.

The upcoming EU elections present a crucial opportunity for voters to elect representatives who are committed to advancing public health through progressive tobacco control policies. By embracing THR, the EU can lead the world in a progressive approach to tobacco control – perhaps even achieving its smoke-free goal before the next elections come to pass.

It's time for policymakers to recognise the potential of THR and commit to a future where fewer lives are lost to tobacco.

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Tobacco Harm Reduction and the EU Elections: A Critical Public Health Issue

Discover how Tobacco Harm Reduction (THR) can save lives. As EU elections begin, leaders must focus on progressive tobacco control to combat smoking-related deaths.

This article explores the divide between harm reduction and prohibition in tobacco control, highlighting six key distinctions.

This month, we mark three important events: [**International Harm Reduction Day**](https://www.hri.global/) on 7 May, [**World Vape Day**](https://worldvapersalliance.com/en_gb/world-vape-day/) on 30 May and [**World No Tobacco Day**](https://www.who.int/campaigns/world-no-tobacco-day/2022) on 31 May. In spite of the dualistic impression one derives from the war-like language that often mars discussion between ‘tobacco control’ and ‘tobacco harm reduction’ (THR) communities, they actually share a common goal: [**to minimise tobacco-related disease and premature death**](https://www.tobaccoharmreduction.net/). 


The harm reduction approach is already enshrined in [**Article 1d**](https://treaties.un.org/doc/Treaties/2003/05/20030506%2002-12%20PM/Ch_IX_04p.pdf) of the World Health Organisation’s ([**WHO**](https://treaties.un.org/doc/Treaties/2003/05/20030506%2002-12%20PM/Ch_IX_04p.pdf)) Framework Convention on Tobacco Control ([**FCTC**](https://treaties.un.org/doc/Treaties/2003/05/20030506%2002-12%20PM/Ch_IX_04p.pdf)). And yet their policies and public discourse do not reflect this. In a recent update of the [**WHO website’s Q&A section about e-cigarettes**](https://www.who.int/news-room/questions-and-answers/item/tobacco-e-cigarettes), they continued to assert the following:
• *E-cigarettes are ‘dangerous’, ‘harmful’, and ‘toxic’* – with no reference to the [**relative risk**](https://media.thr.net/strapi/d5b691d7b57a532da30f41f52dd63dcc.pdf) compared to combustible cigarettes
• *E-cigarettes provide a gateway for youth to cigarettes* – this claim is not backed by any robust evidence, and has in fact been [**refuted by numerous public health experts**](https://www.ucl.ac.uk/news/2022/mar/e-cigarettes-not-substantial-gateway-smoking-young-people#:~:text=E%2Dcigarettes%20not%20a%20substantial%20gateway%20to%20smoking%20for%20young%20people,-11%20March%202022&text=E%2Dcigarette%20use%20in%20England,study%20led%20by%20UCL%20researchers.)
• *Vaping can cause lung injury, misnamed ‘EVALI’*– a misrepresentation that is [**'killing people'**](https://medium.com/the-great-vape-debate/the-cdcs-evali-screwup-ff09f4c3e187)
• *“To date, evidence on the use of ENDS as a cessation aid is inconclusive”* – please refer to the Cochrane Collaboration’s [**living systematic review**](https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used) indicating that [**e-cigarettes do help smokers quit**](https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used) cigarettes, and probably [**more effectively**](https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used) than nicotine replacement therapy.


This [**misrepresentation of facts**](https://media.thr.net/strapi/d5b691d7b57a532da30f41f52dd63dcc.pdf) is squandering the opportunity to help millions of smokers switch to much less harmful products, such as [**nicotine vapes**](https://www.tobaccoharmreduction.net/thr-products) and [**pouches**](https://www.tobaccoharmreduction.net/thr-products). Herein lies the difference in approach amongst [**THR advocates**](https://www.tobaccoharmreduction.net/advocacy); backed by evidence and pragmatism, THR supports the provision, rather than prohibition, of [**safer alternatives**](https://www.tobaccoharmreduction.net/thr-products) to those who are struggling to quit cigarettes. Here are **six ways in which harm reduction differs to prohibition**:


### **1. Dogmatic vs Open-minded**
In the FCTC’s biennial [**Conference of the Parties**](https://fctc.who.int/who-fctc/governance/conference-of-the-parties#:~:text=Conference%20of%20the%20Parties&text=Regular%20sessions%20of%20the%20Conference,of%20its%20next%20regular%20session.) (COP) meetings, ministers from around the globe convene to share their progress on implementation of tobacco control measures. These fora provide an opportunity for international cooperation. The problem is that they [**exclude**](https://clivebates.com/one-hundred-specialists-call-for-who-to-change-stance-on-tobacco-harm-reduction/) any perspective sympathetic towards harm reduction, despite [**reasoned imploration from hundreds of independent experts**](https://clivebates.com/one-hundred-specialists-call-for-who-to-change-stance-on-tobacco-harm-reduction/). Within these ideologically confined meetings, awards are given to those who **toe the dogmatic line** of condemning vaping. Astonishingly, in [**2019**](https://clivebates.com/prohibitionists-at-work-how-the-who-damages-public-health-through-hostility-to-tobacco-harm-reduction/) India’s health minister was lauded with special recognition for his country’s [**ban of e-cigarettes**](https://www.spectator.co.uk/article/the-whos-bizarre-war-on-e-cigarettes), despite [**robust evidence that they are at least 95% safer than cigarettes**](https://media.thr.net/strapi/d5b691d7b57a532da30f41f52dd63dcc.pdf). Rather than viewing all nicotine use with [**irreconcilable hostility**](https://tobaccoreporter.com/2020/11/01/the-irreconcilable-conflict-principle/), harm reduction advocates acknowledge that nicotine is not the enemy. They are open-minded about the [**continuum of risk**](https://media.thr.net/strapi/d5b691d7b57a532da30f41f52dd63dcc.pdf) of products, with the ultimate aim of helping people move away from the most harmful ones.


### **2. Punitive vs Compassionate**
After a [**recent ban of e-cigarettes in Hong Kong**](https://www.scmp.com/news/hong-kong/law-and-crime/article/3176654/hong-kong-police-make-first-arrests-under-law-banning) (despite [**evidence**](https://www.news.gov.hk/eng/2022/05/20220526/20220526_125509_474.html#:~:text=Hong%20Kong's%20smoking%20prevalence%20fell,a%20press%20conference%20this%20morning.) that they are helping reduce smoking rates), two people were recently [**arrested**](https://www.scmp.com/news/hong-kong/law-and-crime/article/3176654/hong-kong-police-make-first-arrests-under-law-banning) for selling nicotine vaping products. Whilst the sale of cigarettes remains legal and widespread, the cost of selling e-cigarettes is up to [**6-months imprisonment**](https://www.scmp.com/news/hong-kong/law-and-crime/article/3176654/hong-kong-police-make-first-arrests-under-law-banning). In contrast, on the [**Isle of Man**](https://www.bbc.co.uk/news/world-europe-isle-of-man-42909703), a 2008 ban on tobacco in prison led to inmates smoking illicit materials, including banana peels, tea bags, and nicotine patches. In response, a [**pilot scheme introduced the provision of regulated e-cigarettes for inmates**](https://www.bbc.co.uk/news/world-europe-isle-of-man-42909703) to use in their cells and outdoor spaces. Since the trial began, there have been 58% fewer behaviour warnings, a [**25% increase in intention to quit smoking**](https://www.bbc.co.uk/news/world-europe-isle-of-man-42909703), and an annual saving of £8500 on nicotine patches. 


### **3. Idealistic vs Pragmatic**
Riding in a car is an activity with inherent risks. Reasonable steps can be taken to minimise driving-related harm, such as seat belts and speed limits. Similarly, [**harm reduction proponents**](https://www.hri.global/what-is-harm-reduction) accept that e-cigarettes, like driving, are not completely risk-free. However, there is [**increasing evidence**](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub5/full), beyond reasonable doubt, that they are **significantly safer** than cigarettes. Bearing this in mind, and the fact that merely [**4-7% of smokers succeed in quitting**](https://media.thr.net/strapi/d5b691d7b57a532da30f41f52dd63dcc.pdf) using traditional measures, the pragmatic approach is to offer safer alternatives. A [**randomised trial**](https://www.nejm.org/doi/full/10.1056/NEJMoa1808779. 
) published in 2019 showed that using [**e-cigarettes nearly doubled the chance of quitting smoking**](https://www.nejm.org/doi/full/10.1056/NEJMoa1808779. 
) compared to nicotine replacement therapy. 


### **4. Ideological vs Evidence-based**
As described earlier, the WHO’s current stance is that “evidence on the use of ENDS as a cessation aid is inconclusive”. This statement is ideologically driven, rather than evidence-based. In contrast, a [**growing list**](https://clivebates.com/expert-statements-on-who-and-tobacco-harm-reduction/) of reputable and independent public health organisations and experts are acknowledging the [**tremendous potential of vaping to displace smoking**](https://clivebates.com/expert-statements-on-who-and-tobacco-harm-reduction/) and improve individual and population health. Two former directors of non-communicable disease control at the WHO, [**Prof Ruth Bonita**](https://clivebates.com/expert-statements-on-who-and-tobacco-harm-reduction/) and [**Prof Robert Beaglehole**](https://clivebates.com/expert-statements-on-who-and-tobacco-harm-reduction/), have [said](https://clivebates.com/expert-statements-on-who-and-tobacco-harm-reduction/): “WHO’s continuing disregard of the wealth of evidence on the value of these products is condemning millions of smokers to preventable disease and premature death.”


### **5. Stigmatising vs Accepting**
At the recent [**E-Cig Summit**](https://www.e-cigarette-summit.us.com/seminar/the-vape-shop-experience/) in Washington D.C., [**Marc Slis**](https://www.e-cigarette-summit.us.com/seminar/the-vape-shop-experience/) delivered a memorable address as an ex-smoker, vaper, and vape shop owner. Commenting on the anti-vaping lobby’s scaremongering campaigns, [he said](https://www.e-cigarette-summit.us.com/seminar/the-vape-shop-experience/): “Smokers are treated as acceptable collateral damage in a war against Big Tobacco. You trained the public to despise us. You trained us to despise ourselves”. It does not need to be this way; harm reduction practitioners are committed to [**meeting people ‘where they are’**](https://www.hri.global/what-is-harm-reduction) in their lives without judgement. Harm reduction focuses on motivating [**positive change**](https://www.hri.global/what-is-harm-reduction) through facilitation rather than coercion. 


### **6. Authoritarian vs Autonomous**
A prime example of prohibitionists’ authoritarian approach is how the [**International Network of Nicotine Consumer Organisations**](https://innco.org/) (INNCO) has been [**repeatedly denied observer status**](https://ahra.info/four-basic-consumer-rights-not-respected-by-the-anti-thr-lobby/) to the FCTC’s COP meetings. Rather than engaging with the very people impacted by their decisions on a daily basis, WHO continues to [**exclude them**](https://innco.org/) from the conversation. Conversely, harm reduction strategies emphasise the importance of empowering people to have [**control over their own health**](https://www.hri.global/what-is-harm-reduction) in order to live healthier lives. It respects people’s [**consumer rights**](https://ahra.info/four-basic-consumer-rights-not-respected-by-the-anti-thr-lobby/), including the [**right to choose**](https://ahra.info/four-basic-consumer-rights-not-respected-by-the-anti-thr-lobby/). 


![Prohibition vs Harm Reduction.png](https://media.thr.net/strapi/f70cead3f7c73c46d421f37845c1081a.png)



Desktop-27.png

SIX DIFFERENCES BETWEEN HARM REDUCTION AND PROHIBITION

This article examines the contrasting approaches of harm reduction and prohibition in the field of tobacco control, particularly in relation to vaping and e-cigarettes.

Exploring the Divide: Harm Reduction vs. Prohibition in Tobacco Control

Revolutionizing Tobacco Control: Dr. Colin Mendelsohn's Vision for Nicotine Harm Reduction in an Era of Information Overload

In our era of big data and hyperconnectivity, “we are drowning in information but starved for knowledge”, as [**John Naisbitt**](https://www.electronicdesign.com/content/article/21802367/drowning-in-information-but-starved-for-knowledge) once said. Since the inception of the like and share buttons on social media over 10 years ago, the [**fragmentation of societal perspectives into echo chambers has intensified**](https://www.theatlantic.com/magazine/archive/2022/05/social-media-democracy-trust-babel/629369/). To counterbalance this catalysation of our [**instinctively tribalistic tendencies**](https://www.theatlantic.com/magazine/archive/2022/05/social-media-democracy-trust-babel/629369/) to organise ourselves into groups with shared beliefs, we need rational thinkers who [**communicate clearly**](http://colinmendelsohn.com.au/dr-mendelsohn/) to challenge the status quo. 
In tobacco control, the decades-long [**status quo**](https://www.tobaccoharmreduction.net/thr) has been to view any nicotine use, regardless of delivery method, through a moralistic, binary lens. Out of this was borne the [**‘quit or die’**](https://www.tobaccoharmreduction.net/health) approach traditionally employed by [**well-meaning health professionals**](https://www.tobaccoharmreduction.net/health) in their interactions with smokers. However, as [**Dr Colin Mendelsohn**](https://colinmendelsohn.com.au/book/) explains in chapter 3 ([**‘Busting the Myths about Nicotine’**](https://colinmendelsohn.com.au/book/)) of his book, [**nicotine does not cause cancer, lung disease or heart disease**](https://ahra.info/what-is-pharmaceutical-grade-synthetic-nicotine-what-is-the-difference-between-s-nicotine-and-r-nicotine/). Backed by [**over 400 scientific publications**](https://colinmendelsohn.com.au/book/), and [**over 30 years of experience as doctor with a specialist interest in smoking cessation**](https://colinmendelsohn.com.au/book/), Dr Mendelsohn articulates compellingly how health professionals and smokers alike need to [**target the smoke**](https://www.tobaccoharmreduction.net/thr-products) from combustible tobacco as the noxious agent, not nicotine. 
By spearheading this revolution in thinking in Australia, [**Dr Mendelsohn**](http://colinmendelsohn.com.au/dr-mendelsohn/) represents one of a [**growing list of eminent global expert individuals and organisations**](https://clivebates.com/one-hundred-specialists-call-for-who-to-change-stance-on-tobacco-harm-reduction/) who support tobacco harm reduction as a pragmatic, compassionate, and [**innovative solution**](https://www.tobaccoharmreduction.net/thr-products) to the [**world’s leading preventable killer**](https://www.youtube.com/watch?v=tpPrDo3bMsU): smoking, not nicotine. 
We spoke to [**Dr Delon Human**](https://ahra.info/about-the-africa-harm-reduction-alliance/#delon), Physician and CEO of the [**Africa Harm Reduction Alliance**](https://ahra.info/), about [**Dr Mendelsohn’s book**](https://colinmendelsohn.com.au/book/). He praised its primary aim – to help smokers, as well as its appeal to a diverse audience: *“Public discourse about vaping and tobacco harm reduction has become increasingly polarised. In such a dogmatic environment, smokers are left wondering in the lurch about what the truth is. Dr Mendelsohn’s book cuts through the noise to provide a compelling and hysteria-busting case for nicotine vaping as a viable and life-saving alternative to combustible tobacco. His authority and clarity of communication is informed by a lifetime professional commitment to helping smokers quit or switch to safer alternatives, and a balanced consideration of scientific evidence; his book references over 400 scientific publications. Dr Mendelsohn’s rational, articulate and compassionate approach will appeal to smokers, their families, health professionals, and policymakers alike.”* – [**Dr Delon Human**](https://ahra.info/about-the-africa-harm-reduction-alliance/#delon).


Not only does [**Dr Mendelsohn’s book**](https://colinmendelsohn.com.au/book/) provide a comprehensive and practical [**how-to guide**](https://colinmendelsohn.com.au/book/) for smokers considering vaping as a safer alternative to smoking, but it also delves into a deeper analysis into societal beliefs around vaping. In Part 3 ([**‘Controversies and Solutions’**](https://colinmendelsohn.com.au/book/)), Dr Mendelsohn dissects how we have reached a point in the debate where an appreciation of the scientific evidence supporting vaping is not enough to overcome the [**vehement backlash**](https://ahra.info/four-basic-consumer-rights-not-respected-by-the-anti-thr-lobby/): *“Much of the opposition is not about the evidence. It is driven more by hidden ideological, moral, political, and other agendas. [Part 3] explores how anti-vaping groups defend the indefensible and justify their position without the support of science”.* 
For [**health professionals**](https://www.tobaccoharmreduction.net/health), this book’s status as ‘required reading’ is cemented by the fact that the vast majority of doctors in a [**recent study**](https://link.springer.com/article/10.1007/s11606-020-06172-8) incorrectly believed that nicotine causes cardiovascular disease, COPD, and cancer. In contrast, [**evidence published this month from an Australian national survey**](https://pubmed.ncbi.nlm.nih.gov/35403757/) found that using nicotine vapes to quit smoking [**increased the odds of success by 68%-124%**](https://pubmed.ncbi.nlm.nih.gov/35403757/) compared to not using a vape. [**Dr Mendelsohn**](https://colinmendelsohn.com.au/book/)’s quest to share the healthy [**truth about vaping**](https://colinmendelsohn.com.au/book/) as a tool to help smokers quit is commendable; we highly recommend reading [**his book**](https://colinmendelsohn.com.au/book/).

![Twitter Infographics THR.NET (15).png](https://media.thr.net/strapi/05972b6c8a750bd860e0c0018544b696.png)

Challenging Tobacco Control Norms: Dr. Colin Mendelsohn's Revolutionary Approach to Nicotine

Revolutionizing Tobacco Control: Dr. Colin Mendelsohn's Innovative Approach to Nicotine and Harm Reduction

Revolutionary Approach to Nicotine: Dr. Colin Mendelsohn

With quitting smoking one of the toughest behaviours to change, the UK is leading the world with its Stoptober campaign, **Dr Derek Yach, President of the Foundation for a Smoke-Free World** told **Great Britain News.**

The month-long campaign focuses on encouraging some of the roughly 7-million smokers in the UK to quit for good or switch to safer alternatives.

View Derek's interview [HERE](https://www.youtube.com/watch?v=QUXto5l9ehI)



Time to Ditch Or Switch This Stoptober

Kantar's 2021 survey in Malaysia reveals insights on vaping, flavor preferences, and strong public support for e-cigarette regulations.

In late **2021**, Kantar undertook a study regarding usage and attitudes towards vaping, tobacco products and cigarettes in Malaysia. In addition, Kantar worked on the survey design, analysis and reporting of results. The study was completed with those people who used e-cigarettes and/or other tobacco products. Questions covered a range of topics including current usage and perceptions of products including attitudes towards quitting smoking and methods used to help giving up.

**Survey Approach and Findings**

An online approach was used with respondents contacted via Kantar’s consumer panel and screening questions used to ensure participants met agreed definitions for target groups in each country. A **total of 500** people were interviewed in Malaysia.

In Malaysia, where recruitment was based on e-cigarettes and oral tobacco usage, four out of ten vapers are also using a heated tobacco product and one in five vapers were also using an oral tobacco product. For those who chose to vape because they like the taste, fruit (**61%**) and mint (**44%**) were the most enjoyed flavours.

In general, people agreed that e-cigarettes should be made available to smokers on the basis of being a less harmful product. Respondents agreed with the promotion of e-cigs as a less harmful alternative to smoking tobacco cigarettes.

**Support for Regulations**

Government regulation of e - cigarettes is strongly supported by the respondents. There is also strong support for regulation of quality and sales to minors.

There is strong support for a tax on e-liquid used in vapes, however, the tax (as announced during the Budget 2022) was perceived as too high.


Malaysian flag blowing in the wind against a blue sky

NEW MALAYSIA STUDY REVEALS THAT NEARLY HALF OF SMOKERS CHOOSE TO VAPE TO CUT DOWN ON SMOKING CIGARETTES OR TO QUIT SMOKING COMPLETELY (49%).

Kantar's 2021 study on vaping, tobacco, and cigarettes in Malaysia. Insights on e-cigs, flavors, and public support for regulations.

Malaysia Vaping & Tobacco Usage Study 2021

Survey in Taiwan explores vaping trends, indicating harm reduction potential but underscoring the need for balanced regulations.

**Survey Approach and Findings**


An **online approach** was used with respondents contacted via Kantar’s consumer panel and screening questions were used to ensure participants met agreed definitions for target groups in each country. **A total of 1001 people** were interviewed in **Taiwan**.


Survey recruitment was based solely on e-cigarettes usage, so all respondents were vapers. Among them more than a third used a heated tobacco product (**38%**) and/or used an oral tobacco product (**36%**). 


Questions covered a range of topics including **current usage** and **perceptions of products** including **attitudes towards quitting smoking and methods used to help giving up**.


Vaping alone was used as a way to cut down on smoking by as **much as 25%** of respondents and after trying to quit smoking on several occasions. However, the most common approach used in these previous attempts was without any medication or substitute. As many as **34%** use any replacement product to cut down the amount smoked and **18%** will use **ANY** replacement product to stop smoking entirely. 


All in all, while vaping is, on balance, more likely to receive approval from peers and family than smoking cigarettes or using heated or oral tobacco products, it is notable that many vapers still expect to receive disapproval for using e-cigarettes. 


*There is a need for risk - proportionate regulations for e-cigarettes, in particular focusing on quality and usage by minors, as well as a correction of misinformation related to any over-perceived harms of vaping and nicotine.*


To read the summary report, click [HERE](https://media.thr.net/strapi/c4c6ea8a52de2c2f88570f6345108858.pdf). 


NEW TAIWAN KANTAR STUDY REVEALS THAT AS MUCH AS 43% OF SMOKERS USE A REPLACEMENT TOBACCO HARM REDUCTION PRODUCT AS A MEANS TO CUT DOWN ON SMOKING OR STOP SMOKING ALTOGETHER.

Discover the findings from a survey on vaping in Taiwan, exploring usage, attitudes, and quitting methods among e-cigarette users.

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NEW WEBINAR - MALAYSIA: ON THE PATH TO LIFE - SAVING ALTERNATIVES. A CALL FOR REGULATION TO PROTECT CONSUMERS

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Tobacco Harm Reduction RESET: Save Lives Through Sound Regulation

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