Although tobacco harm reduction (THR) products have only been available in most markets for a relatively short time compared to cigarettes, the evidence that they are effective in helping to reduce smoking rates is growing.
Cochrane Review of E-Cigarettes
Cochrane Reviews are considered the gold standard for evidence synthesis in health and medicine. They systematically search all research on a question, assess study quality transparently, and publish regular updates as new evidence emerges.
The November 2025 review found:
- People using nicotine e-cigarettes are more likely to quit smoking for at least six months than those using traditional nicotine replacement therapies (NRTs) like patches or gum.
- This demonstrates a clinically important benefit of e-cigarettes, with implications for policymakers, clinicians, and people who smoke.
Lower Smoking, Lower Risk: The Promise of THR
Real-world data shows that THR products significantly help reduce smoking rates, offering effective harm reduction solutions for populations worldwide.
There are now quite a few markets in which the widespread availability of THR products appears strongly linked to steep declines in smoking rates. Here are some examples:
THR Use in the United Kingdom
A 2025 study based on data from the Smoking Toolkit Study found that in 2023-24, in a sample of over 25,000 consumers in England, e-cigarettes were the aid most commonly used in attempts to quit smoking (used in 40% of quit attempts, compared to over-the-counter NRT in 17% of attempts, and 41% of quit attempts occurring unaided).
The study authors found that those using e-cigarettes were 1.95x more likely to successfully quit cigarettes than those trying to quit unaided. Those using NRT were essentially no more likely to be successful in quitting than those making the attempt unaided.
According to the UK’s Office for National Statistics, the proportion of those aged 16 or over in the UK using e-cigarettes daily or occasionally in Great Britain overtook current smokers for the first time in 2024.
Current e-cigarette users
Source: UK Office for National Statistics, Opinion and Lifestyle Survey
Source: Data released
8th November 2025
THR Use in Sweden
Sweden provides a particularly relevant example because snus – a type of reduced-harm oral tobacco – has been used there for decades. Snus and nicotine pouch use has been growing steadily over the long term, while cigarette use has declined.
Smoking & Snus Use in Over-16s, Sweden
Source: Statistics Sweden
Source: Data released
21st February 2025
THR Use in Japan
Japan was the first market where the introduction of non-combusted tobacco heating products made a large impact, led by the IQOS brand from Philip Morris International. In a short space of time heated tobacco replaced a substantial portion of combustible cigarette volumes, accounting for 38% of the combined market in 2023. By Q3 2025 that share had risen to 46% according to Japan Tobacco.
Cigarette & Heated Tobacco Stick Equivalent Sales, Japan
Data from Cummings et al 2024: Transformation of the tobacco product market in Japan, 2011-2023
Further reading:
Transformation of the tobacco product market in Japan, 2011–2023 - Cummings et al, 2024
Next article: The Controversy Surrounding Tobacco Harm Reduction
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