Big Question 10 - Are Smokeless Products Associated with Reductions in Smoking?

Global Cigarette Consumption is Declining

Global cigarette consumption has declined significantly over the past decade and is now at its lowest point in many years. A significant reduction in cigarette consumption, of approximately 20%, was observed since 2012 (Figure 1).^[6] By region, Western Pacific (excluding China) and Europe have shown the greatest reduction in cigarette consumption, whereas Eastern Mediterranean has shown the smallest reduction (Figure 2).^[6]

Figure 1. Time-course plot of global cigarette consumption^[6]

To understand the drivers of such a significant reduction, we need to look at the annual longitudinal reduction and contextualise it relative to tobacco control measures and Tobacco Harm Reduction (THR). We observed that from 2008 to 2012, in the era of extensive tobacco control measures only, cigarette consumption remained relatively stable at around 5.8-5.9 trillion cigarettes per year, underscoring that tobacco control regulation alone is not a sufficient tool to reduce smoking prevalence.

However, post 2012 when companies started to launch Vapour Products, then Heated Products and Oral Nicotine Pouches, alongside tobacco control measures, cigarette consumption dropped dramatically annually, to the current 4.7 trillion consumed cigarettes per year.^[6] To continue to realise this rate of reduction in cigarette consumption, effective and responsible tobacco control measures and Tobacco Harm Reduction should be jointly adopted by governments and public health bodies across the world.

Stakeholders often have diametrically opposed opinions on the issue of driving down global cigarette consumption. But a common thread exists in that all stakeholders are seeking an improvement in public health while minimising unintended consequences. In terms of the prohibitionary nature of certain strategies, there are a number of likely unintended consequences such as (i) an increase in illicit trade and (ii) unregulated alternative products on the market that do not comply with product safety and quality standards such as regulated products from accountable manufacturers.

Smokeless Product use is growing

In the past five years, Smokeless Product use has increased with the global number of adult consumers growing by approximately 70% (68 million Smokeless Product consumers in 2020 to 115 million Smokeless Product consumers in 2024).^[1,2,3] With approximately one billion adult smokers globally,^[5] this equates to around 11.5% of today's smoking population.

However, not all the world's adult smokers have legal access to Smokeless Products. If we consider India and Brazil, two countries that have banned the sale of Smokeless Products, their smoking prevalence is approximately 7% and 11%,^^[5] respectively. This equates to approximately 120 million adult smokers^^ who did not have legal access to Smokeless Products. Therefore, the total number of global Smokeless Product consumers in comparison to global smokers is >13%^^^ (115 million out of 880 million).

However, when access to Smokeless Products is looked at in the top 15 countries in the world by population (Table 1), it’s clear that much more can be done to give adult smokers within these countries access to lower risk profile products. We believe that tobacco control measures and THR can work in concert to reduce cigarette consumption and encourage adults who would otherwise smoke to switch completely to lower risk*^† alternative tobacco and nicotine products. This is aligned with the ambitions of all stakeholders in improving future public health outcomes.

We believe that tobacco control measures and THR can work in concert to reduce cigarette consumption and encourage adults who would otherwise smoke to switch completely to lower risk*† alternative tobacco and nicotine products. This is aligned with the ambitions of all stakeholders in improving future public health outcomes.

Table 1. Access to Smokeless Products in the world’s most populous countries

Access to Smokeless Products = Greater Smoking Prevalence Reductions

The impact of vaping on the incidence of smoking can be seen in countries where vaping products have become widely available compared to the global average. The chart illustrates decreases in smoking prevalence in the UK, France, Canada and New Zealand compared to a global average, in the period 2012 to 2018 (Figure 3).^[9] It shows that while the global average percentage point reduction was 1.5% over this period, the average percentage point reduction in smoking prevalence for these four countries was 3.6% overall. By contrast, in Brazil, where Smokeless Products were unavailable, smoking prevalence declined at a slower rate from 2015 to 2019.^[10]