Big Question 9 - 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 between 2012 and 2022 (Figure 1)^[3]. 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)^[3].

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 cigarettes consumed per year^[3]. 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, including (i) an increase in illicit trade and (ii) the proliferation of unregulated Smokeless Products that do not comply with the safety and quality standards required of regulated products manufactured by accountable companies.

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 100%^#. With approximately one billion adult smokers globally^[2], this equates to around 11% 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%,^{^[2]} respectively. This equates to approximately 120 million adult smokers^{^^} without legal access to Smokeless Products. Therefore, excluding these two countries, the total number of global Smokeless Product consumers in comparison to global smokers is >13%^‡ (~110 million out of 880 million).

When access to Smokeless Products is examined in the world's 15 most populous countries (Table 1), it is clear that much more can be done to give adult smokers in these countries access to products with a lower-risk^*† profile.

We believe that tobacco control measures and THR can work together to reduce cigarette consumption and encourage adults who would otherwise continue to 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.

Access to Smokeless Products = Greater Smoking Prevalence Reductions

The potential impact of vaping on smoking prevalence can be seen in countries where Vapour Products have become widely available. Figure 3 illustrates decreases in smoking prevalence in the UK, France, Canada, and New Zealand compared with the global average between 2012 and 2018^[4]. While the global average reduction in smoking prevalence was 1.5 percentage points over this period, the average reduction across these four countries was 3.6 percentage points. By contrast, in Brazil, where Smokeless Products were not legally available, smoking prevalence declined at a slower rate between 2015 and 2019^[5].