Countries that embrace smoke-free alternatives such as e-cigarettes, heated tobacco and nicotine pouches are experiencing a faster decline in cigarette smoking compared to those with restrictive policies, according to a series of international studies and historical data.

A recent large-scale study published in JAMA Network Open suggests that nicotine pouches are increasingly serving as a transition tool for Americans looking to quit more hazardous tobacco habits.

Conducted by Rutgers Health using US Census Bureau data from over 110,000 adults (2022–2023), the research highlights that while the general public is not rushing to use them, nicotine pouches appear to be a significant alternative for people specifically trying to move away from combustible tobacco or e-cigarettes.

The research led by Rutgers Institute for Nicotine and Tobacco Studies director Cristine Delnevo notes that daily use of nicotine pouches is most common among those who recently stopped smoking. It says former smokers are about four times more likely to use pouches daily compared to those who are still actively smoking.

The study suggests that nicotine pouches support harm reduction efforts, even if they are not marketed as cessation aids. “For people who smoke or use other nicotine products and don't want to stop using nicotine, switching completely from the more harmful product and moving down the risk continuum with nicotine pouches is likely good for public health,” Delnevo said.

This is because nicotine pouches, along with other smoke-free products, delivers nicotine without combustion which is associated with smoking. A 2025 toxicological review published by the U.S. National Library of Medicine (NLM), authored by aerosol chemist Reinhard Niessner, said that because e-cigarettes, heated tobacco products and nicotine pouches avoid combustion, they release markedly lower levels of harmful and potentially harmful constituents (HPHCs).

In the study titled “The potential of smoke-free products to reduce harm for smokers: What does the toxicological evidence say?”, Niessner explained that smoking-related illnesses are primarily caused by the toxins released when tobacco burns, not the nicotine itself. While a lit cigarette releases roughly 6,500 chemicals—100 of which are highly toxic—smoke-free alternatives avoid the combustion process, thereby preventing the creation of these hazardous substances.

E-cigarettes, heated tobacco, and nicotine pouches do not involve burning, resulting in drastically lower levels of harmful and potentially harmful constituents (HPHCs).

Research published in Oxford Academic in February 2024 by Brighton and Sussex Medical School found that smokers who recognized vaping as less harmful than smoking were more likely to make a permanent switch six years later.

The trend is most evident in Sweden, which New Nicotine Alliance Ireland chair Damian Sweeney describes as a powerful "proof of concept." While Sweden’s overall nicotine use matches the European Union average, the majority of consumers use snus or nicotine pouches. This has pushed Sweden’s smoking prevalence down to 5 percent, the lowest in the union.

World Vapers Alliance (WVA) representatives suggest that millions of lives could be improved if regulators prioritized the experiences of those who have successfully transitioned away from combustible tobacco.

This sentiment is echoed in Spain, where a Tholos Foundation and Dynata survey of 515 nicotine pouch users in March 2025 revealed that 2/3 of users adopted the products to quit smoking.

The Global State of Tobacco Harm Reduction report indicates that smoke-free nicotine products are significantly safer than cigarettes. In the United Kingdom, where these products are promoted as lower-risk alternatives, smoking rates fell from 24 percent in 2005 to 10.8 percent in 2025.

University of Queensland researchers observed that smoking rates in New Zealand declined by 10 percent annually between 2016 and 2023, doubling the 5 percent annual decline seen in Australia’s more restrictive regulatory environment.

Former WHO Tobacco-Free Initiative program manager Derek Yack pointed to Japan, South Korea and Norway as additional examples of successful transitions. "Let's put all our focus on getting harm reduction out there. If so, a decade from now, we will be able to cut the billion smokers and users of tobacco by 50 percent, maybe even more," Yack said, adding that the world should aim to "all be Swedes" regarding smoking statistics within 20 years.

University of Catania Professor of Biochemistry Giovanni Li Volti said nicotine itself is not associated with recurrent stroke or poor cardiovascular health, noting that the existence of nicotine replacement therapy proves the medical community accepts its managed use.

In Southeast Asia, the Philippines' Vape Law of 2022 has created a legal framework for tobacco harm reduction.

A joint report by former WHO officials Tikki Pang and Derek Yack, along with Institute for Economic Affairs Economist Chris Snowdon and Clearing the Air co-founder Peter Beckett, warned that ignoring harm reduction could cost millions of lives.

They estimated that embracing these measures could save over 14 million lives in 23 analyzed countries by 2060. "Extrapolated worldwide, over 100 million lives could be saved - preventing over 3 million deaths a year," the authors said.