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Alternative Tobacco and Nicotine Products– Effectiveness and Safety Profile

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4 Oct 2021

Tobacco use is the most major modifiable risk factor for morbidity and death, linked to a wide range of disorders including chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), stroke, lung cancer, and other chronic diseases illnesses. About eight million deaths per annum worldwide are estimated to have been due to smoking. Recent population-based research found that smoking for a long time was connected with a 10-year reduction in life expectancy, and quitting before the age of 40 lowered the risk of smoking-related death by up to 90%.


For smoking cessation therapies, behavioral techniques such as cognitive behavior therapy, group therapy programs, or individual counseling sessions with or without medication, such as varenicline, bupropion, and others, be beneficial. These interventions, however, must be administered by professional facilitators such as physicians, clinical psychologists, nurses, and so on.


Because of their potential involvement in smoking reduction and smoking cessation, alternative tobacco and nicotine products such as electronic cigarettes (EC), smokeless tobacco, and nicotine replacement therapy (NRT) are currently being evaluated as tobacco harm reduction options. Several clinical investigations have shown that alternative nicotine and tobacco products are more effective at aiding long-term abstinence and are much more preferred than other therapies. These methods are both non-invasive and self-initiated.

Smoking Reduction

Several studies have reported a moderate smoking reduction in the participants who used EC. Cohort studies report that EC use led to a reduction in the number of cigarettes smoked per day. Furthermore, studies found a higher reduction in nicotine EC when compared to non-nicotine EC.

Smoking Termination

Overall, the results of seven RCTs in the EC group indicated a relatively small proportion of participants who were cigarette-free. The research on snus as a smoking cessation technique was contradictory. Two research found that snus was about two to three times more effective than placebo in achieving continuous abstinence, but two other studies found that snus could diminish the likelihood of quitting smoking and that snus may not be an appropriate strategy to lessen tobacco harm. The usage of NRTs has shown that they aided in the maintenance of smoking abstinence.


Adverse Events

Mild adverse effects were the most often reported in the EC group, including cough, mouth, and throat discomfort, headache, difficulty sleeping, and odd dreams. The single HNB trial that was included reported the safety profile of the tobacco heating system (THS) and found only minor adverse effects such as headache, oropharyngeal pain, and abnormal spirometry.

All snus studies documented intervention-related adverse effects. The adverse events were largely modest, such as nausea, burning in the throat and tongue, and stomach difficulties. One study compared the usage of snus vs nicotine gum for different genders and discovered that women were more likely than males to report unpleasant occurrences during the study. Furthermore, three NRT trials that evaluated the use of tobacco lozenges, nicotine metered spray, and nicotine patches found that adverse events were more common in the intervention group than in the control or placebo group.

The reported adverse events were usually moderate, although one study revealed the occurrence of severe adverse events, such as acute coronary syndrome, which could have been caused by the use of nicotine patches. The remaining NRT studies revealed only minor side effects.



Although there are differences in the efficacy of different products, the usage of alternative tobacco and nicotine products has the potential to assist smoking reduction by reducing the number of cigarettes consumed by existing smokers.

Despite differences in abstinence verification method and degree of efficiency across different products, the effectiveness of alternative tobacco and nicotine products in smoking cessation was consistently observed in almost all included experimental and observational research. Even though the effectiveness is regarded moderate, the use of these items was associated with a reduction in the number of cigarettes used, emphasizing the strong data suggesting that a gradual reduction in cigarette consumption could further begin future stop efforts.

Further research should focus on the long-term outcome, safety, and effectiveness of alternative tobacco and nicotine products, as well as on monitoring product use and awareness to better inform smoking reduction/cessation strategy.


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Ishani Bose

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