Tobacco Harm Reduction and Nicotine Perceptions

Executive summary

Vaping is an innovative harm reduction tool which has been recognised as a safer alternative to smoking by Public Health England, Cancer Research UK, Ministry of Health New Zealand, among many others. Millions of smokers globally choose vaping as a means to quit smoking. Despite its indisputable successes in bringing about the end of the smoking pandemic, vaping is subject to a wide array of myths. Understanding the prevalence of these myths, as well as the fundamental beliefs surrounding them is key to breaking the vaping stigma.

This report presents the findings of two nation-wide surveys on harm reduction in Germany and France. The report consists of 30 interviews with general practitioners and a quantitative survey of 862 French and German smokers. The main goal of this study is to gain a greater insight into the misperceptions about vaping, their impact, and understand how to tackle them.

In addition to our own research, we compiled a list of misperceptions around vaping and nicotine in several countries. Taken together, this list shows fundamental and pervasive lack of knowledge surrounding the topic of tobacco harm reduction  – including the very meaning of harm reduction, the importance of nicotine alternatives, and misperceptions of the effects of nicotine itself. Moreover, current policies ignore the public health benefits that come with a strategy centred around minimising harm. Current cessation approaches focused on outright quitting or altering smokers’ behaviour have been unsuccessful and have left their intended beneficiaries down. By contrast, campaigns to quit smoking are far more likely to be successful when they focus on the inclusion of alternatives such as vaping.

The report recommends engaging in more robust and scientifically-informed communication with smokers about the real risks involved in smoking as well as informing the latter about possible substitutes for nicotine. Furthermore, future regulatory measures should be risk-based, encouraging doctors and smokers to seek out less detrimental alternatives to classic cigarettes. 

Lack of knowledge on harm reduction among doctors

  • Only three out of 15 doctors in Germany say they know the term harm reduction.
  • In France, the majority of surveyed doctors know the term.
  • Most German doctors do not perceive vaping products as a harm-reduction tool.
  • In France, more doctors perceive vaping products as a harm-reduction tool.

Lack of knowledge about alternatives and wrong perspectives on harm

  • 33% of smokers in France and 43% in Germany say vaping is as harmful or more harmful than cigarettes.
  • In both countries, 11% of smokers perceive cigarettes as the least harmful product.
  • 37% in France and 40% in Germany say vaping should be regulated in the same way as traditional cigarettes.   
  • More than half of smokers in both countries would like to learn more about vaping.

Misconceptions on nicotine

  • 69% of smokers in France and 74% of smokers in Germany believe nicotine causes cancer. 
  • Most doctors have a negative attitude towards nicotine because of its addictive potential and consider it harmful to health.
  • Only a few doctors are aware of any recent studies on nicotine or its benefits.

Traditional smoking cessation fails

  • 44% of smokers in France and 22% of smokers in Germany have tried nicotine replacement therapy.
  • 29% and 45% of smokers in France and Germany respectively haven’t received any doctor’s advice on how to quit smoking.
  • 30% of smokers in France and only 15% of smokers in Germany say that the doctor’s advice on how to quit smoking has been helpful.
  • 62% of smokers in France and 53% in Germany believe anti-smoking policies ignore how difficult it is to stop smoking.

Vaping as a smoking cessation aid

  • About half of respondents in both countries believe the ritual of inhaling is the main reason why they continue to smoke. Nevertheless, many doctors don’t recommend vaping because it “doesn’t break the habit.”
  • 43% of smokers in France and 25% in Germany also regularly vape. The higher share of dual users in France seems to cause French smokers to smoke fewer cigarettes daily compared to German smokers.

Millions of smokers have quit smoking thanks to vaping and similarly less harmful alternatives to smoking. While it is estimated that more than 80 million people worldwide are vaping, the regulatory burden on these products is intensifying.

Traditional anti-smoking policies such as tobacco taxes, advertising and marketing bans, or high taxation, to name a few, have had only limited success so far. Although commendable, the policy measures clearly haven’t brought about the desired outcomes. In the European Union alone, smoking-induced cancer takes nearly 700,000 lives every year. As conventional policies have failed to drive down this staggering number, new innovations have entered the market. Less harmful alternatives such as vaping, nicotine pouches or snus helped millions of people worldwide to quit smoking.  

However, the myths about vaping and nicotine have gotten in the way of embracing harm reduction by many governments. As we discovered during our study, these myths are deeply rooted in the hearts and minds of consumers, doctors, and policymakers in many countries. To tackle the misperceptions around vaping, it is key to lay them out.

What the experts are saying?

"The survey shows that unfortunately, because of lack of information and knowledge, many doctors are neglecting the established fact that vaping is less harmful than combustible cigarettes"
Andria Urushadze
Former Minister of Health, Labor and Social Affairs, Georgia
"Doctors enjoy a high level of trust in the public and could increase quit rates among smokers. Looking at the survey, the lack of knowledge of GPs about tobacco harm reduction is concerning."
Bernd Mayer
Prof. of Pharmacology and Toxicology at the University of Graz, Austria


Bill Wirtz

Senior Policy Analyst at the Consumer Choice Center

Maria Chaplia

Research Manager at the Consumer Choice Center

Michael Landl

Director at the World Vapers’ Alliance


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