Today, many people seek alternatives to smoking cigarettes. Options like vaping, snus, chewing tobacco, snuff, gums, and nicotine pouches have gained popularity in recent years. In our latest M3 Pulse survey, we asked over 3300 doctors worldwide if they consider these smoking alternatives safe enough to recommend to patients.
Continue reading about smoking alternatives and what doctors think about their safety:
In the fight against cancer and efforts to reduce the number of people who smoke, significant progress has been made since 1960s, when over 40% of adults in the USA smoked cigarettes. Similar trends were observed in other countries at the time.
The latest statistics from the USA show that the percentage of people smoking cigarettes has decreased from 41.9% in 1965 to 11% in 2024. This is a 73.7% reduction over six decades.
This decline is partly attributed to the wide range of smoking alternatives, such as vaping, snus, chewing tobacco, snuff, gums, and nicotine pouches, which have become increasingly popular in recent years.
Vaping, for example, emerged as a popular smoking alternative in the mid-2000s, and the global e-cigarette and vape market has experienced substantial growth since then. In 2023, it was valued at approximately USD 28.17 billion and is projected to grow at a compound annual growth rate (CAGR) of 30.6% from 2023 to 2030*. In contrast, the cigarette market is expected to grow at an estimated CAGR of 2.3% from 2024 to 2030* – only a fraction of the growth rate compared to the vape and e-cigarette market.
However, there is still a long way to go in reducing the number of people who smoke cigarettes and die as a result. According to the WHO, more than 6 million people worldwide die from smoking cigarettes each year, along with another 1.3 million non-smokers who are exposed to second-hand smoke.
What Are Smoking Alternatives? Are They Safer?
Smoking alternatives are products designed to help people reduce or quit smoking or provide nicotine without traditional cigarette use. While most smoking alternatives are argued to be less harmful than cigarettes, none are entirely safe. Here’s an overview of popular smoking alternatives:
Vaping
Vaping involves inhaling a vapour containing nicotine or flavourings via an electronic device. Some research shows while vaping is less harmful than smoking due to the absence of combustion, it is not risk-free. Long-term effects are still under study, but potential risks include lung injury and addiction, particularly among youth.
Snus
Snus is a moist powdered tobacco product placed under the lip. Common in Sweden and other Nordic countries, it is linked to reduced smoking rates. Research suggests snus is less harmful than smoking as it avoids inhalation, but it still carries risks like oral cancer and cardiovascular effects.
Nicotine Pouches
Nicotine pouches resemble snus but contain no tobacco. They deliver nicotine through the gums and are considered less harmful than traditional tobacco products. However, they may still contribute to nicotine dependence.
Chewing Tobacco
Chewing tobacco involves placing shredded tobacco in the cheek and slowly releasing nicotine. While it bypasses lung-related risks, it is associated with oral cancers, gum disease, and nicotine addiction.
Snuff
Snuff, either moist or dry, is a finely ground tobacco product inhaled through the nose or placed under the lip. Like other smokeless tobacco products, it avoids smoking’s lung damage but carries risks of oral and nasal cancers.
Nicotine Gums
Nicotine gums deliver nicotine via the oral lining, helping to reduce withdrawal symptoms. Approved as a smoking cessation aid, it is significantly safer than smoking and free from tobacco-associated carcinogens.
Do Doctors Recommend Smoking Alternatives? M3 Pulse Survey Results
While smoking alternatives may appear to be safer choices compared to smoking cigarettes, they still carry health risks and can lead to nicotine addiction. There are also concerns about the long-term health effects of inhaling or ingesting nicotine and other chemicals found in these products, which may contribute to potential cardiovascular and respiratory problems.
To understand what doctors think about smoking alternatives—such as vaping, snus, chewing tobacco, nicotine gums, and nicotine pouches—we conducted our latest M3 Pulse survey. We asked 3339 doctors worldwide whether they consider these smoking alternatives safe enough to recommend to patients at high risk of cancer, cardiovascular disease, respiratory disorders, diabetes, and other serious health conditions.
Almost 70% of doctors would recommend smoking alternatives to patients under certain circumstances, while about 30% remain reluctant.
See the full results of doctors’ opinions on recommending smoking alternatives to patients below:
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The majority of surveyed doctors, 31%, believe that the primary focus should be on cessation rather than promoting alternatives that sustain nicotine use. Meanwhile, 21% do not consider these alternatives safe, even for high-risk patients.
17% are willing to recommend smoking alternatives as a safer option to smoking, while 15% would do so only as a last resort when other cessation methods have failed.
A few doctors support the use of smoking alternatives for specific cases, with 6% recommending them for high-risk patients and 0.2% believing only certain smoking alternatives are safe enough to recommend.
Almost 2% of respondents believe healthcare professionals should not be involved in recommending smoking alternatives. 4% expressed uncertainty, stating they need more information, while another 4% provided alternative responses.
A Swedish Case Study on Snus as a Smoking Alternative
The popular Swedish smoking alternative, snus, offers a compelling case study in reducing smoking rates. Over recent decades, Sweden has seen a significant decline in cigarette use, resulting in some of the lowest smoking rates in Europe. By 2022, only about 6% of Swedes identified as daily smokers, compared to the EU average of 23%.*
This decline is partly attributed to the widespread popularity of snus. In 2024, approximately 22% of Swedish men, and 10% of Swedish women use snus regularly.* The shift from cigarettes to this smoking alternative has significantly influenced Sweden’s smoking reduction efforts, presenting snus as an unintended yet effective smoking alternative.
The decline in smoking has brought measurable public health benefits. For instance, Sweden has much lower rates of smoking-related diseases, including lung cancer. Among Swedish men, the prevalence of lung cancer is less than half the EU average, demonstrating the impact of reduced cigarette consumption.
However, while snus has contributed to lower smoking rates, it is not without risks. Research links snus use to oral and pancreatic cancers, cardiovascular problems, and nicotine addiction. Recognising these risks, Swedish public health authorities have shifted their focus toward eliminating nicotine use altogether, including through smoking alternatives like snus. The ultimate goal is to achieve long-term health improvements by addressing nicotine dependency in all its forms.
Globally, the regulatory landscape for smoking alternatives varies widely. In some countries, products like snus remain restricted, while alternatives like vaping have gained popularity, especially among younger populations. Sweden case study highlights the complex balance between harm reduction and the need to address broader nicotine dependence.
What do you think as a healthcare professional, are smoking alternatives really safer? Please leave your thoughts in the comment section below.
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