ArticlePreventive medicine2018
Managing nicotine without smoke to save lives now: Evidence for harm minimization.
Article in Preventive medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
46 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Comparative disease risks associated with cigarette smoking and use of moist smokeless tobacco and snus: an umbrella review of epidemiological evidence from the United States and Western Europe.BMC public health · 2025Pooled it
- Assessment of Abuse Liability and Nicotine Pharmacokinetics of glo Heated Tobacco Products in a Randomized, Crossover Study.European journal of drug metabolism and pharmacokinetics · 2024Trial
- Nicotine Delivery and Changes in Withdrawal and Craving During Acute Electronic Cigarette, Heated Tobacco Product, and Cigarette Use Among a Sample of Black and White People Who Smoke.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2024Trial
- An assessment of nicotine pharmacokinetics and subjective effects of the pulze heated tobacco system compared with cigarettes.Scientific reports · 2023Trial
- Part one: abuse liability of Vuse Solo (G2) electronic nicotine delivery system relative to combustible cigarettes and nicotine gum.Scientific reports · 2022Trial
- An abuse liability assessment of the glo tobacco heating product in comparison to combustible cigarettes and nicotine replacement therapy.Scientific reports · 2022Trial
- A randomised, crossover, clinical study to assess nicotine pharmacokinetics and subjective effects of the BIDIHarm reduction journal · 2022Trial
- Analysis of ElfBar Elfa vaping product aerosol compared with cigarette smoke and regulatory safety limits.iScience · 2026Article
- Investigating the substitutability of little cigars/cigarillos, e-cigarettes, and other noncombusted tobacco products for cigarettes using the experimental tobacco marketplace.Experimental and clinical psychopharmacology · 2025Article
- Article
- Review
- Repeated point-prevalence of switching away from smoking after electronic nicotine delivery systems (ENDS) purchase.Harm reduction journal · 2025Article
- Assessment of heated herbal products' tobacco harm reduction potential: pre-clinical and clinical studies.Frontiers in toxicology · 2025Article
- Article
- Effect of Flavored on! Nicotine Pouch Products on Smoking Behaviors: Protocol for a Sequential, Multiple Assignment, Randomized Controlled Trial.JMIR research protocols · 2024Article
- Concurrent Choice Assessment of Preference and Substitutability of E-cigarettes and Heated Tobacco Products for Combustible Cigarettes Among African American and White Smokers.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2023Article
- Should We be Concerned with Nicotine in Sport? Analysis from 60,802 Doping Control Tests in Italy.Sports medicine (Auckland, N.Z.) · 2023Article
- Comparison of biomarkers of exposure among US adult smokers, users of electronic nicotine delivery systems, dual users and nonusers, 2018-2019.Scientific reports · 2023Article
- Changes in dependence over one year among US adults who smoke cigarettes and switched completely or partially to use of the JUUL-brand electronic nicotine delivery system.Drug and alcohol dependence reports · 2023Article
- Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
Tobacco control has made strides in prevention and cessation, but deaths will not decline rapidly without massive behavior change. Currently, inhaled smoke from combusting tobacco is chiefly responsible for prematurely killing 7.2 million people worldwide and 530,000 in the United States annually. An array of noncombustible nicotine products (NNPs) has emerged and has disrupted the marketplace. Saving lives more speedily will require societal acceptance of locating a "sweet spot" within a three-dimensional framework where NNPs are simultaneously: 1. Less toxic, 2. Appealing (can reach smokers at scale), and 3. Satisfying (adequate nicotine delivery) to displace smoking. For this harm minimization framework to eliminate smoking, a laser focus on "smoking control" (not general tobacco control) is needed. By adopting these economically viable NNPs as part of the solution, NNPs can be smoking control's valued ally. Synthesis of the science indicates that policy and regulation can sufficiently protect youth while speeding the switch away from smoking. Despite some risks of nicotine dependence that can be mitigated but not eliminated, no credible evidence counters the assertion that NNPs will save lives if they displace smoking. But scientific evidence and advocacy has selectively exaggerated NNP harms over benefits. Accurate communication is crucial to dispel the misperception of NNPs harms and reassure smokers they can successfully replace smoking cigarettes with NNPs. Saving more lives now is an attainable and pragmatic way to call for alignment of all stakeholders and factions within traditional tobacco control rather than perpetuate the unrealized and unrealizable perfection of nicotine prohibition.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.