Tag: Knowledge-Action-Change

Paper Explores British Harm Reduction Success

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The latest briefing paper from the Global State of Tobacco Harm Reduction (GSTHR), a project from public health agency Knowledge Action Change (KAC), focuses on the remarkable shift from smoking to vaping that has taken place in the United Kingdom in recent years.
“A smokefree UK? How research, policy and vapes have cut smoking rates” explores some of the reasons behind the U.K.’s rapid and growing embrace of vaping and provides a case study showcasing the potential of tobacco harm reduction through the adoption of safer nicotine products, following KAC’s recent briefing paper on the effect heated-tobacco products have had in Japan.
One of a number of positive country profiles set to feature in the fourth biennial Global State of Tobacco Harm Reduction report, published later this year, this briefing paper shows the number of people who smoke has fallen by nearly 50 percent since the introduction of vapes nearly two decades ago (from 23.7 percent of adults in 2005 to 12.9 percent in 2022).
KAC’s newest publication also includes a significant forecast, based on the latest available data from the Office for National Statistics and Action on Smoking and Health, that reveals the number of adults who smoke will continue to fall to just over 10 percent in 2025. In contrast, the number of adults who vape will keep rising from the 11 percent recorded in 2024, meaning vaping will overtake smoking for the first time in the U.K. According to KAC, these changes provide further evidence that when consumers have access to safer nicotine products that are acceptable and readily available, they will make the decision to switch in ever-increasing numbers.
While this briefing paper, which will be available in 12 languages as well as English, tells a story of consumers leading the way by adopting a new technology in a bid to improve their health, it also showcases the impact that scientific research and proactive governments can have on public health policies, according to KAC.

The U.K. has played host to some significant milestones in the study of smoking and safer nicotine products. The link between smoking and cancer was first established in the U.K. in 1950 and these studies led to the publication of the Royal College of Physicians’ landmark report “Smoking and Health.” It was the first to widely publicize information about the negative effects of smoking on health, and it is considered to be a turning point in the history of public health in the U.K. Moving forward to 2015, the predecessor of the Office for Health Improvement and Disparities, Public Health England, published an independent evidence review that concluded nicotine vapes were around 95 percent less harmful than smoking. Now referenced around the world as the foremost example of the relative safety of vaping, this report concluded vapes had the potential to help people quit smoking.
Armed with such strong and reliable evidence supporting the role it could play in reducing smoking rates, successive U.K. governments have continued to endorse vaping. Not only are vapes easy to access for those aged over 18, the government and the National Health Service (NHS) have encouraged people to switch from smoking to vaping. One of the most radical ideas came in 2023 when the government announced that 1 million people who smoked would be encouraged to switch from cigarettes to vapes. As part of the “swap to stop” campaign, a world-first national scheme, around one-fifth of those who smoked would be provided with a vape starter kit, alongside behavioral support, to help them quit. For its part, the NHS provides a wealth of evidence-based advice to those who smoke about the relative safety of vapes compared to cigarettes, though it does emphasize that the full benefits of vaping are only achieved by those who manage to stop smoking cigarettes completely.
“In a similar vein to that seen in Japan, the fall in smoking rates in the United Kingdom reinforces just how rapidly situations can improve when people already consuming nicotine by smoking can access a safer alternative like vapes,” said KAC Director David MacKintosh in a statement.
“When vaping overtakes smoking next year in the U.K., it will not be simply the consequence of a consumer-led revolution, although this has been significant, it will also be the result of successive governments making pragmatic policy decisions based on the evidence in front of them. Maintaining a clear focus on reducing the use of combustible cigarettes provides an opportunity to achieve the ambitious 2030 ‘smoke-free’ target.”
October 1, 2024
Role for Social Workers in Harm Reduction

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Social workers should be given the tools to promote tobacco harm reduction as a means to reverse the high smoking rates found in many of the populations with whom they interact, according to a new briefing paper by Knowledge Action Change (KAC)
In 2021, according to the World Health Organization, two-thirds of people with severe mental health conditions were people who smoked and in those experiencing schizophrenia rates can reach as high as 70-80 percent. People who use illicit drugs are also three times more likely to smoke cigarettes compared to non-users. One study in California found that smoking-related conditions comprised around 40 percent of total deaths among people hospitalized with cocaine, opioid and methamphetamine disorders.
The KAC briefing paper explores how, in countries where they are affordable and available, switching from smoking to the use of safer nicotine products could have dramatic positive effects for those supported by social workers.
“Social workers around the world regularly work with individuals who are more likely than the general population to smoke, for example people experiencing mental health and substance use issues,” said KAC Director David Mackintosh in a statement.
“However, few countries train social workers to support those who want to quit smoking. This is a missed opportunity for both individuals in need and the public health system. Equipping social workers with the tools to provide trusted information and advice on tobacco harm reduction options would benefit their clients, as well as their families and communities. It would save lives. The potential is massive, especially in countries where smoking cessation services are rare, non-existent or expensive to access.”
August 5, 2024
New Briefing Details THR Success in Japan

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Knowledge Action Change (KAC) has released a briefing paper on the rapid fall in cigarette sales in Japan following the introduction of heated-tobacco products (HTP).
Titled “Cigarette Sales Halved: Heated-Tobacco Products and the Japanese Experience,” the paper explores some of the social and cultural factors that have made Japan particularly suited to HTP and provides a case study showcasing the potential of tobacco harm reduction through the adoption of safer nicotine products.
As well as referencing a number of peer-reviewed science papers, the briefing paper, available in 12 languages, also includes some new Global State of Tobacco Harm Reduction research, which compares up-to-date sales figures that emphasize the changing nature of cigarette and HTP consumption.
According to KAC, the success of HTP in Japan offers significant hope of their potential to reduce cigarette sales in other similar countries.
“The speed and scale of the change in Japan shows just how quickly things can improve when those people already consuming nicotine are given access to a safer alternative,” said KAC Director David MacKintosh in a statement.
“This is not the result of a specific government policy or initiative, yet the benefits to individuals and society are significant. There are lessons to be learnt from Japan by all those who wish to see the use of combustible tobacco consigned to the history books. Harm reduction is about giving people the opportunity to improve their own health and the health of those around them. Given the chance, most people will do just that.”
May 15, 2024
Briefing Explores THR for the Homeless

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A new briefing paper from the Global State of Tobacco Harm Reduction (GSTHR), a project from U.K.-based public health agency Knowledge Action Change (KAC), examines the significant potential of the approach to help people experiencing homelessness.
Surveys consistently estimate that between 76 and 85 percent of U.K. homeless people smoke—six or seven times the smoking prevalence seen in the general population, which is now at an historic low of 12.9 percent. On average, U.K. homeless men die at 44 years of age, compared to 76 in the general population and homeless women at 42 years, compared to 81 in the overall population.
Tobacco harm reduction helps people quit smoking by giving them the choice to switch to safer nicotine products. A 2019 study found that at least two thirds of rough sleepers who smoked would be willing to switch to vaping if a device was freely available, and would take up smoking cessation support offered at their homelessness service.
Tobacco harm reduction initiatives developed in London, Manchester and Edinburgh included the provision of free vape starter kits to homeless people. As well as the longer term health improvements offered by switching, the leaders of those projects also noticed more immediate benefits; Covid-19 infection risks associated with sharing or smoking discarded cigarettes were reduced, along with the risk of eviction by breaking no smoking policies, and the risk of breaking lockdown to go out and purchase—or look for discarded—cigarettes.
“Homeless populations have long been disproportionately impacted by smoking, and therefore stand to gain enormously from effective and pragmatic harm reduction routes to quitting tobacco,” said KAC Director David MacKintosh in a statement.
“The sustainability of this type of intervention must be approached carefully, but there is real potential here and it should be explored. On average, homeless people in the U.K. live half a life compared to the general population. Reducing their high rates of smoking is one way to start addressing this tragedy.”
December 11, 2023
Consumer Groups Critical to THR: Paper

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Consumer advocacy organizations play a critical role in ensuring safer nicotine products are available as alternatives for those who use high-risk tobacco products, according to a new briefing paper by the Global State of Tobacco Harm Reduction (GSTHR).
The absence of consumer perspectives from 10^th Conference of the Parties to the Framework Convention on Tobacco Control–which was scheduled to be held in November but has been postponed due to social unrest in the host nation, Panama—will hamper collective efforts to bring an end to the smoking epidemic, according to the GSTHR.
Consumer advocacy groups are also overstretched and under-resourced, according to the report. During the 12 months prior to the study, the total funding for all of the groups surveyed was only $309,810. None of this money came from tobacco or pharmaceutical companies, despite oft-repeated allegations from opponents of tobacco harm reduction. By contrast, the Campaign for Tobacco Free Kids received $160 million from Bloomberg Philanthropies in 2019 to oppose flavors in nicotine vapes.

Despite the lack of funding, tobacco harm reduction consumer advocacy organizations have achieved a lot. “From the very early days of simply sharing information on products with peers who hoped to quit smoking, through to the emergence of more organized advocacy efforts, consumers have been central to the development of tobacco harm reduction,” said Jessica Harding, director of external engagement at Knowledge Action Change, in a statement.
“Consumer advocacy groups play a vital role in maintaining access to safer nicotine products throughout the world and, despite the many obstacles they face, their achievements are impressive.”
“People who use safer nicotine products and people who smoke are significantly affected by policy responses to tobacco and nicotine, broadly described as ‘tobacco control,’” said Gerry Stimson on behalf of the GSTHR project.
“They are also the people who would most benefit from tobacco harm reduction. As in other comparable areas of public health, there must be a recognition of the contribution consumer advocacy groups can make to inform decisionmaking at meetings such as COP10. Their experiences are testament to the potential of harm reduction, and they should be heard.”
Tobacco Reporter’s Stefanie Rossel recently explored the role of consumer advocacy groups in her article “Persistence Pays.”
November 10, 2023
Call for Applications to THR Scholarship

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Knowledge Action Change (KAC) is inviting students to apply for its tobacco harm reduction scholarship program (THRSP).
Successful candidates will receive a 12-month bespoke mentoring program to undertake a tobacco harm reduction-related project of their own design plus $12,000 in financial support. New scholars are also invited to the Global Forum on Nicotine in Warsaw, Poland, where they will learn more about tobacco harm reduction and meet leading figures from the field.
Applications for the 2024–2025 program close on Nov. 30, with 25 places available. On completion of the first scholarship, graduates of the THRSP potentially have access to up to a further three years of funded support from KAC through the one-year enhanced scholarship program and the two-year Kevin Molloy fellowship.
Potential scholars must complete a short online course and quiz about tobacco harm reduction at the applications portal before submitting their project ideas.
They can apply by following this link.
October 19, 2023
COP10 to Reject Harm Reduction: Briefing

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Tobacco harm reduction will be absent at the 10^th Conference of the Parties (COP10) to the Framework Convention on Tobacco Control (FCTC), according to new briefing paper published by the Global State of Tobacco Harm Reduction (GSTHR).
Scheduled for Nov. 20-23 in Panama City, COP10 will have a significant influence how tobacco policies are implemented at a national level, which in turn will determine the future of safer nicotine products such as e-cigarettes, heat-not-burn products and nicotine pouches.
To determine the potential impact of the conference on tobacco harm reduction, the GSTHR analyzed the COP10 agenda and supporting documents.
The GSTHR’s analysis indicates that at present, tobacco harm reduction and its potential to reduce smoking-related death and disease are entirely missing from the proceedings. The publicly available documentation ahead of the FCTC COP10 presents safer nicotine products as a threat to tobacco control rather than as potential tools to support a switch from smoking and reduce high-risk tobacco use.
Parties to the FCTC are expected to be encouraged to classify and regulate nicotine vapes, snus, nicotine pouches and heated tobacco products in the same way as tobacco and combustible tobacco. This risks removing or reducing access to safer options from people who already use them and may return to smoking—and from people who smoke and have the potential to switch and improve their health, according to the GSTHR, which is a project of Knowledge Action Change (KAC).

The WHO and FCTC Secretariat’s refusal to engage with evidence from multiple countries that have witnessed accelerated declines in smoking rates is unscientific and unjustifiable.
Gerry Stimson, director, KAC
“Having observed the WHO’s activities on this issue for some time, many are unsurprised that the FCTC COP10 meeting papers reveal a concerning direction of travel,” said KAC Director Gerry Stimson in a statement.
“The WHO and FCTC Secretariat’s refusal to engage with evidence from multiple countries that have witnessed accelerated declines in smoking rates is unscientific and unjustifiable. Their repeated characterization of safer nicotine products as a threat to tobacco control runs directly counter to what should be the overarching goals of the Convention–to reduce smoking-related deaths and disease as rapidly and effectively as possible.
“People who use safer nicotine products are barred and have no voice at the FCTC COP10. Those Parties who have successfully adopted and supported access to these products as effective tools for smoking cessation must ensure that their own progress is not hindered by COP decisions—and that the potential for tobacco harm reduction is given due consideration by all Parties present in Panama next month.”
October 10, 2023
KAC Explains COP

Gerry Stimson | Photo courtesy of GNF
Knowledge Action Change (KAC) has published a briefing to help policymakers, health officials and consumers better understand the Conference of the Parties (COP) to the World Health Organization Framework Convention on Tobacco Control (FCTC). The 10th edition of this event, which normally takes place every two years, is scheduled for November in Panama.
While decisions made at the conference are likely to significantly impact tobacco companies and their customers, industry representatives and organizations advocating for access to safer nicotine products have traditionally been barred from attending the event.
As a result, tobacco harm reduction has been getting short rift at COP meetings despite the fact that the concept is an integral part of the FCTC.
“Harm reduction is explicitly named as one of three tobacco control strategies in the opening lines of the Framework Convention on Tobacco Control, but at present, the indications are that COP10 is unlikely to result in any decisions that support consumer access to safer nicotine products,” said KAC Director Gerry Stimson in a statement.
“Parties to the FCTC must seize the opportunity in Panama to consider evidence from countries where tobacco harm reduction is saving lives, including the U.K., New Zealand, Sweden, Norway and Japan—and ask why the WHO and its influential philanthropic funders are refusing to do the same.
“With no media present, FCTC COP meetings are shrouded in a secrecy more akin to a U.N. Security Council meeting—and in direct contrast to other COP meetings, for example those on climate change. This briefing paper gives policymakers, health officials and consumers more insight into the processes of COP10 and the opportunity to engage more fully prior to and during the event in Panama,” said Stimson
May 15, 2023
Global Number of Vapers Jumps

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The number of vapers has increased significantly worldwide, according to the latest research from the Global State of Tobacco Harm Reduction (GSTHR).
A new peer-reviewed paper published this week in Drugs, Habits and Social Policy estimates there are now 82 million vapers worldwide. The GSTHR project, from the U.K. public health agency Knowledge Action Change (KAC), found that the 2021 figure represents a 20 percent on that for 2020.
According to KAC, vaping is a significantly safer alternative to smoking. “Each year, there are 8 million smoking-related deaths worldwide,” the organization wrote in a press note. “The growth in the number of vapers, most of whom will have swapped smoking for vaping, is therefore a hugely positive step in efforts to reduce the harms of combustible cigarettes and hasten the end of smoking.”
The new study comes shortly after the U.K. government announced its Swap to Stop scheme, which aims to give 1 million smokers a free vaping starter kit to help them quit smoking. According to KAC, the U.K.’s permissive vaping laws have helped drive smoking to its lowest level on record.
“The U.K.’s support of vaping for tobacco harm reduction is in sharp contrast to the situation in many countries, however,” KAC wrote. “GSTHR data shows that vapes are banned in 36 countries, and in a further 84 countries there is a regulatory and legislative vacuum. Millions of smokers who want to switch to much safer vaping cannot do so, or may be forced to purchase potentially unsafe products on black or grey markets, due to bans, or poor or non-existent product regulation.”

The updated Global State of Tobacco Harm Reduction estimate suggests that there are now 82 million people worldwide who vape, proving that consumers find these products attractive.
Gerry Stimson, director of KAC and emeritus professor at Imperial College London
The GSTHR research shows that despite restrictive regulations or bans in many countries, increasing numbers of people are choosing to switch to safer alternatives to combustible tobacco. “Along with other countries like New Zealand, the U.K. offers strong evidence that positive government messaging about vaping for tobacco harm reduction can hasten reductions in smoking prevalence,” wrote KAC. “But an international meeting on tobacco control later this year could jeopardize global progress on reducing smoking-related death and disease through tobacco harm reduction,” the public health agency added, referring to the meeting of the parties to the World Health Organization’s Framework Convention on Tobacco Control scheduled for November in Panama City.
The WHO remains opposed to the use of safer nicotine products for smoking cessation, despite supporting harm reduction in other areas of public health such as substance use and HIV/AIDS prevention.
“The updated Global State of Tobacco Harm Reduction estimate suggests that there are now 82 million people worldwide who vape, proving that consumers find these products attractive,” said Gerry Stimson, director of KAC and emeritus professor at Imperial College London. “As evidenced in the U.K., millions are making the switch from smoking. Safer nicotine products give the world’s 1 billion smokers the chance to quit using alternatives that pose significantly fewer risks to their health.”
April 21, 2023
Paper Addresses Harm Reduction of Pouches

Knowledge-Action-Change (KAC) has published the latest in a series of briefing papers as part of its Global State of Tobacco Harm Reduction (GSTHR) project.
What are nicotine pouches? provides an overview of the latest information about the scientific evidence, market data, regulatory landscape and tobacco harm potential for this relatively new safer nicotine product, according to KAC.
Nicotine pouches are thumbnail-sized sachets that are placed under the lip. They are made from vegetable fibers infused with nicotine and a range of flavors. Nicotine pouches are sometimes confused with Swedish snus, another safer nicotine product that was the subject of a previous GSTHR briefing paper. Both products are placed under the lip, but while Swedish snus contains tobacco, nicotine pouches do not contain any raw or processed tobacco leaves.
As a new product category, the body of evidence examining their safety is still growing, but preliminary findings indicate that nicotine pouches offer people who use nicotine a significantly safer alternative to smoking.
“This briefing paper aims to increase knowledge about, and awareness of, the tobacco harm reduction potential of nicotine pouches,” said Gerry Stimson, director of KAC and emeritus professor at Imperial College London. “Good quality information about the full range of different safer nicotine products is essential for consumers, policymakers and regulators.
“Nicotine pouches could make a significant contribution to tobacco harm reduction. This is particularly the case for the more than 300 million people worldwide who use smokeless tobacco products, most of whom live in low-[income] and middle-income countries where health systems are less well-resourced to diagnose and treat noncommunicable diseases. High-risk oral tobacco products such as betel quid, paan or gutkha contain relatively high levels of carcinogenic and toxic compounds and increase the risk of oral, esophageal and pancreatic cancers. In contrast, nicotine pouches have been found to have a similar risk profile to nicotine replacement therapy.
“Nicotine pouches may not yet be as widely used as nicotine vapes, but the global market for these products is already worth $1.5 billion. This provides good evidence that tobacco users find these products acceptable and will switch to them. In comparison to some other safer nicotine product categories, nicotine pouches are low cost and have minimal start-up and on-costs for consumers, meaning they offer significant hope to many low-[income] and middle-income countries where high-risk oral tobacco use is prevalent.”
March 31, 2023