It is estimated that over 200 million people currently use e-cigarettes, heated tobacco products, snus or nicotine pouches. At the same time, the same pattern is emerging in an increasing number of countries: the use of smoke-free alternatives is rising whilst smoking is falling. This is the finding of Knowledge Action Change in this year’s report on global trends in smoke-free nicotine.
In just over two decades, smoke-free nicotine products have gone from being a relatively minor phenomenon to accounting for a significant share of the global nicotine market.
This is one of the main conclusions in Global State of Tobacco Harm Reduction 2026, published by the British organisation Knowledge Action Change (KAC).
According to the report’s estimates, there are around 129 million e-cigarette users and just under 49 million users of heated tobacco products globally. Added to this are users of snus and nicotine pouches, for which there is still insufficient data to provide a corresponding global estimate. Nevertheless, KAC estimates that the total number of users of smoke-free nicotine products now exceeds 200 million.
In relation to the world’s cigarette smokers, this corresponds to approximately 20–25 per cent. According to KAC, this is a level at which smoke-free products have become sufficiently widespread to have an impact on smoking even at a population level.
– Smoke-free nicotine products are no longer a niche market. They have become an integral part of the global nicotine market and represent a significant opportunity to improve public health, writes the report’s author, Harry Shapiro, in a commentary on the report.
The same pattern across 28 countries
In the report, the researchers have summarised trends in smoking and the use of smoke-free nicotine products in 28 countries between 2010 and 2025.
What these countries have in common is that the trends are moving in different directions: smoking is falling, whilst the use of e-cigarettes, snus, nicotine pouches or heated tobacco is rising. At the same time, the authors emphasise that population data alone cannot show that individual smokers have actually switched products.
In Sweden, Norway, Iceland, New Zealand and the UK, the curves have already crossed. In those countries, the use of smoke-free nicotine products is now more widespread than smoking.
– ‘This is substitution in practice, and it’s good news for both individual health and public health,’ writes Harry Shapiro.
However, the products that have taken over vary considerably from country to country. E-cigarettes play the biggest role in countries such as the UK, New Zealand, the US and Canada. In Japan and South Korea, heated tobacco is significantly more prevalent. In the Nordic countries, on the other hand, snus and other oral nicotine products dominate.
Sweden stands out
Sweden is given its own section in the report. Here, the authors link the low smoking rates to the long-standing widespread use of snus.
Among other things, the report refers to the EU’s cancer profile for Sweden, where cancer mortality is below the EU average. The incidence of lung cancer among Swedish men is stated as 39 cases per 100,000 inhabitants, compared with the EU average of 95. At the same time, the authors highlight research estimating that around 3,000 deaths a year are prevented because snus has replaced cigarettes.
This trend is in line with the Swedish statistics previously reported by Vejpkollen: smoking has fallen to historically low levels, whilst the use of snus and nicotine pouches in particular is significantly higher.
This development is taking place mainly in wealthier countries
However, this global shift is far from evenly distributed.
Of the 28 countries where KAC finds the clearest signs that smoke-free products are replacing cigarettes, 27 are high-income countries. Malaysia is the only country in the group that is classified as an upper-middle-income country.
At the same time, a large proportion of the world’s smokers live in low- and middle-income countries. In these countries, alternatives are often banned, difficult to obtain or significantly more expensive than cigarettes. According to the report, single-use e-cigarettes in these countries cost, on average, around 2.5 times more than the cheapest cigarettes.
– “In most low- and middle-income countries, where 80 per cent of the world’s smokers live, cigarettes are still the cheapest source of nicotine,” notes Harry Shapiro.
More bans despite increasing use
At the same time, the report highlights a contrary political trend. Since 2025, more countries have introduced bans, nicotine limits, flavour restrictions and taxes on alternative nicotine products.
Harry Shapiro points, amongst other things, to Denmark, where the new limit of nine milligrams of nicotine per pouch is expected to eliminate a large proportion of the existing range. He also highlights that at least ten countries have introduced new bans on smokeless nicotine products during the period covered by the report.
The same tug-of-war is also taking place within the EU. The report highlights how Sweden, together with Romania, the Czech Republic, Croatia, Greece and Italy, amongst others, has protested against Spain’s plans for a nicotine cap of 0.99 milligrams per pouch and extensive flavour restrictions. These countries have, amongst other things, warned of the consequences for both the free movement of goods and public health.
This is a development that Vejpkollen has reported on repeatedly in the run-up to the EU’s forthcoming revision of the Tobacco Products Directive (TPD) and the negotiations on common nicotine taxes. Among other things, the European Commission has proposed a common minimum tax on nicotine pouches that is significantly higher than the current Swedish rate.
Smoking is on the decline – but at a slower pace
At the same time, underlying the report’s arguments is an ongoing global problem. The WHO’s own figures show that cigarette smoking has fallen from 22.4 per cent of the world’s adult population in 2000 to 14.9 per cent in 2024. However, the rate of decline has slowed.
Furthermore, in parts of Africa, the Middle East and Asia, the number of smokers is expected to be higher in 2030 than it was in 2000, partly as a result of population growth.
KAC’s conclusion is therefore that traditional tobacco control policies alone are not enough to reduce smoking at the same rate across the globe.
– Cigarettes are here to stay for a long time. But despite political opposition, millions of people are already giving up smoking. When smoke-free alternatives finally gain the upper hand, it is therefore not a question of if, but of when, writes Harry Shapiro.
