Half of doctors discuss smokeless alternatives weekly, but only 21% feel informed enough to recommend them. Photo credit: RDNE Stock Project, Pexels.
A new multi-market survey commissioned by British American Tobacco (BAT) reveals that misconceptions about nicotine remain widespread among policymakers, despite growing scientific evidence that nicotine itself is not the main cause of smoking-related disease.
The survey, conducted in 2024 and 2025 across 15 markets by research firm Kantar, questioned three groups — policy experts, medical professionals, and nicotine users — to assess attitudes toward nicotine and tobacco harm reduction (THR). According to the findings, 70% of policy experts continue to believe that nicotine is the primary cause of smoking-related diseases such as cancer and cardiovascular conditions. The figure underscores a persistent gap between scientific consensus and policy perception. While research over the past decade has shown that combustion, not nicotine, drives most smoking-related harm, this view has yet to be reflected broadly among decision-makers.
“This survey shows that while change is possible, it’s not a given,” said Kingsley Wheaton, chief corporate officer at BAT. “We’re seeing green shoots of progress, especially where we’ve launched new product innovations and invested in clear, science-led communication. But the data also tells us we must go further and faster to equip those making decisions with the latest scientific evidence about smokeless products.”
The research also highlights shortcomings among healthcare professionals. Although half of medical professionals surveyed said they discuss smokeless alternatives with patients at least weekly, only 21% feel well-informed enough to recommend them. More than 75% of healthcare professionals expressed trust in scientific and public health messaging on THR, yet awareness remains low — with only around 1 in 5 respondents familiar with the scientific literature or able to dedicate time to further education on the topic.
This knowledge gap, the report suggests, contributes to regulatory inertia and limits the dissemination of accurate information to consumers.
Perceptions of alternative nicotine products vary sharply between markets. Sweden stands out for its consistently high awareness: around 80% of policymakers, health professionals, and active users view oral nicotine pouches as less harmful than cigarettes. By contrast, Australia and New Zealand show a negative trend in perceptions of vapor products, a shift possibly linked to stricter regulations. In France, nearly 9 in 10 medical professionals believe vapor products are less harmful than cigarettes, while in the UK, more than 60% of smokers view oral nicotine pouches as potentially lower-risk alternatives. However, policy experts in the US, France, and the UK show the highest rates of misunderstanding about nicotine’s health impact — exceeding 85%.
The survey also found that 65% of policy experts support cigarette-equivalent or stricter regulation for smokeless products, a stance that runs counter to harm reduction principles. BAT argues that such approaches could hinder smokers’ transition to less harmful alternatives.
The findings come just weeks ahead of the WHO’s Framework Convention on Tobacco Control (FCTC) COP11 in November, where regulators are expected to reinforce their opposition to alternative nicotine products. While the FCTC continues to advocate for abstinence-based tobacco control, the survey results highlight the growing divergence between global policy frameworks and harm reduction science.
This gap was also highlighted by Italian researcher Professor Giovanni Li Volti at the 2025 Scientific Summit on Tobacco Harm Reduction, who cited European data showing that 80% of health professionals still associate nicotine with smoking-related disease. “This is the result of the failure of scientists to communicate and teach medical students what exactly the effect of nicotine is,” he said. The persistence of such misconceptions among both experts and policymakers underscores how far scientific understanding has yet to travel into the policy sphere.