Anti-smoking activists have worked for centuries to get people to stop smoking. One successful way to do that is by recognizing that many smokers are addicted to nicotine. They need their “fix.” That’s why people endorse nicotine-replacement therapy (NRT) to help smokers quit.

But rather than accept victory, many anti-smoking crusaders now embrace incoherent and seemingly contradictory positions regarding tobacco-harm reduction.

America’s love/​hate relationship with tobacco dates back to the late 19th century, when a member of the Women’s Christian Temperance Movement established the Anti-Cigarette League of America in 1890. In the following decades, several states banned smoking entirely, but then states abandoned prohibition and decided to tax and regulate tobacco by the late 1920s. When conclusive scientific evidence of tobacco harms emerged in the 1950s, the anti-smoking crusade resumed. But this time, the anti-smoking movement had scientific — rather than moral — arguments.

The movement has been successful. In 2023, adults smoking tobacco in the U.S. reached an all-time low of one in nine people, down from 42 percent of adults in the 1960s. Less than 1 percent of teens light up today.

Harm reduction is a realistic way to help people who make unhealthy lifestyle choices. Researchers learned long ago that the tar, carbon monoxide, and toxic chemicals in the tobacco leaf cause cancers, cardiovascular diseases, and lung problems.

But contrary to what many people think, nicotine — the addictive compound in tobacco — is relatively harmless. Britain’s Royal Society for Public Health proclaimed nicotine is “no more harmful to health than caffeine.” Nicotine, like caffeine, stimulates and enhances concentration. Unlike caffeine, nicotine increases beta-endorphins and helps relieve anxiety. This may explain why people under stress say, “I need a cigarette.”

Like caffeine, nicotine can be addictive. And if people use tobacco as their nicotine-delivery system, they continuously expose themselves to tobacco’s harmful compounds. And like many drugs people consume regularly, using nicotine or caffeine long-term is not without risk. Consuming nicotine long-term can cause high blood pressure and may contribute to blood-vessel narrowing. Prolonged caffeine consumption can cause ulcers, irregular heartbeat, tremors, and insomnia.

As mentioned above, NRT is one type of tobacco-harm reduction. It comes in many forms, such as nicotine gum and patches. They provide alternative, safer ways for people to get their nicotine without smoking. Varenicline is a different kind of smoking-cessation aid; it’s a pill that works by blocking nicotine receptors in the brain so users cannot experience nicotine’s desirable effects. People take varenicline to abstain from nicotine as opposed to consuming it more safely.

For many people, NRT works better when it mimics the action of smoking, not merely the psychosomatic effects. For example, e‑cigarettes (also called “vapes”) allow consumers to inhale and exhale a vapor containing nicotine while avoiding the carcinogens and toxic chemicals of tobacco smoke. A study reported in the New England Journal of Medicine found nicotine e‑cigarettes superior to other forms of nicotine-replacement therapy for reducing or quitting smoking.

Despite success in reducing cigarette use, the FDA and states have taken steps to curtail nicotine vaping, starting with banning flavors, even though surveys show that adults find it much easier to quit smoking with flavored e‑cigarettes. These policy-makers claim they want to reduce teen vaping, fearing that it is a gateway to smoking tobacco. They also worry that researchers might discover long-term vaping damages the lungs, since the technology is relatively new and there aren’t many longitudinal studies.

Yet studies show most teens who vape would otherwise be smoking tobacco. The decline in youth smoking coincided with the advent of e‑cigarettes. And teen e‑cigarette use has been declining as well, with only 10 percent of high schoolers indulging between 2022 and 2023.

For anti-smoking crusaders uncomfortable with the idea of people inhaling nicotine without tobacco, there is an alternative form of NRT that has not received much press coverage in this country. It’s a tobacco-based product developed in Sweden called “snus,” which is far safer than smoking. It is a moistened-tobacco product that people place between the lip and gum. However, the tobacco is steam-pasteurized, which gives it a lower concentration of the compounds in smokeless or chewing tobacco that can cause oral, throat, esophageal, and pancreatic cancer. Researchers surveying the scientific and long-term population studies have concluded that “the health risks associated with snus are considerably lower than those associated with cigarette smoking.”

In Sweden, for the past 30 years, snus has been more popular than smoking among men. Over the same period, smoking in Norway decreased while consuming snus has increased. A recent study revealed that Sweden has the lowest daily cigarette-use rate, the lowest tobacco-related mortality rate, and the lowest male lung-cancer rate in the European Union.

Inexplicably, while chewing tobacco, which is not steam-pasteurized like snus, is legal there, the European Union bans snus sales everywhere except Sweden. Snus is legal in Norway, Switzerland, the U.S., and Canada.

Why ban a safer alternative to traditional tobacco as a nicotine-delivery system? Perhaps the anti-smoking purists worry that a relatively safe form of tobacco might reduce the stigma they’ve worked so hard to attach to the plant.

If that’s their concern, then they should be pleased to learn of a tobacco-free, nicotine-delivery system: nicotine pouches, which usually come in flavors. Like snus, they work by placing them between the lip and gums, and they slowly release nicotine.

Nicotine pouches should satisfy anti-smoking activists. But recently, Senate Majority Leader Chuck Schumer called for a crackdown on a nicotine pouch sold by the brand Zyn. He claims the nicotine pouches are a danger to teens who use them as an alternative to e‑cigarettes. Schumer said Zyn is “dangerous” and “packed with problems.”

Noting that teens endorse Zyn on social-media platforms, Schumer, in a press conference, mentioned studies showing that nicotine may harm the developing brains of children and adolescents. According to the Centers for Disease Control and Prevention, only 1.5 percent of middle-school and high-school students use nicotine pouches.

There is indeed evidence, some observational and some based on animal studies, that regular use of nicotine might harm the developing brain. There is also evidence that caffeine can cause harm to adolescents, which is why pediatricians warn against kids drinking coffee. And we all know alcohol can damage the developing brain.

But, as with alcohol, people must be aged 21 and over to buy nicotine. Laws should not prohibit adults from consuming substances or engaging in activities simply because they might be harmful to children who do.

This is not an argument for marketing or selling these products to minors. However, hyperbolic language about nicotine being “dangerous” only misleads the public into associating nicotine with more hazardous drugs that the Drug Enforcement Administration classifies as Schedule I. Stoking fears in this way can lead people and their representatives to make poor policy choices.

So, what is causing this nascent nicotinophobia? For centuries, people have associated nicotine with smoking without realizing that smoking — not nicotine itself — is unhealthy. Maybe anti-smoking activists are simply biased against anything that, in any way, connects to that behavior.