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Glossary

A

Abstinence-only approach

A tobacco control strategy that focuses solely on complete cessation of all tobacco and nicotine use, without offering safer alternatives for people who cannot or do not wish to quit entirely.

Accessibility

The ease with which safer nicotine products can be obtained by adults who wish to use them. This includes physical availability, distribution networks, and social or cultural acceptance.

Advocacy

Strategic actions aimed at influencing public opinion, policy, and decision-making to advance tobacco harm reduction (THR) goals.

Affordability

The degree to which individuals can purchase safer nicotine products relative to their income. In many LMICs, affordability is limited by high import costs, taxes, and low purchasing power.

Atherosclerosis

A disease in which plaque builds up inside arteries, leading to reduced blood flow and increased risk of heart attack and stroke.

B

Ban

An official prohibition of an action, substance, or item.

Betel quid with tobacco

A chewable preparation made of betel leaf, areca nut, slaked lime, and often tobacco. Common in South Asia and linked to cancers of the mouth and throat.

Bidis

Small, hand-rolled cigarettes common in South Asia, made from tobacco wrapped in a tendu leaf. They deliver high levels of nicotine and tar.

Biomarkers

Measurable biological indicators used to assess the presence and level of exposure to harmful chemicals and toxins in the body.

C

Carcinogens

Substances that can cause cancer in living tissue.

Cardiovascular diseases

A group of disorders of the heart and blood vessels, including heart attacks, strokes, and other conditions affecting the cardiovascular system.

Cessation support

Programmes and services, including counselling and medication, that assist tobacco users in quitting successfully.

Chronic respiratory illness

Long-term lung diseases, such as chronic obstructive pulmonary disease (COPD) and chronic bronchitis, often caused or worsened by smoking.

Cochrane Review

A systematic, high-quality, evidence-based review of research in healthcare and health policy.

Co-Creation

A participatory process in which stakeholders - such as nicotine users, health workers, policymakers, and civil society - collaborate to design, test, and implement THR communication or policy initiatives.

Combustion

The process of burning tobacco, which produces smoke containing thousands of toxic chemicals responsible for most of the harm from smoking.

Communication Framing

The way information is presented to shape understanding and response. In THR, framing can emphasise equity, compassion, and informed choice rather than blame or moral judgement.

Counterfeit Products

Illegally manufactured or falsified safer nicotine products that imitate legitimate brands but often lack quality control, posing risks to consumer safety.

Cross-cutting Barriers

Challenges, such as misinformation, stigma, moral framing, and political resistance, that affect multiple aspects of tobacco harm reduction and hinder progress across policy, regulation, and practice.

D

de facto ban

An effective prohibition achieved through stringent regulations, making a product nearly inaccessible or unusable, such as allowing only prescription-based access.

Disability-Adjusted Life Years

A measure of overall disease burden, expressed as the number of years lost due to ill-health, disability, or early death.

E

Equity Lens

An approach that recognises differences in power, access, and opportunity across populations.

F

G

Gateway theory

A hypothesis suggesting that the use of a less harmful drug can lead to future use of more harmful substances.

GothiaTek

A voluntary quality standard for Swedish snus ensuring low levels of unwanted substances through specific production techniques and raw material selection.

Gutka

Forms of smokeless tobacco widely used in South Asia, often mixed with spices, sweeteners, or lime. All carry high risks for oral cancer and other health problems.

H

Harm reduction

A public health approach that seeks to minimise the health and social harms associated with risky behaviours, rather than requiring complete abstinence.

Health Justice

A principle that links health outcomes to social justice, asserting that everyone deserves equal access to tools and knowledge that can reduce harm.

Heated Tobacco Products (HTPs)

Devices that heat, rather than burn, processed tobacco sticks to release nicotine and flavour with substantially lower toxicant emissions than cigarettes.

Heavy Metals

Metallic elements with high density that are toxic in low concentrations. Examples include lead, mercury, cadmium, and arsenic.

I

Illicit tobacco trade

The illegal production or sale of tobacco products that avoids taxes and regulations.

Informal Education Channels

Community-based communication platforms such as radio, storytelling, and social media that spread THR information in accessible and culturally familiar ways.

Informal Market

Unregulated sales channels where safer nicotine products are distributed outside official retail or import systems. These markets are common in LMICs due to weak regulation and enforcement.

K

Kreteks

Clove-flavoured cigarettes popular in Indonesia, containing a mix of tobacco, cloves, and additives. They produce high levels of harmful chemicals.

L

Local Innovation

THR solutions developed within LMICs, such as local manufacturing, culturally tailored campaigns, or digital tools, designed to improve relevance, access, and sustainability.

Low and middle income countries

Countries that have a gross national income (GNI) per capita of $4,255 or less (World Bank threshold, 2023-24; reviewed annually).

M

Moderate-certainty evidence

Researchers are fairly confident that the evidence matches their estimate of the effect. The true effect is likely to be close to the estimate, but there is a possibility that it is substantially different.

Morbidity

The presence or rate of disease in a population. Unlike mortality, which refers to death, morbidity refers to illness and poor health.

Mortality

The occurrence of death in a population, usually expressed as a rate (e.g., deaths per 100,000 people).

MPOWER

A WHO package of six measures—Monitor, Protect, Offer, Warn, Enforce, Raise—designed to support FCTC implementation.

N

Nicotine

An addictive substance found in tobacco that can be delivered through both combustible and non-combustible products. While it causes dependence, it is not the main cause of smoking-related diseases.

Nicotine addiction

A compulsive need to use nicotine despite harmful consequences, often characterised by cravings and loss of control.

Nicotine dependence

A physical condition where the body adapts to regular nicotine use, leading to withdrawal symptoms when use stops.

Nicotine Pouches

Small, tobacco-free sachets placed between the gum and lip to deliver nicotine orally. They are smokeless, discreet, and increasingly available in some LMICs.

Nicotine Replacement Therapy

Treatments that provide low levels of nicotine without the harmful chemicals found in tobacco smoke, used to help people quit smoking. Examples include nicotine gum, patches, lozenges, nasal spray, and inhalers.

Nitrosamines

Carcinogenic compounds found in tobacco, certain foods, and industrial products.

P

Policy Inertia

The tendency of governments to maintain existing policies despite new evidence or changing circumstances, often due to institutional conservatism or reliance on external guidance.

Premature death

Death that occurs before the average age of death in a certain population.

Prevalence

The proportion of a population that has a particular characteristic (such as smoking) at a specific time.

Prohibition-based policy

A tobacco control approach relying mainly on bans or restrictions, such as sales bans or age limits, often with mixed results.

Pulmonary Diseases

Diseases affecting the lungs and respiratory system. Examples include Chronic Obstructive Pulmonary Disease (COPD), asthma, lung cancer.

Q

Quality Control

Processes and standards designed to ensure the safety, consistency, and reliability of manufactured products. Weak quality control in LMIC markets allows counterfeit or unsafe safer nicotine products to circulate.

R

Randomised Controlled Trials

Studies where participants are randomly assigned to treatment or control groups to test the effectiveness of interventions.

Regulation

Rules or directives made and maintained by an authority to manage behaviours or processes.

Regulatory Framework

The set of laws, rules, and guidelines that govern the production, sale, and use of nicotine products. In most LMICs, such frameworks are outdated or non-existent for safer nicotine products.

Relative Risk Communication

Clear messaging that explains how risks differ across nicotine products, helping the public understand that smoking is far more harmful than non-combustible alternatives.

Risk Proportionate

A regulatory approach where the strictness of regulation is based on the product's risk level. Higher-risk products face stricter controls, encouraging a switch to safer alternatives.

Risk spectrum

Range of health risks associated with different nicotine-delivery products.

S

Safer nicotine products

A collective term for non-combustible products such as vaping devices, nicotine pouches, snus, and heated tobacco products that provide nicotine with greatly reduced risk compared to smoking.

Secondhand smoke

Tobacco smoke that is inhaled involuntarily or passively by someone who is not the active smoker.

Shisha

A water pipe used for smoking flavoured tobacco. A single session often involves inhaling much more smoke than a cigarette.

Single-stick sales

The practice of selling cigarettes individually rather than in packs, making them more affordable but also increasing access, especially for young or low-income people.

Smoke-free laws

Regulations banning smoking in public spaces and workplaces to protect people from secondhand smoke exposure.

Smokeless tobacco

Non-combustible tobacco products used without smoking. Health risks vary widely across products and are often driven by additives and processing methods rather than tobacco itself.

Stakeholder Engagement

Collaboration among civil society, researchers, policymakers, donors, and nicotine users to shape THR policies that reflect community needs and local realities.

Stakeholders

Individuals or groups with an interest or concern in a particular issue or organisation.

Stigma

Negative social attitudes or discrimination directed at individuals who use nicotine products, often based on moral or cultural judgments rather than scientific evidence.

T

Tobacco Control

Public health strategies and policies aimed at reducing tobacco use and its harmful effects on health.

Tobacco harm reduction

A public health approach to minimise the negative health effects of tobacco use, often by promoting safer alternatives.

Tobacco taxation

Government-imposed taxes on tobacco products aimed at reducing affordability and consumption while raising public revenue.

Toombak

A traditional Sudanese form of fermented smokeless tobacco, strongly associated with oral cancer.

W

World Health Organization (WHO)

A specialised United Nations agency responsible for international public health. Its cautious stance on safer nicotine products strongly influences tobacco control policy in many LMICs.