Advocacy and public education: building THR literacy

In LMICs, even in many high-income settings, understanding of nicotine and THR is limited [^1]. Nicotine is often wrongly assumed to be the main cause of smoking-related disease, and safer nicotine products (SNPs) such as vaping products are sometimes believed to be just as harmful as cigarettes. This misunderstanding makes it harder for people who smoke to make informed choices and discourages attempts to move away from combustible tobacco.

Clear communication can make a difference. For example, explaining that burning tobacco produces the toxins that cause most harm, while nicotine itself is responsible mainly for dependence, helps people understand why switching away from smoking can reduce risk. Simple comparisons, such as “smoking is the most harmful option, while non-combustible products are less harmful,” are often more effective than technical explanations.

Advocacy can also help improve policy discussions. In many LMICs, debates about nicotine products are shaped by global narratives rather than local evidence. Health professionals, civil society groups, and patient organisations can contribute by sharing local data, such as smoking prevalence, quit attempt rates, or the lack of cessation services, and by explaining where harm reduction might help fill gaps. The focus should be on reducing smoking-related harm, not on promoting specific products.

Public education works best when it uses trusted local channels. Community health workers, teachers, pharmacists, and local media are often more credible messengers than international campaigns. For example, brief explanations delivered through radio programmes, clinic waiting rooms, or community meetings can help correct myths and reach people who may not access online information.

Addressing misinformation is particularly important. Claims that all nicotine products are equally dangerous, or that switching offers no health benefit, can discourage people who smoke from changing behaviour. Countering this does not require overstating benefits. A balanced message, acknowledging that SNPs are not risk-free but are substantially less harmful than smoking, is usually sufficient to build trust.

Overall, improving THR literacy is about clear, honest, and locally relevant information. When people who smoke, health workers, and policymakers better understand relative risk and the limits of existing cessation support, discussions about harm reduction become more practical and less polarised.