Substitution, Not Abstinence: Danish Data Are The Latest to Teach us About Tobacco Harm Reduction

A sweeping shift in youth nicotine use reveals a powerful truth: safer alternatives, not prohibition, are driving smoking’s historic collapse across Denmark and beyond.

Throughout history, major advances in public health have rarely moved forward without opposition. From clean water systems to food safety laws, vaccinations, and air-quality protections, evidence-based reforms have consistently wrestled with ideological resistance. The modern struggle over tobacco harm reduction fits squarely into this pattern. Even as safer alternatives to smoking deliver some of the most promising population-level health gains in decades, they face fierce and sometimes irrational pushback from groups who insist—despite overwhelming evidence to the contrary —that abstinence alone is the only acceptable path.

This resistance persists even though scientists have long known the core truth that should guide tobacco policy: people smoke for nicotine, but they die from inhaling smoke. Professor Michael Russell articulated this in the 1970s, yet decades passed before the technology existed to meaningfully separate nicotine from combustion. When innovators finally developed cleaner options to deliver nicotine—first through early nicotine replacement products, later through heated tobacco technologies, and eventually via modern e-cigarettes—the response from many public health institutions was not support but suspicion.

New methods intended to reduce harm were often greeted as threats instead of opportunities. Heated tobacco prototypes like Premier and Eclipse were withdrawn after hostile campaigns. Snus and smokeless products faced bans and regulatory barriers. Even nicotine pouches and low-risk oral products, now widely used, were dismissed as dangerous despite decades of safety data from Sweden’s near smoke-free population. By the time vaping emerged as a scalable alternative capable of competing directly with cigarettes, the political battle lines were already drawn.

Ideology is stifling smoking cessation  progress
Compounding this resistance is a long-standing failure to communicate accurately about risk. Many health agencies still discuss nicotine and tobacco interchangeably, leaving the public unaware that nicotine, while addictive, is not the cause of smoking-related disease. In several countries, it is even illegal to inform consumers that a non-combustible nicotine product is less harmful than smoking. Infact, during the opening session of the ongoing COP11, instead of prioritising evidence-based strategies, many governments were congratulating themselves for introducing even more restrictions on lower-risk nicotine products, all while ignoring their real-world consequences.

The result of these ideological forces is consumer confusion that protects cigarettes by default. A population kept in the dark will rarely switch to safer products, especially when policymakers reinforce confusion through bans, taxes, or exaggerated scare stories. These approaches now collide with a new wave of global data showing something unprecedented: as safer alternatives become more accessible, especially to young adults, smoking collapses.

Denmark’s quiet revolution
Denmark offers one of the latest examples of this shift. The newly released UngMap 2025 study from Aarhus University surveyed more than 2,100 young people aged 15 to 25 and revealed a historic transformation. Daily cigarette smoking among youth has fallen to just 2.7 percent—a staggering decline from 15.4 percent in 2014. Past-month smoking is also down sharply, dropping from 26.4 percent in 2022 to 17.3 percent today.

Reflecting what is happening in neighbouring Nordic countries, these declines are not happening in isolation; they are occurring alongside a rise in the use of non-combustible nicotine. Between 2022 and 2025, youth use of smokeless products increased from 23.6 percent to 26.3 percent. Snus now leads among these alternatives, with puff bars and vapes also gaining ground. Younger teens, especially those aged 15 to 17, reported notable use of puff bars (13.9 percent) and vapes (8.8 percent), while older youth showed more balanced use across the product spectrum. Men tend to favour snus while women more frequently use vapes or disposables.

Scandinavia leads the way
Public health researchers interpret these trends not as an explosion of nicotine addiction, but as a clear substitution effect. Young people who might otherwise have experimented with cigarettes are instead turning to non-combustible products—precisely the pattern seen in Sweden, Norway, Iceland, and increasingly in the UK before recent policy reversals. The Nordic Welfare Centre’s 2025 regional overview confirms that this shift is occurring across Scandinavia: youth smoking is collapsing fastest where non-combustible nicotine is most accessible.

This pattern also aligns with the Danish Health Authority’s Smoking Habits 2024 report, which documented increasing use of vaping and oral nicotine among 15- to 29-year-olds. While such trends understandably raise concerns for regulators focused on youth access, the broader public health implications are profound. When nicotine use transitions from combustible to non-combustible forms, disease declines dramatically. This is why Sweden—thanks to snus and pouches—has the lowest smoking rates and tobacco-related mortality in Europe.

Meanwhile, the right regulations play a key role in shaping the speed and direction of this transition. Denmark has tightened age restrictions, increased enforcement on retail sales, and limited advertising. These measures appear to have made youth cigarette purchases more difficult, supporting the downward trend in smoking. But enforcement remains uneven when it comes to disposable vapes. Despite restrictions, about eight percent of young adults report using disposables, demonstrating that simply banning or limiting products rarely eliminates them. Instead, poorly designed restrictions often create illicit markets, where product safety and responsible sales are impossible to regulate.

This dynamic mirrors experiences in countries like Australia, where aggressive anti-vaping policies have failed to curb youth access and succeeded in undermining smoking cessation. In such countries, public confidence in vaping has fallen sharply due to misinformation, sensationalised media coverage, and contradictory government messaging. As a result, fewer smokers are switching, and some have returned to smoking—an entirely predictable outcome when safer products are demonised while cigarettes remain legal, cheap, and ubiquitous.

Innovation again outruns prohibition
The Danish example offers a counterbalance to these missteps. When policymakers focus on reducing harm rather than eliminating nicotine, the public health results are unmistakable. Youth smoking plummets. Adult smokers transition to less harmful alternatives. And the entire population faces lower risk.

The UngMap 2025 findings—together with Nordic trend data and earlier Danish national surveys—paint a consistent picture: nicotine use is not disappearing, but its form is changing. Combustion is fading. Non-combustible alternatives are rising. And the shift is occurring fastest where policy, innovation, and accurate information align.

For tobacco harm reduction advocates, the message is clear. Progress depends on embracing realism rather than ideology, supporting safer alternatives rather than banning them, and correcting misinformation rather than amplifying fear. When given access to lower-risk products, young people overwhelmingly choose them over cigarettes. When adult smokers are supported—rather than stigmatised—they make life-saving transitions. Ultimately, the Danish data confirm what harm reduction science has been saying for years: if society wants smoking to disappear, the way forward is not prohibition or panic, but substitution.