Continuum of tobacco product risk

Tobacco products along the harm minimization continuum. The harm minimization continuum posits that all nicotine-containing products are not equally harmful and, instead, range from exceptionally low harm (eg, NRT) to exceptionally high harm (eg, combusted tobacco such as cigarettes, cigars, hookah, pipe). The figure depicts 4 panels representing classes of products.

Panel 1 (right) depicts products containing tobacco that is combusted or smoked.

Panel 2 (right middle) depicts products containing tobacco that is noncombusted or smokeless. Smokeless products are far less harmful than smoked tobacco, but there is variation in the smokeless tobacco category. Low nitrosamine Swedish-type snus is lower in relative harm than unrefined tobacco. Heat-not-burn tobacco products (eg, heat sticks) would fall into this panel.

Panel 3 (left middle) depicts the class of nicotine delivery products without any tobacco (e-cigs/e-vapor products and NRTs).

Panel 4 (left) depicts no use.