Abstract

The global tobacco epidemic continues to pose a significant public health threat, accounting for over eight million 
deaths annually. Despite major policy advances under the World Health Organization’s Framework Convention 
on Tobacco Control (WHO FCTC), tobacco use remains deeply entrenched, particularly in low- and middle
income countries where industry expansion, weak regulation, and limited cessation support persist. This narrative 
review examines global tobacco harm reduction (THR) strategies as complementary approaches to conventional 
tobacco control. It explores product-level interventions such as nicotine replacement therapies (NRTs), 
pharmacotherapies, and safer nicotine alternatives, including electronic cigarettes and heated tobacco products, 
alongside population-level policies, including taxation, smoke-free laws, and marketing restrictions. The review 
highlights that while nicotine replacement therapies remain the safest and most evidence-based cessation aids, 
emerging reduced-risk products continue to raise ethical, regulatory, and equity challenges. A comparative 
analysis of high-, middle-, and low-income contexts highlights disparities in access, regulation, and public 
awareness of harm reduction. The paper further identifies gaps in surveillance, monitoring, and policy coherence 
that limit the global effectiveness of THR initiatives. Overall, it argues that effective harm reduction requires an 
integrated approach that balances risk mitigation, equity, ethical governance, and industry accountability to 
accelerate global progress toward reducing tobacco-related diseases and eventual cessation.