Our Enhanced Scholar Dr. Sree Sucharitha, M.D. and her colleague Dr. S. Manikandan presented at the International Conference on Biomedical and Cancer Research in February 2021. Drs. Sucharitha and Manikandan, both of Tagore Medical College and Hospital, Chennai, showcased their work on assessing the levels of cotinine, a metabolite of nicotine with a long half-life, in the urine of migrant workers in Chennai. This group is especially vulnerable to high tobacco use and poor health outcomes. The study, sponsored by CHRA-Mumbai, demonstrated that cotinine measurement has the potential to offer a better understanding of tobacco use prevalence, as self-reporting is unreliable, and that targeted cessation and tobacco harm reduction interventions for this population should be actively pursued.

Ashok, a researcher at the Nepal Health Research Council, undertook a review with his co-authors of the existing scientific literature on vaping as a potential harm reduction intervention for adolescents already using tobacco in risky ways such as smoking. The review followed the Standard Cochrane method, covering articles published between January 2003 and June 2018. The resulting paper is available to access as a preprint on ResearchGate.

In September 2018, Will founded the news website Filter with the help of his Scholarship. Filter’s mission is to advocate through journalism for rational and compassionate approaches to drug use, drug policy and human rights. Since the start, tobacco harm reduction has been fully integrated into the magazine’s vision. By 2021, Filter attracts millions of unique visitors annually, with hundreds of thousands of people reading its THR-related stories each year. The website also provides comment and analysis on a range of research studies in the THR field, helping to disseminate the latest scientific information to non-specialist audiences. Filter’s work has been praised and republished by dozens of media outlets, as well as being translated into other languages, with recent citations of its reporting in the Washington Post, the Boston Globe and TIME.

Filter published Uche’s article on the need to make tobacco harm reduction affordable for smokers in Nigeria. In a THR Nigeria survey of smokers in Lagos, more than two thirds of respondents reported they would like to switch to a less harmful alternative. Yet 60 per cent said the price of vaping devices in Nigeria was a major barrier to switching. In a country where single-stick sales are still common despite being illegal, the low cost of cigarettes make them accessible to everyone – driving experimentation and use among children and teenagers. THR Nigeria continues to work to raise awareness of the potential of tobacco harm reduction among policymakers and consumers alike. As part of his project, Uche also set up the THR Nigeria website.

The Snus Revolution podcast is a collaboration between 2021/22 Scholar Bengt Wiberg, from Sweden, and former Scholar Michael McGrady, from the US. With a mix of discussion, snus news and interviews, Bengt and Michael use the podcast to share the message of tobacco harm reduction and how snus could offer a significant contribution to a smoke-free world in the future.

While doing a PhD at the School of Health Sciences, Waterford Institute of Technology, Florian wanted to see if providing vapes to people accessing homeless services in Ireland could help them quit smoking. The use of combustible cigarettes is widespread among homeless populations. They are disproportionately affected by tobacco-related diseases such as chronic obstructive pulmonary disease (COPD) and Florian’s study showed vaping could be effective for this population. His paper, originally published in Harm Reduction Journal, was then cited by a Cochrane Review on ‘Interventions to reduce tobacco use in people experiencing homelessness’ and was included in the Cochrane Review of ‘Electronic cigarettes for tobacco cessation’.

Ngirimbo is a form of oral smokeless tobacco used by smokers in Malawi. For his Enhanced Scholarship, Vita performed a range of scientific tests on the ngirimbo used in the Chitipa District of Malawi to determine the concentration of toxic heavy metals, minerals of potential toxicity and other harmful chemicals found in the samples. A preprint of his research, published on Research Square, suggests that prolonged use of ngirimbo is a significant health risk to people with chronic diseases. Nonetheless, with the application of the recommended toxicological processes of refinement, reduction and replacement, ngirimbo may provide a valid method of tobacco harm reduction and a potential smoking cessation tool.

Lithuania has no national smoking cessation programme, while novel tobacco and nicotine products are primarily portrayed by the media as dangerous. Since 2019, behavioral support to quit smoking is offered at five branches of the Republican Centre for Addictive Disorders (RCAD), a healthcare institution that provides medical, psychological and social services to people experiencing alcohol, drug or tobacco dependency in Lithuania. For their Scholarship project, Aušra and Dovilė set out to both assess the tobacco harm reduction knowledge base of RCAD staff and other specialists working in governmental institutions and NGOs, and provide them with training. Their research revealed a general lack of awareness among specialists about novel tobacco and nicotine products. But they did find those who attended their training modules went on to understand the benefits of harm reduction measures.

It is currently illegal to sell e-liquid containing nicotine for vaping in Norway, so the country’s vapers have to buy these products abroad. Norway has declared it will lift its ban on e-cigarettes with nicotine when it adopts the EU’s Tobacco Products Directive (TPD), and Helene wanted to study the impact of this new legislation by carrying out surveys with vapers before and after its implementation. While the new laws were expected in 2020, they have since been delayed, so Helene was unable to complete both parts of her project. But her first survey produced some interesting findings. Only 9% of the vapers are under 30 years of age, a fact that should reassure policymakers worried that legalisation will recruit young people to vaping. She found that while Norway’s vapers currently use relatively low levels of nicotine, many of them started with higher levels. Therefore, any law restricting the legal limit to 20 mg/ml could prevent some smokers quitting as they needed higher levels of nicotine to successfully make the switch away from combustible cigarettes.

While little known in Malawi, snus is a widely used oral safer nicotine product in Scandinavia. Its popularity in Sweden is associated with that country having the lowest rate of smoking-related mortality in Europe and half the average EU rate for smoking-related disease. As an Enhanced Scholar, Patrick explored the feasibility of local snus production using Malawian-grown tobacco leaf. This project complements a snus-use feasibility study being conducted by fellow Scholar Sahan Lungu (see the Meet our Scholars section above for more on Sahan’s work). Patrick concluded that snus could be locally produced, providing an economically viable safer nicotine product for consumers in Malawi.

For his Enhanced Scholarship, Chimwemwe set up THR Malawi, an organisation that shares the latest knowledge on tobacco harm reduction and nicotine science with the people of Malawi. The website provides a range of resources that put sciencebased information in the hands of consumers and allow them to make informed decisions about their health. After completing his projects, Chimwemwe was invited to mentor other Scholars and he is now helping to support tobacco harm reduction worldwide after being recruited to join the K•A•C team as THR Scholarship Manager. To find out more about his experiences, read the Focus on Malawi section above.

Greece has the highest smoking prevalence in the European Union according to the latest Eurobarometer survey (2017). But Eleni’s survey found Greek healthcare professionals working in both public and private smoking cessation clinics in Athens have poor knowledge levels about nicotine, vaping devices and heated tobacco products (HTP). Despite the fact nicotine is not a carcinogen, more than 40% of respondents mistakenly believed nicotine’s contribution to smoking-related diseases was “extremely important” while a further 25% believed it was “important”. In addition, while Public Health England estimates that vapes are 95% less harmful than smoking, nearly 70% of the Greek healthcare professionals who completed the questionnaire would not recommend smokers to switch to vaping devices or HTP in a bid to quit combustible cigarettes. The study’s findings suggest the lack of tobacco harm reduction knowledge among those working in these clinics may have a negative impact on the provision of appropriate and reliable counselling to smokers in Greece who are looking to quit.

With the number of cigarette smokers in Kenya increasing, Christopher’s project aimed to empower the residents of 10 villages in Nairobi’s Kibera slum to take control of their health. The resulting Kibera Tobacco Harm Reduction Network has directly engaged more than 1,000 community members. These include five Community Health Workers, who gained popularity as champions of tobacco harm reduction within their health facilities, and a further 10 community tobacco harm reduction champions who received specialist training before leading weekly group meetings to promote the use of safer nicotine products. The project uses community radio stations and has had a particular focus on the creative arts. With low literacy levels, many members of the community have only been introduced to the field through the Kibera Tobacco Harm Reduction theatre group. Every Sunday they perform street theatre on the health risks associated with tobacco smoking while educating the community about safer alternatives. They have also been invited to appear in schools where they have informed not just the children, but teachers as well.