Sources

Smoker wants e-ciggie nicotine at a shop near him

Martin Johnston. The New Zealand Herald, 2010.

Mark, featured in 2010: down from 30 cigarettes a day to three. The Ministry of Health’s position at the time was that distributing nicotine e-cigarettes would be an offence.

Pneumothorax (patient information) ↗

North Tees and Hartlepool NHS Foundation Trust. nth.nhs.uk, 2026.

Treatment of a collapsed lung: a small one may need none; otherwise the air is drawn off with a needle, or through a thin tube (a chest drain) between the ribs. About 1 in 3 people have another within 12 months.

Pneumothorax: information for patients (PI22/2698/01) ↗

Thoracic Surgery, Queen Elizabeth Hospital Birmingham. uhb.nhs.uk, 2024.

What the operation involves: general anaesthetic, usually keyhole (VATS) with up to four small cuts; blebs and bullae stapled and removed (bullectomy); the lung made to stick to the chest wall (pleurectomy or pleurodesis); a chest drain for at least two days. Recurrence: 20–30% without surgery, about 5% after VATS.

Smoking and the increased risk of contracting spontaneous pneumothorax ↗

Bense L, Eklund G, Wiman LG. Chest 92(6):1009–1012, 1987. doi:10.1378/chest.92.6.1009

Swedish study: smoking raised the risk of a first spontaneous pneumothorax about ninefold in women and 22-fold in men, with a clear dose-response.

Nicotine without smoke: tobacco harm reduction ↗

Royal College of Physicians (London). RCP report, 2016.

Quotes Michael Russell (1970s): “smokers smoke for nicotine but are killed by tar”. Concludes the long-term hazard of vaping is “unlikely to exceed 5% of the harm from smoking tobacco”.

Low-tar medium-nicotine cigarettes: a new approach to safer smoking ↗

M. A. H. Russell. British Medical Journal 1(6023):1430–1433, 1976. doi:10.1136/bmj.1.6023.1430

The original paper behind the famous nicotine-versus-tar line. The full text is a scanned image we couldn’t check word for word, so we quote the wording as verified in the RCP’s 2016 report.

Health Effects of Cigarettes: Cancer ↗

US Centers for Disease Control and Prevention. cdc.gov, 2024.

“Cigarette smoke contains more than 7,000 chemicals. At least 69 of these chemicals can cause cancer.”

Temperature variation within a cigarette combustion coal during the smoking cycle ↗

R. R. Baker. High Temperature Science 7:236–247, 1975.

Measured about 850°C in the centre of the burning coal during a puff, and about 900°C at its edge. The author worked for British American Tobacco; the physical measurements are widely cited.

Measurement of heating coil temperature for e-cigarettes with a “top-coil” clearomizer ↗

Chen W, Wang P, Ito K, et al.. PLOS ONE 13(4):e0195925, 2018. doi:10.1371/journal.pone.0195925

Properly wicked coils peaked at 110–185°C; a dry, overheating coil reached 322–1,008°C — the “dry puff” that vapers taste and avoid.

Using e-cigarettes to stop smoking ↗

NHS (England). nhs.uk, 2026.

“Most of the harm from smoking comes from the thousands of other chemicals in tobacco smoke, many of which are toxic.” Also: vaping is not completely risk-free and long-term effects aren’t yet known.

Is vaping harmful? ↗

Cancer Research UK. cancerresearchuk.org, 2026.

“Research so far shows vaping is far less harmful than smoking.”

Public Health Consequences of E-Cigarettes ↗

National Academies of Sciences, Engineering, and Medicine. The National Academies Press, 2018.

Conclusive evidence that completely switching reduces exposure to numerous toxicants and carcinogens (18-1). Also substantial evidence that e-cigarette use increases the risk of young people ever trying a cigarette (16-1).

Tobacco (fact sheet) ↗

World Health Organization. who.int, 2026.

“Tobacco kills more than 7 million people each year, including over 1.6 million non-smokers who are exposed to second-hand smoke.”

Levels of selected carcinogens and toxicants in vapour from electronic cigarettes ↗

Goniewicz ML, Knysak J, Gawron M, et al.. Tobacco Control 23(2):133–139, 2014. doi:10.1136/tobaccocontrol-2012-050859

Toxicants in vapour were 9 to 450 times lower than in cigarette smoke. Tested early (2012-era) devices.

Nicotine, carcinogen, and toxin exposure in long-term e-cigarette and nicotine replacement therapy users ↗

Shahab L, Goniewicz ML, Blount BC, et al.. Annals of Internal Medicine 166(6):390–400, 2017. doi:10.7326/M16-1107

People who had fully switched had under 3% of smokers’ levels of the carcinogen marker NNAL. Dual users (still smoking) saw little benefit. Small cross-sectional study, funded by Cancer Research UK.

Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes ↗

Goniewicz ML, Smith DM, Edwards KC, et al.. JAMA Network Open 1(8):e185937, 2018. doi:10.1001/jamanetworkopen.2018.5937

US PATH Study: exclusive vapers vs exclusive smokers — NNAL about 98% lower, acrylonitrile marker about 97% lower, 2-naphthol about 62% lower, cadmium about 30% lower.

Exhaled carbon monoxide levels in forty resistant-to-cessation male smokers after six months of full switch to e-cigarettes or a tobacco heating system ↗

Beatrice F, Massaro G. Int J Environ Res Public Health 16(20):3916, 2019. doi:10.3390/ijerph16203916

Median exhaled carbon monoxide fell from 12 ppm to 2 ppm after six months of fully switching. Small study (20 per group).

Estimating the harms of nicotine-containing products using the MCDA approach ↗

Nutt DJ, Phillips LD, Balfour D, et al.. European Addiction Research 20(5):218–225, 2014. doi:10.1159/000360220

An expert panel scored 12 nicotine products: cigarettes 100, e-cigarettes 4, snus 5, nicotine replacement about 2. Expert judgement, not measurement — and funding/conflicts were criticised.

E-cigarettes around 95% less harmful than tobacco estimates landmark review ↗

McNeill A, Brose LS, Calder R, et al.. GOV.UK press release and evidence update, 2015.

E-cigarettes: Public Health England’s evidence-based confusion ↗

The Lancet. The Lancet 386(9996):829, 2015. doi:10.1016/S0140-6736(15)00042-2

Criticised the 95% figure’s reliance on a single expert workshop and its disclosed funding.

Evidence about electronic cigarettes: a foundation built on rock or sand? ↗

McKee M, Capewell S. BMJ 351:h4863, 2015. doi:10.1136/bmj.h4863

Nicotine vaping in England: 2022 evidence update ↗

McNeill A, Simonavičius E, Brose LS, et al.. Office for Health Improvement and Disparities (UK), 2022.

Vaping “poses only a small fraction of the risk of smoking” and the “at least 95% less harmful” estimate “remains broadly accurate, at least over short term and medium term periods”.

E-cigarettes and harm reduction: an evidence review ↗

Royal College of Physicians (London). RCP report, 2024.

E-cigarettes “are not harmless” but are “demonstrably less harmful than smoked tobacco to user and bystander alike”. Also calls for measures to curb youth vaping.

Electronic cigarettes for smoking cessation ↗

Lindson N, Butler AR, Hartmann-Boyce J, et al.. Cochrane Database of Systematic Reviews (6th update, published 26 August 2026), 2026. doi:10.1002/14651858.CD010216.pub11

80 randomised trials, 29,861 people. Nicotine e-cigarettes vs nicotine replacement: risk ratio 1.61 (95% CI 1.23–2.12), high-certainty evidence — about 10 in 100 quit versus 6 in 100.

A randomized trial of e-cigarettes versus nicotine-replacement therapy ↗

Hajek P, Phillips-Waller A, Przulj D, et al.. New England Journal of Medicine 380(7):629–637, 2019. doi:10.1056/NEJMoa1808779

886 smokers in UK stop-smoking services. One-year validated abstinence: 18.0% with e-cigarettes vs 9.9% with nicotine replacement.

Electronic cigarettes for smoking cessation: a randomised controlled trial ↗

Bullen C, Howe C, Laugesen M, et al.. The Lancet 382(9905):1629–1637, 2013. doi:10.1016/S0140-6736(13)61842-5

Auckland trial (ASCEND), 657 smokers: 7.3% quit with e-cigarettes vs 5.8% with patches at six months — not statistically significant; early devices and low quit rates left the trial underpowered.

Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial ↗

Walker N, Parag V, Verbiest M, et al.. The Lancet Respiratory Medicine 8(1):54–64, 2020. doi:10.1016/S2213-2600(19)30269-3

1,124 NZ smokers (about 40% Māori). Six-month abstinence: patches + nicotine e-cigarette 7%, patches + nicotine-free e-cigarette 4%, patches alone 2%.

Vaping to quit initiative ↗

Health New Zealand | Te Whatu Ora. healthnz.govt.nz, 2026.

Official position: “For people who smoke, vaping is less harmful but not harmless.” Free vape kits through Stop Smoking Services since January 2025: 1,889 of 5,261 people who quit (Jan–Aug 2025) used one.

Vaping to stop smoking ↗

Health New Zealand | Te Whatu Ora. healthnz.govt.nz, 2026.

Official advice for switching: start at a nicotine strength that matches how much you smoke (20+ a day: 18–20 mg/mL; 10–20: 12–18 mg/mL; under 10: 6–12 mg/mL), switch completely as soon as you can, a slip isn’t failure, and keep e-liquid away from children — it’s poisonous if swallowed.

Stopping smoking ↗

Health New Zealand | Te Whatu Ora. healthnz.govt.nz, 2026.

Free Stop Smoking Services: support where it suits you, free nicotine replacement therapy, free vape kits, vouchers and advice on medicines. Many offer kaupapa Māori and whānau-centred support.

Nicotine is why tobacco products are addictive ↗

US Food and Drug Administration. fda.gov, 2026.

“It’s the thousands of chemicals contained in tobacco and tobacco smoke that make tobacco use so deadly.”

Evidence summary: the health effects of nicotine ↗

Action on Smoking and Health (UK), with academics from King’s, UCL, Imperial, Dundee and the RCP Tobacco Advisory Group. ash.org.uk, 2025.

“The research consensus is that nicotine does not cause cancer, nor is it linked in isolation to most of the diseases that smoking causes.” On the teenage brain: animal findings; “it is unclear whether these effects occur in humans”. Also summarises a 2025 Korean study: heart-stent patients who switched completely to vaping had 18% lower long-term cardiac risk than those who kept smoking.

Agents classified by the IARC Monographs ↗

International Agency for Research on Cancer (WHO). monographs.iarc.who.int, 2026.

Tobacco smoke and smokeless tobacco are Group 1 carcinogens. Nicotine itself has not been classified.

Does nicotine replacement therapy cause cancer? Evidence from the Lung Health Study ↗

Murray RP, Connett JE, Zapawa LM. Nicotine & Tobacco Research 11(9):1076–1082, 2009. doi:10.1093/ntr/ntp104

3,320 people followed for up to 12.5 years: nicotine gum use did not predict cancer (all cancers HR 1.00); smoking did predict lung cancer.

WHO Model List of Essential Medicines — nicotine replacement therapy ↗

World Health Organization. list.essentialmeds.org, 2009.

Nicotine replacement therapy has been on the core list since 2009.

Cardiovascular events associated with smoking cessation pharmacotherapies: a network meta-analysis ↗

Mills EJ, Thorlund K, Eapen S, et al.. Circulation 129(1):28–41, 2014. doi:10.1161/CIRCULATIONAHA.113.003961

63 trials: nicotine replacement was linked to more cardiovascular events, driven mainly by less serious ones such as palpitations, not heart attacks.

Cardiovascular safety of varenicline, bupropion, and nicotine patch in smokers: a randomized clinical trial ↗

Benowitz NL, Pipe A, West R, et al.. JAMA Internal Medicine 178(5):622–631, 2018. doi:10.1001/jamainternmed.2018.0397

8,058 smokers: no evidence the nicotine patch increased serious cardiovascular events.

Transdermal nicotine treatment and progression of early Parkinson’s disease ↗

Oertel W, Müller HH, Schade-Brittinger C, et al.. NEJM Evidence, 2023. doi:10.1056/EVIDoa2200311

163 people with early Parkinson’s: nicotine patches did not slow the disease.

Transdermal nicotine for induction of remission in ulcerative colitis ↗

McGrath J, McDonald JWD, Macdonald JK. Cochrane Database of Systematic Reviews, 2004. doi:10.1002/14651858.CD004722.pub2

Mixed results, and people on nicotine were far more likely to drop out because of side effects.

Nicotine treatment of mild cognitive impairment: a 6-month double-blind pilot clinical trial ↗

Newhouse P, Kellar K, Aisen P, et al.. Neurology 78(2):91–101, 2012. doi:10.1212/WNL.0b013e31823efcbb

Small pilot (74 people): improved attention measures, no change in clinicians’ overall rating. A larger trial finished in 2026; results weren’t available when we checked.

Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial ↗

Hajek P, Przulj D, Pesola F, et al.. Nature Medicine 28(5):958–964, 2022. doi:10.1038/s41591-022-01808-0

1,140 pregnant smokers: 6.8% vs 4.4% quit — not statistically significant — and no safety signal from either product.

E-cigarettes, vapes, and other electronic nicotine delivery systems (ENDS) ↗

US Food and Drug Administration. fda.gov, 2026.

“E-cigarettes can generally be a lower-risk alternative for adults who smoke cigarettes, [but] the use of e-cigarettes is not risk-free.” Long dual use can be as harmful as smoking.

Metal concentrations in e-cigarette liquid and aerosol samples: the contribution of metallic coils ↗

Olmedo P, Goessler W, Tanda S, et al.. Environmental Health Perspectives 126(2):027010, 2018. doi:10.1289/EHP2175

Metals leach from heating coils. In many users’ devices nickel and chromium exceeded reference limits — for those two metals, emissions were higher than from cigarettes.

National estimates of poisoning events related to liquid nicotine in young children treated in US hospital emergency departments, 2013–2017 ↗

Chang JT, Wang B, Chang CM, Ambrose BK. Injury Epidemiology 6:10, 2019. doi:10.1186/s40621-019-0188-9

An estimated 4,745 US emergency visits for children under five, peaking in 2015 and falling after child-resistant packaging became law.

Electronic cigarette fires and explosions in the United States 2009–2016 ↗

McKenna LA Jr. U.S. Fire Administration (FEMA), 2017.

195 incidents in eight years; 133 injuries; no US deaths recorded. Almost always a battery problem.

PubMed records on e-cigarettes and vaping, counted by year ↗

US National Library of Medicine. pubmed.ncbi.nlm.nih.gov, 2026.

17,561 records as of 25 September 2026, counted by the date each was added to PubMed.

CDC, states update number of hospitalized EVALI cases and EVALI deaths ↗

US Centers for Disease Control and Prevention. CDC media statement (archived), 2020.

2,807 hospitalised cases and 68 deaths. Vitamin E acetate — an additive in illicit THC cartridges — was “strongly linked”.

Outbreak of lung injury associated with the use of e-cigarette, or vaping, products ↗

US Centers for Disease Control and Prevention. cdc.gov (archived), 2020.

Vitamin E acetate found in 48 of 51 patients’ lung samples. 82% reported THC products; 78% of those got them from informal sources such as dealers.

Does vaping cause popcorn lung? ↗

Cancer Research UK. cancerresearchuk.org, 2024.

“There have been no confirmed cases of popcorn lung linked to e-cigarettes.”

Evaluation of electronic cigarette liquids and aerosol for the presence of selected inhalation toxins ↗

Farsalinos KE, Kistler KA, Gillman G, Voudris V. Nicotine & Tobacco Research 17(2):168–174, 2015. doi:10.1093/ntr/ntu176

Diacetyl exposure from sweet-flavoured liquids was about 100 times lower than from smoking — but about half of the samples containing it still exceeded strict workplace limits.

Hidden formaldehyde in e-cigarette aerosols ↗

Jensen RP, Luo W, Pankow JF, Strongin RM, Peyton DH. New England Journal of Medicine 372(4):392–394, 2015. doi:10.1056/NEJMc1413069

No formaldehyde-releasing agents at 3.3 volts. At 5.0 volts, high levels — the basis of “worse than cigarettes” headlines.

E-cigarettes generate high levels of aldehydes only in ‘dry puff’ conditions ↗

Farsalinos KE, Voudris V, Poulas K. Addiction 110(8):1352–1356, 2015. doi:10.1111/add.12942

Electronic cigarette use and myocardial infarction among adults in the US Population Assessment of Tobacco and Health ↗

Bhatta DN, Glantz SA. Journal of the American Heart Association 8(12):e012317 — retracted 18 February 2020, 2019. doi:10.1161/JAHA.119.012317

Retracted because the analysis couldn’t show the heart attacks happened after people started vaping.

Evidence review of e-cigarettes and heated tobacco products 2018 ↗

McNeill A, Brose LS, Calder R, Bauld L, Robson D. Public Health England, 2018.

“To date, there have been no identified health risks of passive vaping to bystanders.” Adds that any effects should be monitored.

Young vapers perform worse in exercise testing, research shows ↗

Manchester Metropolitan University. MMU news release, 2025.

Widely reported as “vaping worse than smoking”. At the time, the work was an unpublished conference abstract based on incomplete data (44 of 60 planned participants).

Cigarette smoking and e-cigarette use induce shared DNA methylation changes linked to carcinogenesis ↗

Herzog C, Jones A, Evans I, et al.. Cancer Research 84(11):1898–1914, 2024. doi:10.1158/0008-5472.CAN-23-2957

Found some shared molecular changes. A biomarker signal worth watching — not evidence that vapers get cancer.

Association of electronic cigarette use and risk of COPD: a systematic review and meta-analysis ↗

Shabil M, Malvi A, Khatib MN, et al.. npj Primary Care Respiratory Medicine 35:31, 2025. doi:10.1038/s41533-025-00438-6

Headline odds ratio 1.48 — but in the stronger cohort studies the link wasn’t statistically significant (1.145, CI 0.842–1.557), and the authors say it may partly reflect past or current smoking.

Vaping, smoking and lung cancer risk ↗

Bittoni MA, Carbone DP, Harris RE. Journal of Oncology Research and Therapy 9(3):10229, 2024. doi:10.29011/2574-710x.10229

The study states “nearly all vapers also smoked” — it measures dual use, not vaping on its own.

Survey shows misperceptions about vaping and nicotine are keeping people smoking ↗

Action for Smokefree 2025 (ASH NZ); survey by Talbot Mills Research. ash.org.nz, 2026.

2,291 New Zealanders: 31% of smokers and 19% of the public agree vapes are less harmful than cigarettes; 71% think nicotine is extremely or very harmful. 46% of smokers who tried vaping and went back to cigarettes cited worries about vaping’s health risks.

Trends in harm perceptions of e-cigarettes vs cigarettes among adults who smoke in England, 2014–2023 ↗

Jackson SE, Tattan-Birch H, East K, Cox S, Shahab L, Brown J. JAMA Network Open 7(2):e240582, 2024. doi:10.1001/jamanetworkopen.2024.0582

Smokers in England who think vaping is as harmful as smoking or more: 41.1% (Nov 2014) → 57.0% (June 2023).

Changing perceptions of harm of e-cigarette vs cigarette use among adults in 2 US national surveys from 2012 to 2017 ↗

Huang J, Feng B, Weaver SR, et al.. JAMA Network Open 2(3):e191047, 2019. doi:10.1001/jamanetworkopen.2019.1047

Use of vapes among young people in Great Britain (fact sheet) ↗

Action on Smoking and Health (UK). ash.org.uk, 2026.

62% of 11–17-year-olds wrongly believe vaping is as harmful as smoking or worse.

Trends in smoking and vaping: New Zealand Health Survey 2024/25 (and earlier annual updates) ↗

Ministry of Health | Manatū Hauora. health.govt.nz, 2025.

Adult daily smoking 16.4% (2011/12) → 6.8% (2024/25). Daily vaping 0.9% (2015/16) → 11.7% (2024/25). The Ministry says the survey can’t show that vaping caused the fall.

Smokefree Aotearoa 2025 Action Plan — Auahi Kore Aotearoa Mahere Rautaki 2025 ↗

Ministry of Health. health.govt.nz, 2021.

“Smoking tobacco products kills approximately 4,500 to 5,000 people every year in New Zealand.”

Smoking prevalence and trends: important findings from the 2024-25 New Zealand Health Survey ↗

Public Health Communication Centre Aotearoa (Otago). phcc.org.nz, 2025.

The Smokefree 2025 goal (under 5% daily smoking for all groups) will not be met; progress has stalled.

New Zealand’s accelerating smoking decline: lessons for tobacco harm reduction ↗

Beaglehole R, Bonita R, Youdan B. The Lancet Regional Health – Western Pacific 72:101882, 2026. doi:10.1016/j.lanwpc.2026.101882

Argues vaping helped speed up the decline, while acknowledging this kind of analysis can’t prove cause.

Misplaced optimism about e-cigarettes for smoking cessation in New Zealand ↗

Blum, Yao, Mock. The Lancet Regional Health – Western Pacific 72:101911, 2026. doi:10.1016/j.lanwpc.2026.101911

The counter-argument, published in the same journal volume.

Smokefree Environments and Regulated Products Act 1990 (consolidated) ↗

New Zealand Parliament. legislation.govt.nz, 2026.

Section 24(j) exempts unsponsored commentary and opinion that encourages people to switch to a significantly less harmful product.

Recent changes to Smokefree laws; Vaping and smokefree history and timelines ↗

Ministry of Health. health.govt.nz, 2025.

R18 sales (2020); dairies and service stations limited to tobacco, mint and menthol; specialist stores at least 300 m from schools and marae; fines for selling to minors up to $100,000 (Dec 2024); disposable vapes banned (17 June 2025).

Quitline — free support to stop smoking or vaping ↗

Quitline | Te Hā. quit.org.nz, 2026.

0800 778 778 · text 4006.

ASH Year 10 Snapshot Survey 2024: Topline — youth smoking and vaping ↗

Action for Smokefree 2025 (ASH NZ). ash.org.nz (30,339 students), 2024.

14–15-year-olds: daily smoking 1.2%; daily vaping 8.7%, down from 10.0% — the first fall. Regular vaping peaked at 20.2% in 2021 and has fallen for three years. Among never-smokers, daily vaping is 3.7%.

Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis ↗

Soneji S, Barrington-Trimis JL, Wills TA, et al.. JAMA Pediatrics 171(8):788–797, 2017. doi:10.1001/jamapediatrics.2017.1488

Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check ↗

Levy DT, Warner KE, Cummings KM, et al.. Tobacco Control 28(6):629–635, 2019. doi:10.1136/tobaccocontrol-2018-054446

US youth smoking fell two to four times faster after vaping spread (2014 onward).

Trends in electronic cigarette use and conventional smoking: quantifying a possible ‘diversion’ effect among US adolescents ↗

Selya AS, Foxon F. Addiction 116(6):1424–1433, 2021. doi:10.1111/add.15385

Associations of flavored e-cigarette uptake with subsequent smoking initiation and cessation ↗

Friedman AS, Xu S. JAMA Network Open 3(6):e203826, 2020. doi:10.1001/jamanetworkopen.2020.3826

People who started on non-tobacco flavours were not more likely to take up smoking.

Drug harms in the UK: a multicriteria decision analysis ↗

Nutt DJ, King LA, Phillips LD; Independent Scientific Committee on Drugs. The Lancet 376(9752):1558–1565, 2010. doi:10.1016/S0140-6736(10)61462-6

Experts scored 20 drugs on 16 kinds of harm. Alcohol was the most harmful overall (72 out of 100), ahead of heroin (55) and crack cocaine (54), and the most harmful to other people. Expert judgement, not measurement; e-cigarettes weren’t among the drugs scored.

Global status report on alcohol and health and treatment of substance use disorders (news release) ↗

World Health Organization. who.int, 25 June 2024, 2024.

2.6 million deaths a year attributable to alcohol (2019 data), 4.7% of all deaths. The highest share, 13%, was among people aged 20–39.

Flavored alcoholic beverage use, risky drinking behaviors, and adverse outcomes among underage drinkers: results from the ABRAND Study ↗

Albers AB, Siegel M, Ramirez RL, Ross C, DeJong W, Jernigan DH. American Journal of Public Health 105(4):810–815, 2015. doi:10.2105/AJPH.2014.302349

1,031 US drinkers aged 13–20. Drinking only alcopops was linked with heavy episodic drinking and alcohol-related injuries; drinking only premixed cocktails with heavy drinking and injuries needing medical care. A survey, so it shows links, not cause.

Tobaksrökning i Sverige (tobacco smoking in Sweden) ↗

Folkhälsomyndigheten. folkhalsomyndigheten.se, 2024.

5% of Swedes aged 16–84 smoked daily in 2024.

Attitudes of Europeans towards tobacco and related products ↗

European Commission. europa.eu (fieldwork May–June 2023), 2024.

24% of EU respondents smoke cigarettes, cigars, cigarillos or a pipe. A broader measure than Sweden’s daily-smoking figure, so treat the gap as indicative.

Council Directive 92/41/EEC — labelling of tobacco products and ban on tobacco for oral use ↗

Council of the European Communities. EUR-Lex, 1992.

Banned oral tobacco across the EU. Sweden kept snus when it joined in 1995.

Overview of tobacco-based and synthetic-based oral nicotine products ↗

Medsafe (NZ Medicines and Medical Devices Safety Authority). medsafe.govt.nz, 2025.

Selling snus, or recreational nicotine pouches, is currently illegal in New Zealand without a medicine or psychoactive-substance approval. Importing tobacco-based products for your own use is allowed.