The most commonly used method of quitting smoking in the United States, substituting e-cigarettes for cigarettes, was not conceived by, is not recommended by, and was, until very recently, not controlled by the U.S. Food and Drug Administration (FDA). The increasing popularity of a method of quitting smoking that is not recognised by FDA as an effective smoking cessation method highlights a divergence between how tobacco harm reduction has been conceptualised within the medical science and health policy communities and how tobacco harm reduction is being exercised in the real world by more and more smokers.

In this presentation, I argue that, for the past decade, tobacco harm reduction in the real world has been driven by manufacturers, vendors, consumers and advocates of vapour products. Testimony reveals that smokers rarely initiate vaping without first researching the products or talking to a vaper or a vape shop sales assistant about why they vape, how the vaping experience compares to smoking, or how their life and health has changed since becoming a former-smoking vaper. The knowledge, practical advice and encouragement that have been transferred to smokers through millions of such interactions have likely rationalised and motivated millions of attempts to substitute e-cigarettes for conventional cigarettes that may not have occurred in the absence of these peer interactions.

The increasing preference of U.S. smokers to use nicotine-containing products as a method of quitting smoking suggests progress towards a smoke-free society may be further accelerated by a nicotine regulatory system that encourages an expansion and diversification of the market in new tobacco and nicotine products that appeal to and reduce harm to smokers, and maximises the user community’s opportunities to interact with smokers.