Smokers who combine cigarettes with alternative nicotine products smoke significantly less, a new study from Spain reveals, and in some cases quit completely, poking holes in misplaced fears about the dynamics of dual use.  

The study, published in Research in Economics, analysed usage patterns among more than 1,300 nicotine consumers in Spain. The analysis focused on the relationship between cigarettes, e-cigarettes, and heated tobacco.  

The results challenge several concerns commonly voiced by anti-nicotine advocates about claiming that “dual use” of cigarettes and non-combustible nicotine alternatives lead to more smoking, not less. 

Smokers start with cigarettes, not alternatives 

A central conclusion is that cigarettes are in almost all cases the starting point. 89 percent of the participants state that their nicotine consumption started smoking, while alternative products were added later.  

This dynamic goes against the narrative that new nicotine products act as a gateway. 

“The results confirm what we have long seen in Sweden,” says Patrik Strömer, Secretary General of the Association of Swedish Snus Manufacturers. 

“The problem starts with cigarettes, not with smokeless alternatives.” 

Dual use linked to reduced smoking 

At the same time, the study shows that dual use is associated with a clear reduction in smoking.  

People who combine cigarettes with alternative nicotine products smoke an average of 34 percent fewer cigarettes per year. Viewed over a five-year period, this is a reduction of 42 percent. 

The results show that less-harmful nicotine alternatives replace a significant portion of smokers’ cigarette consumption. 

“When smokers have access to less harmful alternatives, we see that cigarettes get pushed out,” says Strömer. 

“That’s the essence of harm reduction.” 

Total nicotine consumption actually decreases slightly among dual users, indicating dynamics marked by not only substitution, but also reduction, are at play. Furthermore, nearly one in five (19 percent) report having quit using nicotine completely. 

Taken together, the study’s results point to a clear pattern: dual use more often appears as an exit ramp away from cigarettes rather than resulting in sustained consumption alongside alternative nicotine products. 

Snus and nicotine pouches not included 

The study analyses the use of cigarettes, e-cigarettes, and heated tobacco, while smokeless products such as snus and nicotine pouches are not included.  

The researchers themselves highlight the need for future studies to include more product categories.  

They highlight several other limitations to the study, such as a reliance on self-reported consumption and a sample that is not representative of the entire population. The study is also based on cross-sectional data rather than following individuals over time.  

Dual use and the harm reduction debate 

Despite this, the study contributes an important perspective to a polarized debate that can have a significant impact on public health in Europe.  

In Spain, the government has advanced proposals that would impose severe restrictions on nicotine pouches, prompting pushback at the EU level from Sweden. Meanwhile, in France, nicotine pouches have been banned completely starting in April 2026. 

The study, in contrast to recent policy choices in some European countries, demonstrates that alternative nicotine products can play a role in reducing smoking, rather than being a gateway. 

“If we are serious about reducing smoking, we need to distinguish between the most dangerous products and those that can help people quit cigarettes,” says Strömer. 

“Sweden is the clearest example, where providing regulated access to nicotine alternatives has helped us become virtually smoke-free. Banning these products, as we now see in France, is contrary to the logic behind that success.”