Risk reduction and informed decision-making: why Macedonia needs accurate statistics on tobacco consumption?

Tobacco consumption remains a major public health problem in Macedonia. To address this phenomenon effectively, a strategy is required that combines detailed data, preventive actions, assistance for quitting, and transparent guidance for those adult smokers who cannot quit.

The healthiest alternative for a smoker is still quitting completely, while for those who have never smoked, never starting. However, given the reality that a certain number of smokers will not immediately stop this habit, it is essential that they be provided with evidence-based information about the difference between traditional cigarettes and alternatives that do not involve combustion.

Consequently, the philosophy of harm reduction should be seen as a more pragmatic perspective for individuals who would otherwise continue to smoke, and not as a suggestion that there is any completely risk-free product.

The combustion process constitutes the main scientific dividing line

From a scientific perspective, the distinguishing element lies precisely in combustion. In the case of traditional cigarettes, tobacco burns releasing a cloud of smoke with a significant amount of toxic constituents. Products that operate without combustion are not harmless and are not designed for anyone to use, but they do not produce smoke as a result of cigarette combustion. For this reason, the differences between them must be communicated clearly.

A well-informed choice simply cannot exist if all products are treated as the same. A heavy smoker needs to understand precisely that quitting smoking is the safest path, but also that different products cause different levels of exposure to risks. This is not advertising, but a prerequisite for a decision based on facts.

Why statistics should differentiate

In public discourse, we often encounter comprehensive terms like “tobacco and related products.” These may be suitable for registrations, but they cannot provide the full picture. If cigarette consumers, users of heat-not-burn devices, e-cigarettes, or nicotine pouches, and those who use them in combination are grouped within a single figure, then the statistic loses its primary role: to reflect what is really changing.

Therefore, it is vital to monitor not just overall use, but also how many individuals smoke cigarettes, how many have quit, how many have migrated to non-combustion alternatives, and how many use multiple products in parallel.

Only in this way can we judge whether policies are actually reducing smoking or simply masking a broader consumption. Without such a breakdown, numerical data may appear correct while concealing the authentic picture.

Prevention, cessation, and information must go hand in hand

An effective policy does not rely on a single measure. For adolescents and non-smokers, the cornerstones are prevention, education, and limiting access; for smokers, support to quit smoking; while for adult smokers who cannot quit, accurate information about risks and the differences between products. This represents a public health logic with different guides for different groups.

As a consequence, communication with the public must be measured but complete: warn that nicotine is addictive, that no product is risk-free, and that the best option is quitting smoking, but at the same time clarify that smoking cigarettes and switching to a non-combustion alternative do not represent the same health status.

Greece: an example that prevention works when it is systematic

The case of Greece shows that protecting young people is not ensured solely by bans, but through education, information, practical skills, and well-defined rules. Within the SmokeFreeGreece initiative, since 2009, educational activities have been developed in schools, modeled according to age groups, with an emphasis on nicotine risks, critical thinking, and coping with peer pressure.

Prevention begins before addiction appears. Therefore, programs include interactive interventions, didactic materials, training for teachers and health professionals, as well as student conferences that strengthen a smoke-free culture.

Figures show that from 2009 to 2014, tobacco use among young people aged 16 to 24 in Greece fell by 33.3 percent. Although this result must be interpreted within a broader context, it reconfirms that continuous, science-based education can help change behavior. More recent activities have also focused on limiting minors’ access to tobacco and nicotine products. Digital age verification solutions, such as Gov.gr Wallet and Kids Wallet, illustrate how control can be simpler, more invisible, and more effective.

The main message is that young people are protected by knowledge, critical judgment, and a system that limits their early access. This does not conflict with the concept of informed choice for adults, but rather constitutes an essential complement to it.

Well-informed decision-making requires trust in facts

Accurate data builds trust in health messages. When all products are lumped into the same category, an illusion is created that differences do not exist, which serves neither institutions, nor health personnel, nor heavy smokers.

A conscious choice requires a clear message: the best is to quit consumption; young people and non-smokers should never start; nicotine is addictive; no product is risk-free; while non-combustion alternatives differ from cigarettes in their operating principle and the level of exposure they generate. Therefore, the real question is not simply how many people use tobacco or nicotine products, but how fewer people are smoking cigarettes, how better we are protecting young people, and how many decisions are based on concrete evidence.