Authors:
Dr. Jason Attard, Consultant in Public Health Medicine
Dr. Charmaine Cordina, Higher Specialist Trainee in Public Health Medicine
This article is being published to mark World No Tobacco Day, a global initiative led by the World Health Organization (WHO) and observed every year on 31 May to raise awareness about the harms of tobacco use and the tactics of the tobacco and nicotine industries. You can learn more about the WHO campaign here: World No Tobacco Day – World Health Organization.
Despite decades of progress in tobacco control, nicotine and tobacco use remain one of the world’s leading causes of preventable death, claiming over 7 million lives every year.[i] In Malta alone, tobacco-related diseases are responsible for around 500 deaths annually.[ii]
A changing industry, not a declining one
As cigarette smoking becomes more regulated and less socially acceptable, the tobacco industry has not disappeared. It has evolved.
Its business model still depends on one key factor: replacing users who die or quit. In fact, up to half of long-term smokers may die from tobacco-related illness.[iii] To sustain profits, the industry increasingly focuses on recruiting new users, particularly young people who are more likely to develop lifelong addiction.[iv]
Today’s products are designed with this in mind. Flavoured options, sleek and discreet devices such as e-cigarettes and nicotine pouches, and single-use products, supported by heavy promotion through social media influencers and celebrities that make nicotine more appealing, more accessible, and easier to hide from parents and teachers.[v]
New products, familiar strategies
As cigarette use declines, the market has expanded rapidly to include e-cigarettes, heated tobacco products (HTPs), nicotine pouches, and snus. These are often presented as “safer” or as part of a harm reduction policy. However, long-term independent evidence is still limited.[vi] This “harm reduction” message has also become a powerful marketing tool that allows the industry to position itself as part of the solution while continuing to shape public opinion, influence policy discussions, and protect its commercial interests through sponsorships, philanthropy, and corporate social responsibility campaigns.[vii]
Health risks across all nicotine products
No nicotine or tobacco product is risk-free.
Combustible products such as cigarettes and waterpipes contain thousands of toxic and carcinogenic chemicals.[viii]
Heated tobacco products avoid burning tobacco but still produce an inhaled aerosol containing nicotine and harmful substances, including known carcinogens. Evidence shows they can increase exposure to toxic chemicals and cause short-term effects such as higher heart rate and blood pressure. However, there is still not enough evidence to confirm that they significantly reduce long-term health risks compared to cigarettes.[ix]
E-cigarettes deliver nicotine in aerosol form and are linked to cardiovascular and respiratory harm. During pregnancy, they may affect foetal development. Among adolescents, nicotine exposure can disrupt brain development, increase the risk of addiction, and raise the likelihood of later cigarette smoking. Device malfunctions can also lead to burns and other injuries.[x]
Nicotine pouches, often marketed as “tobacco-free,” can contain high levels of nicotine, sometimes comparable to or exceeding cigarettes. They carry a strong risk of addiction, and accidental ingestion.[xi]
The situation in Malta
Conventional smoking is decreasing but we have very limited data on the use of alternative nicotine or tobacco products in Malta.
Malta has dropped from the 14th to the 19th place out of 37 countries reporting on the Tobacco Control Scale, reflecting concerns about the strength and enforcement of tobacco control policies.
Heated tobacco products, previously not available on the local market, may become commercially available in 2026 following regulatory notification procedures.
Concerns remain about enforcement of smoke-free rules in indoor public spaces, including bars and restaurants, as highlighted in the 2023 Eurobarometer survey. Cigarette prices in Malta also remain relatively low, with minimal changes between 2018 and 2024, reducing one of the most effective tools for reducing smoking rates.[xii]
A familiar industry playbook
Despite new products and branding, the industry’s approach remains consistent: [xiii] [xiv]
- Targeting young people
- Creating doubt around scientific evidence on tobacco harm
- Influencing policy debates
- Framing regulation as an attack on personal freedom
What needs to happen
A stronger, coordinated public health response is essential.[xv]
Key actions include:
• Using taxation and pricing measures more effectively
• Stronger regulation of all nicotine products
• Closing legal and regulatory loopholes
• Tightening rules on advertising, sponsorship, and digital marketing
• Increasing public awareness of health risks
• Expanding cessation support services
While nicotine products continue to evolve in form and marketing, their health risks remain substantial. Without sustained and coordinated action, new generations risk continued addiction under the false perception of reduced harm.
Strong regulation, evidence-based policy, and prevention-focused public health action are essential to reduce harm and move toward a tobacco- and nicotine-free future.
[i] World Health Organization. (2025). Tobacco. Available at: https://www.who.int/news-/room/fact-sheets/detail/tobacco as on 07/10/2025
[ii] Environmental Health Directorate (2026). Tobacco Free Life. Available at: https://environmentalhealth.gov.mt/en/ehs/tsur/tfcr/tfc-life/
[iii] World Health Organization. (2025). Tobacco. Available on: https://www.who.int/news-/room/fact-sheets/detail/tobacco as on 07/10/2025
[iv] World Health Organization. (2020). Tobacco: Industry tactics to attract younger generations. Available at: https://www.who.int/news-room/questions-and-answers/item/tobacco-industry-tactics-to-attract-younger-generations
[v] World Health Organization. (2020 March 25). Tobacco: Industry tactics to attract younger generations. Available at: https://www.who.int/news-room/questions-and-answers/item/tobacco-industry-tactics-to-attract-younger-generations
[vi] World Health Organization (2025). WHO position on Tobacco Control and Harm Reduction. Available at: https://www.who.int/publications/m/item/who-position-on-tobacco-control-and-harm-reduction
[vii] Fitzpatrick I, Dance S, Silver K, Violini M, Hird TR. Tobacco industry messaging around harm: Narrative framing in PMI and BAT press releases and annual reports 2011 to 2021. Front Public Health. 2022 Oct 18;10:958354. doi: 10.3389/fpubh.2022.958354. PMID: 36330126; PMCID: PMC9623273.
[viii] Li Y, Hecht SS. Carcinogenic components of tobacco and tobacco smoke: A 2022 update. Food Chem Toxicol. 2022 Jul;165:113179. doi: 10.1016/j.fct.2022.113179. Epub 2022 May 25. PMID: 35643228; PMCID: PMC9616535.
[ix] Znyk M, Kaleta D. The Health Effects of Heated Tobacco Product Use-A Narrative Review. Healthcare (Basel). 2025 Aug 18;13(16):2042. doi: 10.3390/healthcare13162042. PMID: 40868658; PMCID: PMC12385413.
[x] World Health Organization (2026). Electronic cigarettes (E-cigarettes): advocacy brief. Available at: https://www.who.int/publications/i/item/WPR-2026-DPC-001
[xi] WHO study group on tobacco product regulation. Report on the scientific basis of tobacco
product regulation: ninth report of a WHO study group. Geneva: World Health Organization; 2023 (WHO
Technical Report Series, No. 1047). Licence: CC BY-NC-SA 3.0 IGO.
[xii] Joossens L., Abbink H., Roman E., The Tobacco Control Scale 2025 in Europe. Brussels: Smoke Free Partnership, 2026. Available from: http://www.tobaccocontrolscale.org/TCS2025
[xiii] St Claire S, Fayokun R, Commar A, Schotte K, Prasad VM. The World Health Organization’s World No Tobacco Day 2020 Campaign Exposes Tobacco and Related Industry Tactics to Manipulate Children and Young People and Hook a New Generation of Users. J Adolesc Health. 2020 Sep;67(3):334-337. doi: 10.1016/j.jadohealth.2020.06.026. Epub 2020 Jul 15. PMID: 32682598; PMCID: PMC7456773.
[xiv] Gannon, J., Bach, K., Cattaruzza, M. S., Bar-Zeev, Y., Forberger, S., Kilibarda, B., Azari, R., Okwor, U., Lomazzi, M., & Borisch, B. (2023). Big tobacco’s dirty tricks: Seven key tactics of the tobacco industry. Tobacco Prevention and Cessation, 9(December), Article 39. https://doi.org/10.18332/TPC/176336
[xv] World Health Organization (2003). WHO Framework Convention on Tobacco Control. Available at: https://fctc.who.int/resources/publications/i/item/9241591013