Relative Risk Hierarchy

The Tobacco Transformation Index seeks to accelerate tobacco harm reduction by encouraging tobacco companies to reduce the health impacts caused by tobacco use, beginning with the elimination of its highest risk products. Key to this approach is monitoring companies’ activities and investments as they pertain to high-risk tobacco products versus reduced-risk alternatives.

In the absence of an established, internationally standardized classification of tobacco products based on risk, the Foundation for a Smoke-Free World commissioned a scientific literature review to identify a relative risk assessment for all products in scope. The table below summarizes a working classification for the purposes of the first edition of the Index.

The relative risk hierarchy developed is based on a systematic review of previous scientific studies of the health risk associated with nicotine products. A total of 320 studies were reviewed in detail to extract data and assess the level of risk for each product type. The products were analyzed in terms of their toxin emissions and epidemiological data, which were combined on a scale from 0 to 100 (low to high risk) to derive a combined risk score for each product. Additional details on the relative risk assessment are available in the publication “Nicotine Products Relative Risk Assessment: A Systematic Review and Metaanalysis.”

The relative risk assessment, summarized in the adjoining figure, was leveraged to effectively evaluate companies’ offerings and sales of reduced-risk products, and to further compare these according to their relative risk. To do so, the relative risk by product was used as a multiplier for each company’s sales and offer in the high-risk and reduced-risk categories. Additional details are provided in the 2020 Index Methodology.

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