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Introduction Around one billion adults worldwide smoke,1 with high prevalence in developing countries, where 49% of men and 11% of women use tobacco.2 Although the prevalence of current smokers has decreased over time in several countries, the global absolute number of smokers has increased owing to population growth.3 Policies have successfully encouraged people to quit, using aids such as nicotine replacement therapy and electronic cigarettes (e-cigarettes).4 In the Health Survey for England (2013 and 2014), 26% of current smokers reported that they wanted to cut consumption down but were not trying to stop, and 40-41% said that they smoked less than in the previous year.5 The percentage of smokers who consume one to five cigarettes per day has steadily risen (from 18.2% to 23.6% between 2009 and 20145), with a similar pattern in the US, where the proportion of smokers who consume less than 10 cigarettes per day increased from 16% to 27% between 2005 and 2014.6 A recent Cochrane review discussed the evidence for ways of helping smokers who wish to reduce their consumption.7 Smoking few cigarettes is generally believed to be relatively safe, as has been incorrectly assumed for light/low nicotine cigarettes.8 Among 24 658 US adolescents, 10% thought that light smoking was not harmful, and only 35% of light smokers considered their habits to be associated with a lot of harm.9 Reducing consumption might be expected to reduce harm in a proportionate waythat is, that smoking one instead of 20 cigarettes per day has about one twentieth (5%) of the risk

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