Nearly 29 million Americans regularly smoke cigarettes, a drastic decline from 1964, when more than 40 percent of adults smoked and the surgeon general first linked tobacco to cancer. Still, that’s a lot of people hooked on nicotine. In an effort to end these addictions and prevent new ones, the Food and Drug Administration in the Biden administration’s last days proposed a plan that, if finalized, would require tobacco companies to reduce the level of nicotine in their cigarettes to doses below those associated with addiction.

Slashing nicotine levels in cigarettes could save millions of lives. But it creates a conundrum for regulators. If they make cigarettes less satisfying without offering appealing alternatives, smokers who can’t quit may turn to illicit markets. At the same time, regulators fear that the very products that help smokers quit — such as vapes or oral nicotine pouches — also attract young people. In response, the F.D.A. has imposed strict regulations on these products, banning flavors and slowing the approval of new vapes (also known as e-cigarettes). As a result, most vapes sold in the United States are unauthorized, posing safety risks to users. Many are imports from China.

What Americans really need is access to safer products. Controversially, this will require approving more vapes and oral nicotine products, and making them more affordable than cigarettes via sales taxes. It will also mean aggressively communicating to the public that what kills smokers is primarily smoking itself, not nicotine.

Many anti-tobacco activists understandably want to vanquish nicotine addiction entirely, not just cigarettes. Their concerns intensified as vaping among teenagers surged, peaking in 2019 when more than a quarter of 12th graders reported using vapes in the past month. That number has since fallen to 15 percent, yet fears persist that vaping could lead more teenagers to smoking or make quitting harder.

However, those fears haven’t materialized. In fact, some studies suggest the opposite — vaping may be replacing smoking rather than encouraging it. Cigarette smoking among teenagers is at an record low: In 1976, more than a third of high school seniors smoked; by 2024, just 2.5 percent did.

Regulators may need to accept that wider access to vaping could mean more young people use these products. But if vaping continues to displace smoking rather than fuel it, that trade-off could ultimately be a public health win.