Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit.

Peter Hajek, Jean Francois Etter, Neal Benowitz, Thomas Eissenbert and Hayden McRobbie

 During the past few years e-cigarettes have been gaining popularity, primarily among smokers who want to reduce the risks of smoking. The growing sales of e-cigarettes, driven initially by word of mouth and user enthusiasm, are now seen by financial analysts to threaten sales of cigarettes.  The reaction by the public health community to this unfolding phenomenon has ranged from enthusiastic support to vigorous opposition. Regulatory bodies around the world are deciding whether to allow e-cigarettes to compete with cigarettes freely, submit them to a more restrictive regulation than cigarettes e.g. as medicinal devices, or ban them.  Their verdicts will probably feature among the key public health decisions of our time.

Commentators in favour of e-cigarette restrictions believe that the product has a potential to increase cigarette use by re-normalising smoking, i.e. reducing motivation of smokers to quit completely, providing a gateway to smoking for non-smokers or facilitating an increase in smoking prevalence indirectly.  They argue that e-cigarettes should be banned or submitted to much stricter controls than smoked tobacco. They emphasise evidence that nicotine can be addictive and warn that the health risks from long term e-cigarette use may yet emerge. 

E-cigarette advocates believe that, on the contrary, the product has a potential to reduce and, if it continues to develop, eventually end cigarette use by allowing smokers to switch to a safer product.  They argue that achieving this potential requires little government expenditure and involvement and that it is in the public health interest to allow e-cigarettes to compete with cigarettes in the market-place.  They emphasise evidence that use of nicotine without tobacco toxicants poses minimal risks, except in the case of well-defined sub-populations such as pregnant smokers.

Both sides of the debate agree that any policy and regulatory decisions affecting e-cigarettes should be guided by evidence.

Please click here to read the full report that summarises the literature on patterns of e-cigarette use, content, safety and effects on users and considers the implications of the evidence