The Absolute and relative risks of electronic cigarettes in a wider public health context 

Cigarette smoking is a significant public health concern, despite stringent regulation. Switching smokers to a less harmful product would therefore mitigate some of this harm. Few alternatives have proven attractive to smokers. Electronic nicotine delivery systems (ENDS or e-cigarettes) deliver nicotine in a way similar to that of conventional cigarettes and hence potentially provide an acceptable alternative. The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) was asked to review the relative toxicological risks from ENDS, compared to smoking conventional cigarettes, and the absolute risks from use of ENDS. ENDS are substantially less harmful than conventional cigarettes, although the difference varies with the health effect. There is little evidence that short to medium term use of ENDS causes major harm, but the effects of long-term use are uncertain, though still likely to be less than those of conventional cigarettes. Use of ENDS by non-smokers is potentially associated with adverse health effects to which they would not otherwise have been subject. This information should not be considered in isolation, but in the wider context of the public health consequences of cigarette smoking.