18B.0 Introduction

Last updated: August 2016 

Suggested citation: Greenhalgh, EM, & Scollo, MM. InDepth 18B: Electronic cigarettes (e-cigarettes). In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from: http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes

Electronic cigarettes (e-cigarettes) provide users with aerosolised nicotine for inhalation. These devices usually comprise a battery to heat an element that vapourises a solution, typically containing nicotine, propylene glycol or glycerine, and flavourings, which is held in a cartridge/tank in the device. Users of e-cigarettes, or ‘vapers’, breathe in the aerosol.1 The action of inhalation and exhalation mimics the use of conventional cigarettes,2 and provides some of the same cues or sensory effects such as hand to mouth action, taste and throat rasp.3 Many e-cigarettes are designed to look like traditional tobacco products, such as cigarettes, cigars, cigarillos, and pipes. Others more closely resemble other everyday items such as pens, USB memory sticks, and larger cylindrical or rectangular devices.1 E-cigarettes are also commonly referred to in the literature as electronic nicotine delivery devices (ENDs), alternative nicotine delivery devices (ANDs), and personal vapourisers (PVs).  E-cigarettes that do not contain nicotine but deliver a flavoured aerosol (commonly fruit, confectionary, tobacco, or other food and drink flavours) are also available.2  

There is ongoing debate within the public health community as to whether e-cigarettes have a potential role in smoking cessation; whether use of e-cigarettes can reduce harm for individual users; whether widespread use of the devices has the potential to reduce or increase population-level harm; and how best to regulate e-cigarettes to minimise both individual and population-level harmi.4 Producing nicotine aerosol from a solution rather than by burning tobacco gives rise to fewer harmful substances than cigarette smoke does to users and non–users,2 but the long-term effects of e-cigarette use are not known. Because of the likely lesser health risks associated with vaping, some experts advocate wider availability and softer regulation, and see e-cigarettes as holding great potential to help smokers quit or switch to a harm-reducing way to consume nicotine.5, 6 Others call for the application of the ‘precautionary principle’ in public health, and argue that it is not sound public health policy to allow e-cigarettes onto the market until such time as robust evidence is available supporting the safety of e-cigarettes and their efficacy in reducing harm.7, 8 They cite the addictiveness of nicotine, and the potential for harm from ongoing use of e-cigarettes compared with complete cessation of all nicotine and tobacco products.4 There are also concerns that e-cigarettes will be used in combination with tobacco products (‘dual use’), or that ex-smokers will re-initiate their nicotine addiction or return to smoking,8, 9 particularly if exposed to glamorous e-cigarette advertising.10, 11 Other serious issues include the possibilities that e-cigarette use might promote nicotine use among non-smokers, especially children; serve to renormalise smoking; or serve as a gateway to the use of combustible cigarettes or illicit drugs.8, 12, 13

Recent news and research

For recent news items and research on this topic, click here (Last updated July 2018) 

 

 

i. For a background and overview of harm reduction as an approach within public health and tobacco control, see Section 18.0  

References  

1. World Health Organization (WHO), Electronic nicotine delivery systems. Conference of the parties to the who Framework Convention on Tobacco Control Moscow, Russian Federation 2014. Available from: http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf?ua=1 .

2. Britton J and Bogdanovica I. Electronic cigarettes: A report commissioned by Public Health England. 2014. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/311887/Ecigarettes_report.pdf .

3. UK Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. 2016. Available from: https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0

4. Lindblom EN. Effectively regulating e-cigarettes and their advertising—and the first amendment. Food & Drug Law Journal, 2015; 70:57–94. Available from: http://www.law.georgetown.edu/oneillinstitute/news/documents/March10-LindblomFDLJ_001.pdf

5. Hajek P, Etter JF, Benowitz N, Eissenberg T, and McRobbie H. Electronic cigarettes: Review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction, 2014; 109(11):1801–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25078252

6. Abrams DB. Promise and peril of e-cigarettes: Can disruptive technology make cigarettes obsolete? Journal of the American Medical Association, 2014; 311(2):135–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24399548

7. Kriebel D and Tickner J. Reenergizing public health through precaution. American Journal of Public Health, 2001; 91(9):1351–5. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446776/

8. E-cigarettes--aid to smoking cessation or smokescreen? The Lancet, 2014; 384(9946):829. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25209468

9. Grana R, Benowitz N, and Glantz SA. E-cigarettes: A scientific review. Circulation, 2014; 129(19):1972–86. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24821826

10. King AC, Smith LJ, Fridberg DJ, Matthews AK, McNamara PJ, et al. Exposure to electronic nicotine delivery systems (ends) visual imagery increases smoking urge and desire. Psychology of Addictive Behaviors, 2016; 30(1):106–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26618797

11. Durkin SJ, Bayly M, and Wakefield MA. Can e-cigarette ads undermine former smokers? An experimental study. Tobacco Regulatory Science, 2016; 2(3):263–77. Available from: http://dx.doi.org/10.18001/TRS.2.3.6

12. Kandel ER and Kandel DB. A molecular basis for nicotine as a gateway drug. New England Journal of Medicine, 2014; 371(10):932–43. Available from: http://www.nejm.org/doi/full/10.1056/NEJMsa1405092

13. Chapman S. E-cigarettes: The best and the worst case scenarios for public health. British Medical Journal, 2014; 349:g5512. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25204397

 

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