Abstract
E-cigarettes, or electronic nicotine delivery systems, are popular among smokers who are looking for a less harmful alternative to conventional tobacco, and the use of e-cigarettes is affected by existing tobacco control policies. E-cigarettes, which are electronic devices designed to allow the user to inhale nicotine as a vapor, are controversial in terms of their harm reduction claims as it can undermine existing tobacco control policies and has the potential to re-normalize smoking behavior. Currently, many of the chemicals used in e-cigarettes have not been comprehensively disclosed, and there is no adequate data on their emissions. Furthermore, the benefits of e-cigarettes have not been adequately shown. To date, a small number of studies have evaluated e-cigarettes as a harm reduction and cessation aid and have found conflicting findings. Meanwhile, e-cigarette or vaping product use associated lung injury has been identified, and an increased use of e-cigarettes in the youth has also been reported recently in the United States. These raise a great social concern around how to regulate e-cigarettes for the protection of public health. A range of current and proposed legislative and regulatory options exists. Some countries have banned e-cigarettes entirely, while others are ready to regulate e-cigarettes as a type of medicine. A lack of consensus on whether e-cigarettes facilitate or threaten existing tobacco control strategies is driving a discussion on how to regulate e-cigarettes in terms of the protection of public health.
References
1. Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Saf. 2014; 5:67–86.
2. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR): E-cigarette use associated lung injury [Internet]. Atlanta: Centers for Disease Control and Prevention;2019. cited 2019 Dec 28. Available from: https://www.cdc.gov/mmwr/ecigarette_lung_injury.html.
3. Brady BR, De La Rosa JS, Nair US, Leischow SJ. Electronic cigarette policy recommendations: a scoping review. Am J Health Behav. 2019; 43:88–104.
4. Lee C, Kim S, Cheong YS. Issues of new types of tobacco (e-cigarette and heat-not-burn tobacco): from the perspective of ‘tobacco harm reduction’. J Korean Med Assoc. 2018; 61:181–190.
5. Soneji S, Barrington-Trimis JL, Wills TA, Leventhal AM, Unger JB, Gibson LA, Yang J, Primack BA, Andrews JA, Miech RA, Spindle TR, Dick DM, Eissenberg T, Hornik RC, Dang R, Sargent JD. Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis. Version 2. JAMA Pediatr. 2017; 171:788–797.
6. Zhu SH, Zhuang YL, Wong S, Cummins SE, Tedeschi GJ. E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys. BMJ. 2017; 358:j3262.
7. Levy DT, Borland R, Lindblom EN, Goniewicz ML, Meza R, Holford TR, Yuan Z, Luo Y, O'Connor RJ, Niaura R, Abrams DB. Potential deaths averted in USA by replacing cigarettes with e-cigarettes. Tob Control. 2018; 27:18–25.
8. Abrams DB. Promise and peril of e-cigarettes: can disruptive technology make cigarettes obsolete? JAMA. 2014; 311:135–136.
9. Russell A, Wainwright M, Tilson M. Means and ENDS: e-cigarettes, the Framework Convention on Tobacco Control, and global health diplomacy in action. Glob Public Health. 2018; 13:83–98.
10. Medicines and Healthcare Products Regulatory Agency. E-cigarettes: regulations for consumer products. Guidance on how to get an e-cigarette on the market in the UK, including the notification scheme and reporting problems with e-cigarettes [Internet]. London: Medicines and Healthcare Products Regulatory Agency;2020. cited 2020 Jan 21. Available from: https://www.gov.uk/guidance/e-cigarettes-regulations-for-consumer-products.