E-cigarettes are battery-operated handheld devices which, upon inhalation, vaporize a solution of propylene glycol or glycerin (with or without added nicotine) to produce smoke-like vapor. E-cigarettes have grown to be extremely popular recreational devices, with many people using them to stop smoking. However, research has not conclusively shown them to be effective for smoking cessation, and their long-term safety profile remains unknown.
Public opinion is strongly divided concerning the risks and benefits of e-cigarette use. However, because they are free of combustion, most scientists agree that e-cigarettes are significantly less harmful than tobacco cigarettes.
E-cigarettes may therefore constitute a form of harm reduction, a relatively safer alternative to tobacco cigarette smoking. Many nevertheless believe there are risks involved with their largely unregulated use, including unknown long-term safety concerns, their possible impact on children and youth, increased nicotine addiction in the population at large, and the renormalization of a smoking culture.
What was the aim of your review, publishing in the thematic series?
The aim of our review was to use an ethical lens to examine the arguments both for and against the use of e-cigarettes for tobacco harm reduction. We used a public health framework that balanced tensions between utilitarianism, which posits that actions are desirable if they benefit the majority, and liberalism, which maintains above all that individuals have the right to self-determination in health.
What were the key findings and conclusions?
Overall, we found that the ethical arguments in support of e-cigarette use for tobacco harm reduction largely outweigh the arguments against them.
Overall, we found that the ethical arguments in support of e-cigarette use for tobacco harm reduction largely outweigh the arguments against them. Relative to the known harms of tobacco cigarettes, e-cigarettes are unlikely to warrant serious long-term public health concerns.
Therefore, it is likely that the public health gains obtained from tobacco harm reduction among current smokers would outweigh any population-level harms that result from non-smoker uptake.
However, while the existence of a gateway effect for youth remains uncertain, e-cigarette use in this population should be discouraged, with policies and regulations aligned to this effect.
We concluded that in light of the current evidence, interventions aimed at promoting e-cigarettes as attractive and competitive alternatives to cigarette smoking are ethically sound.
What further research needs to be done?
There is an urgent need for data from high-quality randomized controlled trials to conclusively establish the safety and efficacy of e-cigarettes for smoking cessation. This data would allow government agencies to define the regulatory profile of e-cigarettes as either smoking cessation aids or consumer products, which would in turn impact on their availability, and use.
As well, longitudinal data will be required to examine the long-term safety of frequent and prolonged inhalation of propylene glycol or glycerin, with and without nicotine.