E-cigarettes are NOT safe, highly addictive, harmful to health – WHO

By Frank Ulom

The World Health Organization, WHO, has said that e-cigarettes with nicotine are highly addictive and harmful to health, especially for young people.

According to the report published by the world health leading body on Friday (19 Jan. 2024), on its website, these products also harm non-users through second-hand exposure to toxic emissions.

The WHO report stated that e-cigarette use has been linked to delayed brain development and learning disorders, heart disease, lung disorders and cancer, among others.

The report stated further that there are many different types of e-cigarettes, which are the most common type of electronic nicotine delivery system (ENDS) and electronic non-nicotine delivery system (ENNDS). These systems heat a liquid to create aerosols that are inhaled by the user. These so-called e-liquids may or may not contain nicotine (but do not contain tobacco). They also typically contain additives, flavours and chemicals that can be harmful to people’s health.

E-cigarettes are part of broader product categories of ENDS and ENNDS, which include products such as e-cigars and e-pipes.

WHO is concerned that these products have been allowed on the open market as consumer products and aggressively marketed to young people.

Currently, 88 countries have no minimum age at which e-cigarettes can be bought and 74 countries have no regulations in place for these harmful products.

E-cigarettes target children through social media and influencers, with at least 16,000 attractive flavours.

Some of these products use cartoon characters and have sleek designs, which appeal to the younger generation. Some look like toys and games. There is an alarming increase in the use of e-cigarettes among children and young people, with rates exceeding adult use in many countries.

Even brief exposure to e-cigarette content on social media is associated with greater intention to use these products, as well as more positive attitudes toward e-cigarettes.

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Frequently Asked Questions (FAQs) on e-cigarettes

Are e-cigarettes dangerous?

ENDS contain varying amounts of nicotine and harmful emissions.

E-cigarette emissions typically contain nicotine and other toxic substances that are harmful to both users and non-users who are exposed to the aerosols second-hand. Some products claiming to be nicotine-free (ENNDS) have been found to contain nicotine.

Nicotine exposure in pregnant women can adversely affect the development of the fetus. Further, the consumption of nicotine in children and adolescents has negative impacts on brain development, leading to long-term consequences for brain development and potentially leading to learning and anxiety disorders.

Nicotine is highly addictive and harmful to health. Additionally, high-quality epidemiology studies consistently demonstrate that e-cigarette use increases conventional cigarette uptake, particularly among non-smoking youth, by nearly 3 times. Evidence reveals that these products are harmful to health and are not safe. However, it is too early to provide a clear answer on the long-term impact of using them or being exposed to them. Whilst long-term health effects are not fully known, we do know that they generate toxic substances, some of which are known to cause cancer and some that increase the risk of heart and lung disorders. Electronic delivery systems have also been linked to a number of physical injuries, including burns from explosions or malfunctions, when the products are not of the expected standard or are tampered with by users.

Accidental exposure of children to ENDS e-liquids poses serious risks as devices may leak or children may swallow the poisonous e-liquid.

Do e-cigarettes (ENDS) cause lung injuries?

There is growing evidence that ENDS could be associated with lung injuries. E-cigarettes have also been linked to an episode of lung injury in the United States of America. This is described by the United States Centers for Disease Control and Prevention (CDC) as e-cigarette or vaping-associated lung injury (EVALI), which led the CDC to activate an emergency investigation into EVALI on 17 September 2019.

The United States Centers for Disease Control and Prevention noted, “As of 18 February 2020, there have been a total of 2,807 cases of EVALI reported from all 50 states, the District of Columbia, Puerto Rico, and the US Virgin Islands, including 68 deaths confirmed in 29 states and the District of Columbia. While the cause of these deaths has not been conclusively determined, vitamin E acetate (VEA), a common additive in ENDS that contains cannabis (or THC), is thought to have played a significant role in these cases of lung injury. Further information on this incident, including a strong link of the EVALI outbreak to Vitamin E Acetate and the latest report, is available here, which is updated every week, as the evidence is not sufficient to exclude the contribution of other chemicals.”

Are e-cigarettes more or less dangerous than conventional tobacco cigarettes?

Both tobacco products and ENDS pose risks to health. The safest approach is not to use either.

The levels of risk associated with using ENDS or tobacco products are likely to depend on a range of factors, some relating to the products used and some to the individual user. Factors include product type and characteristics, how the products are used, including frequency of use, how the products are manufactured, who is using the product, and whether product characteristics are manipulated post-sale.

Toxicity is not the only factor in considering the risk to an individual or a population from exposure to ENDS emissions. These factors may include the potential for abusing or manipulating the product, use by children and adolescents who otherwise would not have used cigarettes, simultaneous use with other tobacco products (dual or poly use) and children and adolescents going on to use smoked products following experimentation with ENDS. Further, not all ENDS are the same and the risks to health may differ from one product to another, and from user to user.

Are ENDS addictive?

Nicotine is highly addictive. A non-smoker who uses ENDS may become addicted to nicotine and find it difficult to stop using ENDS or become addicted to conventional tobacco products.

Are second-hand ENDS emissions dangerous?

The aerosols generated by ENDS typically raise the concentration of particulate matter in indoor environments and contain nicotine and other potentially toxic substances. ENDS emissions therefore pose potential risks to both users and non-users.

What are the policy options for regulating ENDS?

How a country approaches ENDS will depend on factors particular to its situation. The sale of ENDS is currently banned in over 30 countries worldwide. Analyses conducted as of December 2020 indicate that 79 other countries regulated ENDS by adopting one or more legislative measures, while 84 countries still have no bans or regulations in place to address these products.

Where they are not banned, WHO recommends that ENDS be regulated.

Regulatory objectives include:

• preventing initiation of ENDS use by non-smokers and children, such as by preventing or restricting advertising, promotion and sponsorship, and restricting flavours that appeal to children;

• minimising as far as possible potential health risks to ENDS users, such as by regulating product characteristics;

• protecting non-users from exposure to their emissions, such as by prohibiting ENDS use in indoor spaces where smoking is not permitted;

• preventing unproven health claims; and

• protecting public health policies from commercial and other vested interests.

What role do ENDS play in smoking cessation?

To date, evidence on the use of ENDS as a cessation aid is inconclusive. In part due to the diversity of ENDS products and the low certainty surrounding many studies, the potential for ENDS to play a role as a population-level tobacco cessation intervention is unclear.

To truly help tobacco users quit and to strengthen global tobacco control, governments need to scale up policies and interventions that we know work. Tried and tested interventions, such as brief advice from health professionals, national toll-free quit lines and cessation interventions delivered via mobile text messaging are recommended. Where economically feasible, governments should also consider promoting nicotine replacement therapies and non-nicotine pharmacotherapies for cessation.

What is WHO doing about ENDS?

WHO regularly monitors and reviews the evidence on ENDS and health and offers guidance to governments.

This includes the biennial WHO Report on the Global Tobacco Epidemic, which tracks the status of the tobacco epidemic and interventions to combat it and other relevant resources.

WHO strives to build a safer, healthier world for everyone, everywhere.

What further information is available?

Links to WHO reports with further information on e-cigarettes or ENDS to which the reader can refer are provided below:

• WHO report on the global tobacco epidemic, 2021. Geneva: World Health Organization, 2021

• Ghebreyesus TA. (2019). Progress in beating the tobacco epidemic. Lancet. (published online July 26)

• WHO Study Group on Tobacco Product Regulation. Report on the scientific basis of tobacco product regulation: seventh report of a WHO study group. Geneva: World Health Organization; 2019 (WHO Technical Report Series, No. 1015). Licence: CC BY-NC-SA 3.0 IGO

• FCTC/COP6 10 Rev 1 (2014) –WHO. Electronic nicotine delivery systems. Report by WHO, Conference of the Parties to the WHO Framework Convention on Tobacco Control, sixth session

• FCTC/COP7/11 (2016) – WHO. Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS). Report by WHO, Conference of the Parties to the WHO Framework Convention on Tobacco Control, Seventh session