Public Health

Are e-cigarettes healthy?

Clearly, the answer is no.  It is best not to smoke at all.  From a policy perspective, however, there is a question of whether e-cigarettes should be regulated and taxed heavily–like regular cigarettes–or more lightly.  If e-cigarettes are relatively healthier than standard cigarettes, less taxes/regulation would be merited.  If, however, e-cigarettes induce more individuals to begin smoking or do not have any incremental health benefits relative to standard cigarettes, higher taxes and regulation are needed.

So what does the science say? The National Academies of Sciences, Engineering, and Medicine report Public Health Consequences of E-Cigarettes aims to synthesize existing evidence.  A Vox piece summarizes the report’s findings, which I repeat below.

  1. Unclear whether e-cigarettes can help people quit smoking. Some observational studies found that e-cigarettes helped people quit smoking but RCT evidence was less conclusive. Overall, there is some suggestive evidence but it is far from conclusive.
  2. E-cigarettes increase the likelihood that kids smoke.  “The evidence base was large enough and consistent enough and strong enough to conclude that there’s an association between e-cigarette use and ever-use of combustible tobacco [cigarettes],” said committee member Adam Leventhal.  In short, one can consider e-cigarettes as sort of a ‘gateway’ drug to standard smoking.  However…
  3. E-cigarettes are less harmful than conventional cigarettes.  E-cigarettes have fewer toxins than standard cigarettes. Note that fewer does not mean none as some e-cigarettes do contain harmful chemicals such as formaldehyde and acrolein. Because they are so new, however, the long-term effect of e-cigarettes is not known.

The report takes these three elements and concludes the following:

Under the assumption that using e-cigarettes increases the net cessation rate of combustible tobacco cigarettes among adults, the modeling projects that in the short run, use of these products will generate a net public health benefit, despite the increased use of combustible tobacco products by young people. Yet in the long term (for instance, 50 years out), the public health benefit is substantially less and is even negative under some scenarios. If the products do not increase combustible tobacco cessation in adults, then with the range of assumptions the committee used, the model projects that there would be net public health harm in the short and long term.

In short, while evidence is accumulating regarding e-cigarettes, there is still much that needs to be learned.  On an individual–rather than policy level–the message is clear: don’t smoke cigarettes, whether electronic, conventional or otherwise.


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