Abstract
Due to their similarity to tobacco cigarettes, electronic cigarettes (e-cigarettes) could play an important role in tobacco harm reduction. However, the public health community remains divided concerning the appropriateness of endorsing a device whose safety and efficacy for smoking cessation remain unclear. We identified the major ethical considerations surrounding the use of e-cigarettes for tobacco harm reduction, including product safety, efficacy for smoking cessation and reduction, use among non-smokers, use among youth, marketing and advertisement, use in public places, renormalization of a smoking culture, and market ownership. Overall, the safety profile of e-cigarettes is unlikely to warrant serious public health concerns, particularly given the known adverse health effects associated with tobacco cigarettes. As a result, it is unlikely that the population-level harms resulting from e-cigarette uptake among non-smokers would overshadow the public health gains obtained from tobacco harm reduction among current smokers. While the existence of a gateway effect for youth remains uncertain, e-cigarette use in this population should be discouraged. Similarly, marketing and advertisement should remain aligned with the degree of known product risk and should be targeted to current smokers. Overall, the available evidence supports the cautionary implementation of harm reduction interventions aimed at promoting e-cigarettes as attractive and competitive alternatives to cigarette smoking, while taking measures to protect vulnerable groups and individuals.
Highlights
Electronic cigarettes (e-cigarettes) have polarized the public health community unlike any previous alternative to smoking. Their efficacy as smoking cessation aids remains unclear [1], anecdotal evidence suggests that many people have successfully quit smoking with the use of e-cigarettes. Due to their similarity in form and function to tobacco cigarettes, e-cigarettes could play an important role in tobacco harm reduction
In light of incomplete information concerning the safety and efficacy of e-cigarettes as smoking cessation aids, thresholds of reasonable risk must be established through a frequently revisited balance of probable benefits and harms with which they are associated. Their exponential growth in consumer markets has outpaced the development of an ethical framework with which to establish the appropriate conditions for their availability and use
Current evidence suggests that e-cigarettes have the potential to make significant public health gains through their role as tobacco harm reduction devices
Summary
Electronic cigarettes (e-cigarettes) have polarized the public health community unlike any previous alternative to smoking. E-cigarettes are likely to be considerably less toxic than tobacco cigarettes [31] given the absence of tobacco combustion inherent to cigarette smoking, which releases pulmonary carcinogens including polycyclic aromatic hydrocarbons, N-Nitrosamines, and various other cytotoxic compounds [58] From both utilitarian and liberal perspectives, misinformation through the provision of inaccurate comparative risk is fundamentally unethical for its failure to allow consumers to make informed choices, and for effectively conveying the message that smokers may as well continue to smoke [59]. If the public health community’s aim is to market e-cigarettes to current smokers, it follows that advertisements should have at least equal reach to this target audience as tobacco cigarettes This strategy, termed “levelling up,” would allow e-cigarettes to be sold and marketed to conventional tobacco products, as well as benefiting from the possibility of lower tax rates owed to their reduced potential for harm [60]. Market ownership As cigarette companies have acquired the largest ecigarette brands, they currently benefit from a dual
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