E-cigarettes: Harm reduction or public health menace?

By Shelby Huffman

Local public health advocates recently celebrated a victory with the decision by Saskatoon city counselors to ban the use of electronic-cigarettes in public places1. While the use of the e-cigarettes has been condemned by several prominent organizations including the Canadian Cancer Society, the Heart and Stroke Foundation, The Lung Association and the World Health Organization, other organizations such as Public Health England have adopted the position that e-cigarettes can be used for harm reduction purposes2. Whether electronic cigarettes will be harmful or beneficial to public health is a hotly contested issue, even among experts. Policy makers are faced with a dilemma: unnecessarily restricting access to e-cigarettes could prevent declines in cigarette smoking rates, but condoning their use without understanding their long-term effects is similarly unappealing.

Opponents of e-cigarettes cite concerns about the unknown long-term health effects of e-cigarettes, as well as concerns that their popularity will introduce a new generation to nicotine dependency, gradually undermining the decades work by public health advocates to de-normalize smoking. Proponents claim that they can serve as a harm reduction measure by replacing cigarettes, and by assisting current cigarette smokers to quit. The latter stance is being promoted by Public Health England, which after reviewing the available evidence did not find that e-cigarettes are undermining long-term declines in cigarette smoking2.

While current evidence does indicate that e-cigarettes are safer than cigarettes, concerns about their unknown long-term health effects are not unwarranted. Furthermore, transnational tobacco companies like Philip Morris International increasingly control the e-cigarette market5. The adoption of the harm reduction label by these companies is suspect because it is intended more as an attempt to improve the reputation of big tobacco and re-establish dialogue with policy makers and public health experts than a genuine commitment to reduce harm5. Attempts to engage young, new users with marketing and youth-appealing flavors are indicative of this.

Snus, a smokeless, less harmful form of tobacco that is popular in Scandinavian countries is often cited as an example of how e-cigarettes might affect smoking rates. In Sweden, snus has been credited with declining lung cancer rates in the country and often lauded as harm reducing. In Finland, however, the use of snus was found to supplement rather than replace cigarette smoking by increasing dependence of tobacco users3. Because e-cigarettes are a relatively new phenomenon and their long-term health effects have yet to be determined, experts can only speculate about whether they will ultimately be good or bad for public health. Advocates on either side of the debate can probably agree that some level of regulation is required to control manufacturing standards, labeling, advertising, and possibly usage, but how these regulations are created will continue to make for an interesting debate.


  1. http://thestarphoenix.com/news/local-news/vaping-legal-in-e-cig-shops-but-not-other-public-places
  2. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/457102/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England_FINAL.pdf
  3. http://scopeblog.stanford.edu/2014/03/25/what-the-experience-of-swedish-snuff-can-teach-us-about-e-cigarettes/
  4. http://scopeblog.stanford.edu/2014/03/25/what-the-experience-of-swedish-snuff-can-teach-us-about-e-cigarettes/
  5. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62439-3/abstract



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