Policy Documents

A Fresh Look at Tobacco Harm Reduction: The Case for the Electronic Cigarette

Riccardo Polosa, Brad Rodu, Pasquale Caponnetto, Marilena Maglia and Cirino Raciti –
October 4, 2013

Smokers of any age can reap substantial health benefits by quitting. In fact, no other single public health effort islikely to achieve a benefit comparable to large-scale smoking cessation. Surveys document that most smokerswould like to quit, and many have made repeated efforts to do so. However, conventional smoking cessationapproaches require nicotine addicted smokers to abstain from tobacco and nicotine entirely. Many smokers areunable – or at least unwilling – to achieve this goal, and so they continue smoking in the face of impendingadverse health consequences. In effect, the status quo in smoking cessation presents smokers with just twounpleasant alternatives: quit or suffer the harmful effects of continuing smoking. But, there is a third choice forsmokers: tobacco harm reduction. It involves the use of alternative sources of nicotine, including modern smokelesstobacco products like snus and the electronic cigarette (E-cig), or even pharmaceutical nicotine products, as areplacement for smoking. E-cigs might be the most promising product for tobacco harm reduction to date,because, besides delivering nicotine vapour without the combustion products that are responsible for nearly all ofsmoking’s damaging effect, they also replace some of the rituals associated with smoking behaviour. Thus it is likelythat smokers who switch to E-cigs will achieve large health gains. The focus of this article is on the health effects ofusing an E-cig, with consideration given to the acceptability, safety and effectiveness of this product as a long-termsubstitute for smoking.