ENDS Public Health: Difference between revisions

The straight-forward principles of harm reduction should be as uncontroversial for tobacco products as they are for alcohol, cars, air travel, children's clothing, sexual practices, electrical goods and other goods and activities.

Concerns for some adverse public health effects of harm reduction products such as SLT (Smokeless Tobacco) and vape are reasonable and worth trying to minimize, but there is no current evidence that such products actually represent an imminent danger to public health overall.  

Current evidence suggests that e-cigarettes have the potential to make significant public health gains through their role as tobacco harm reduction devices. In clinical practice, physicians have an ethical duty to provide their patients with evidence-based comparative risk assessments to allow them to make informed choices with respect to their smoking status. At its core, the objective of the smoking cessation agenda should be to improve population health, which will likely require some concessions in the form of harm reduction. This entails a willingness to negotiate the tensions between utilitarian and liberal ethics in designing policy that upholds autonomy while protecting broader public health interests.

The group defined 12 products and 14 harm criteria. Seven criteria represented harms to the user, and the other seven indicated harms to others.

The results of this study suggest that of all nicotine-containing products, cigarettes (and small cigars in the USA) are very much the most harmful. Interventions to reduce this pre-eminence are likely to bring significant benefits not just to users but also to non-smokers and society as a whole. Attempts to use other forms of nicotine such as ENDS and NRT to reduce cigarette smoking should be encouraged as the harms of these products are much lower.

Among current users, dependence on e‐cigarettes was significantly lower than dependence on cigarettes, in within‐subjects comparisons among dual users of both e‐cigarettes and cigarettes, and in separate groups of e‐cigarette users and cigarette smokers, and among both daily and non‐daily users of each product.

Among former users, residual symptoms were significantly lower for e‐cigarettes than cigarettes, both among former dual users and among users of one product.  

Cigarette smokers are more likely to consider themselves addicted, to have strong cravings, and to feel like they really needed to use their product. Cigarette smokers found it more difficult not to use in places where prohibited.

E-cig users report less dependence on their product than cigarette smokers. E-cig users report a longer time-to-first-use after waking.

Results showed that e-cigarette users scored lower than cigarette smokers in both FTND (Fagerström test for nicotine dependence) and all NDSS (nicotine dependence syndrome scale) subscales. Our findings extend previous research on e-cigarette use and nicotine addiction and suggest that e-cigarette users are less dependent on nicotine than current tobacco cigarette smokers.

Given the large range of factors that can impact nicotine delivery, not only within the e-liquids but also in the hardware and user behavior, any regulatory framework intended to moderate nicotine exposure in users may not achieve its intended aim if it is solely limited to a regulation of the nicotine concentration of the e-liquid.

E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive.