Harm reduction or added harm? Reviewing the danger and impact of e-cigarettes and heated tobacco products
More details
Hide details
Department of Preventive Medicine and Public Health, University of Valencia, Spain
Tobacco Addiction Group of the Valencian Society of Family Medicine, Valencia, Spain
Service of Pneumology, Clinical University Hospital & Department of Medicine, University of Valencia, Spain
Biomedical Research Institute INCLIVA, Clinical University Hospital, Valencia, Spain
Prevention Unit contra el cancer- AECC, Valencia, Spain
Ministry of Health Region of Murcia & Department of Social and Health Sciences, Faculty of Medicine, University of Murcia, Spain
Primary Care Physician. Associated professor School of Medicine. Aragonish Health Service, Zaragoza, Spain
Member of the Spanish Boards of SEDET, EVICT, SEFAC & Community Pharmacist, Ferrol, Spain
Clinica Dental Tejina, Tenerife, Spain
European Network for Smoking and Tobacco Prevention, Brussels, Belgium
National Committee for Smoking Prevention, Spain
Publication date: 2023-04-25
Corresponding author
Joan Antoni Ribera-Osca   

Primary Care Physician. Coordinator of the Tobacco Addiction Group (GAT) of the Valencian Society of Family Medicine. Member of the national GAT of the SEMFYC.Valencia, Spain
Tob. Prev. Cessation 2023;9(Supplement):A45
Smoking is one of the leading causes of morbidity and mortality worldwide, and being gradually aware of this, the world has united to gradually control this scourge. However, in the face of this awareness, the tobacco industries have promoted new consumer products to continue selling and producing nicotine addiction. These include electronic cigarettes (e-cigs, also known as Electronic Nicotine Delivery Systems (ENDS)), heated tobacco products (HTPs) and oral nicotine products. Some types of ENDS appear to potentially help some smokers to quit in certain circumstances, but the evidence is insufficient to issue a blanket recommendation to use any type of the above ENDS or HTPs as a cessation aid for all smokers, especially given the high level of addiction that nicotine continues to generate.

To review the applicability of e-cigarettes and HTPs in our context and the existing evidence regarding the harms associated with their use, the possibility of their use as a smoking cessation method and their use for harm reduction purposes, as well as the most appropriate measures to take in this regard.

Material and Methods:
Comprehensive review of national and international studies of the last 5 years on e-cigarettes and HTPs in the main scientific journals and databases. This review is in the process to be complemented by a qualitative study consisting of structured, focused interviews to field experts.

Despite e-cigs and HTPs may not be comparatively as toxic as conventional cigarettes, they still have toxic and addictive components. There is evidence that compounds in these products can cause respiratory, cardiovascular, dermatological, immune and other diseases. While e-cigs and HTPs have been marketed as alternatives for smoking cessation, there is no evidence that they are an adequate alternative for smoking cessation. Accordingly, WHO does not recommend them, being more useful the use of cognitive-behavioral therapy potentially combined with the approved pharmacological treatments.

The use of e-cigarettes or HTPs are harmful to health. Therefore, they are not appropriate methods for smoking cessation and should not be considered as tool for harm reduction compared to available proven interventions. Stricter taxation and regulatory policies are required, and devices need to be regulated according to a consistent approach for ‘tobacco,’ with proper taxation, mandating the addition of health warnings for these devices, point-of-sale restrictions, and banning advertising and marketing.

Journals System - logo
Scroll to top