Analysis

Evidence about electronic cigarettes: a foundation built on rock or sand?

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4863 (Published 15 September 2015) Cite this as: BMJ 2015;351:h4863

Re: Evidence about electronic cigarettes: a foundation built on rock or sand?

Fifteen questions to clear the fog around e-cigarettes.

Recently there has been much debate of various kinds about e-cigarettes and we have contributed in a small way to it (1-7). However, there is still a need for greater clarity. Succinct research based answers to the following fifteen questions may help to provide a clearer way forward.

Enjoyment
1. If a product is enjoyable and harmless why shouldn’t individuals be freely allowed to use it?

Health
2. Are e-cigarettes safer than traditional cigarettes?
3. Do e-cigarettes encourage traditional smokers to cut down or quit?
4. Is the long-term use of nicotine however used harmful?
5. Are the other ingredients used in e-cigarettes harmful?
6. Do we know the long term health consequences of e-cigarettes?
7. Are manufacturers free to add what they want to e-cigarettes?

Marketing
8. Would manufacturers promote a product that is harmful?
9. Are e-cigarettes encouraging non-smokers to smoke traditional cigarettes?
10. Are non-smokers being encouraged to smoke e-cigarettes?
11. Are sufficient steps being taken to ensure that young people are not encouraged to use e-cigarettes as a lifestyle choice?
12. Will the promotion of e-cigarettes be driven by a business or public health model or both?
13. Will the marketing of e-cigarettes in high income countries encourage people to smoke in low and middle income countries?

Research
14. Do we need more research into the efficacy and marketing of e-cigarettes?

History
15. Are there lessons to be learned from the promotion of traditional cigarettes?

References

1) Institute of Health Promotion and Education. IHPE Position Statement: Electronic Cigarettes. Sept. 2014. [viewed 22 September 2015]. Available from: http://ihpe.org.uk/2014/09/ihpe-position-statement-electronic-cigarettes/

2) LLOYD J. President’s Letter. International Journal of Health Promotion and Education. Vol 52, No 2, 116-117. 2014

3) WATSON M C and FORSHAW M, 2014. Re: Regulation of electronic cigarettes British Medical Journal Rapid Response 10th September 2014.

4) WATSON M C and FORSHAW M, 2014. Re: E-cigarettes latest: users on the up but rules tighten British Medical Journal Rapid Response 28th October 2014.

5) WATSON M C and FORSHAW M, 2015. Re: Why e-cigarettes are dividing the public health community British Medical Journal Rapid Response 28th June 2015.

6) WATSON M C and FORSHAW M, 2015. Why we shouldn’t normalise the use of e-cigarettes BMJ 2015;351:h3770.

7) WATSON M C and LLOYD J, 2015. Re: Fuming about e-cigarettes and harm British Medical Journal Rapid Response 28th August 2015.

Competing interests: No competing interests

22 September 2015
Michael Craig Watson
Associate Professor of Public Health.
Dr John Lloyd (Immediate Past President, Institute of Health Promotion and Education).
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA
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