The American Association of Public Health Physicians recommends the following State response to proposed legislation to ban or otherwise restrict the sale and use of nicotine vaporizers (commonly referred to as E-cigarettes or electronic cigarettes).
1. Sale to adults should be permitted.
2. Sale to minors should be banned.
3. AAPHP takes no stance on the question of whether E-cigarettes should be banned in no-smoking areas. (see explanation)
AAPHP favors a permissive approach to E-cigarettes because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years.
The only feasible way to achieve this remarkable public health benefit will be to inform smokers of the differences in risk posed by different categories of nicotine-delivery products. Conventional cigarettes account for about 80% of nicotine consumption in the United States, but more than 98% of the illness and death. This harm is not caused by the nicotine, but by toxic products of combustion. A cigarette smoker can reduce his or her risk of future tobacco-related death by 98% or better by switching to a low risk smokeless tobacco product. He or she could cut that risk by 99.9% or better by switching to a nicotine-only delivery product like one of the pharmaceutical products or E-cigarettes.
Experience suggests that E-cigarettes may be more acceptable to smokers than the currently available pharmaceutical alternatives. A smoker can secure almost all the health benefits of quitting if he or she transitions to an E-cigarette.
Quitting, of course, is best. About 3% of smokers succeed in quitting each year. Pharmaceutical smoking cessation products, when used as directed, can increase that to about 7%. Thus, the current pharmaceutical products fail 93% of those who try them, even with the best of health education and counseling. Long term use of an alternative nicotine delivery product can achieve almost all of the benefits of quitting for those unable or unwilling to quit.
E-cigarettes can and should be marketed as a substitute for conventional cigarettes for smokers unable or unwilling to quit.
State legislatures and, hopefully the FDA should see them in this light and regulate their marketing to reflect this purpose.
Given the current lack of federal regulation, some, but not all, E-cigarette vendors adhere to this guideline.
Sales to minors should be prohibited. If someone does not become addicted to nicotine as a minor, it is unlikely that he or she will ever become addicted.
E-cigarettes deliver the same nicotine found in the pharmaceutical products, with no more contamination by toxic substances than the pharmaceutical products already approved by FDA.