World Health Organization: Public Health Rules Needed to Curb E-Cigarette Risks

Man Using Electronic Nicotine Delivery System
  • E-cigarettes pose significant public health hazards because of toxins emitted from the devices.

  • The World Health Organization takes misleading marketing to task, noting the frequent use of unsubstantiated claims about e-cigarettes in ads.

  • WHO calls on countries to adopt new standards to protect the public from the risks associated with e-cigarettes.

  • The global community must adopt WHO’s recommendations so that people understand the risks associated with e-cigarettes.


Contrary to industry advertising, a new report by the World Health Organization (WHO) finds that electronic cigarettes (e-cigarettes) and other electronic nicotine delivery systems pose significant public health hazards because of toxins emitted from the devices. The agency recommends that countries adopt e-cigarette rules to prevent misleading marketing of the products and to educate the public about the potential health risks involved.

E-Cigarettes Emit Dangerous Toxins

E-cigarettes contain a battery that heats a nicotine fluid inside the device until it produces a mist-like aerosol that the user can inhale. According to the WHO report, the aerosol contains “nicotine and a number of toxicants” that pose health hazards to users and non-users, especially pregnant women and children, contrary to claims that these devices release nothing more than water vapor. Nicotine use is linked to long-term adverse effects on brain development. Moreover, the aerosol typically contains “some carcinogenic compounds,” including formaldehyde.

Although the report finds that adult smokers who completely switch from regular cigarettes to e-cigarettes will be exposed to lower levels of toxins, WHO warns that the “amount of risk reduction . . . is presently unknown.” The report also notes uncertainty about whether second-hand exposure risks from e-cigarettes are lower than regular cigarettes.

Marketing Contains Unsubstantiated Claims, Targets Children

The WHO report also takes misleading marketing to task, noting the frequent use of unsubstantiated claims about e-cigarettes in product ads. According to the report, there is insufficient evidence that using e-cigarettes will help people quit smoking, yet ads commonly market e-cigarettes as a smoking-cessation device.

Other marketing tactics may even encourage more frequent smoking. For example, many ads promote using e-cigarettes in places where regular smoking is banned. WHO cautions that this could interfere with the intent of smoke-free policies, which “are designed not only to protect non-smokers from second-hand smoke, but also to provide incentives to quit smoking and to denormalize smoking . . . .”

Moreover, e-cigarette marketing has “the potential to glamorize smoking,” which may encourage nonsmokers and children to start using e-cigarettes. The endless variety of designs and flavor options can also appeal to adolescents.

WHO Recommends Developing Public Safeguards

The WHO report says, “Regulation of [e-cigarettes] is a necessary precondition for establishing a scientific basis on which to judge the effects of their use, and for ensuring that adequate research is conducted, that the public has current, reliable information as to the potential risks and benefits of [e-cigarettes], and that the health of the public is protected.”

The report will be a topic of discussion this October at the Sixth Conference of the Parties to the WHO Framework Convention on Tobacco Control. The Convention is an international effort to address global tobacco use. The report calls on the 179 countries that are parties to the Convention to adopt new standards to protect the public from the hazards associated with e-cigarettes. Such safeguards would:

  • Prohibit claims that these products can help people quit smoking until manufacturers provide sufficient scientific evidence to support the claim and gain regulatory approval

  • Ban indoor use of e-cigarettes unless it is proven there are no health effects from second-hand exposure

  • Restrict marketing by requiring that all ads, promotions, or sponsorships provide warnings, encourage people to quit smoking, in no way promote use by nonsmokers or adolescents, contain no images, words, etc. associated with a tobacco product, and more

  • Require that manufacturers design products to reduce exposure to toxins, make information about contents and exposure levels available to users, register products with a governmental body, and report design and emissions information to a governmental body

  • Prohibit sales to people under the age of 18 and ban fruit, candy-like, and alcohol-drink flavors unless and until it is proven that these flavors do not appeal to minors

To ensure strong public health protections, the global community must adopt WHO’s recommendations so that people understand the risks associated with e-cigarettes and adults can make informed choices about whether or not to use them.

Protecting Public Health in the U.S.

Although the U.S. is a signatory to the Convention, it has not yet ratified the tobacco control treaty. However, the U.S. Food and Drug Administration (FDA) is taking some steps similar to WHO's recommendations.

FDA proposed a rule in April that would ban the sale of e-cigarettes to anyone under the age of 18. The rule would also require e-cigarette manufacturers to register with the agency and report the manufacturing process and ingredients used in their products. Moreover, companies would be required to place health-warning labels on e-cigarettes.

However, some tobacco control advocates believe the proposal does not go far enough and are urging FDA to prohibit manufacturers from marketing candy-flavored options that attract children. The Center for Effective Government and other health and safety groups also heavily criticized the FDA’s decision to discount the benefits of the proposed rule by 70 percent, which the agency claims is necessary to account for the “lost pleasure” from reducing tobacco use.

FDA is currently reviewing public comments and considering any changes to its draft rule. We hope the agency will correct its flawed benefit calculation and move forward with strong safeguards without delay. The U.S. should also ratify the treaty and communicate its support for global efforts to combat the tobacco use epidemic.

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The WHO funded USC study recently released shows that the e-cigarette tested was cleaner than the outdoor air. The authors were aware of this and only claimed the study was good for "Good Manufacturing Practices' regulation. The amount of chrome is below the daily required intake to be healthy. The daily recommended amount of chrome ranges from 0.2-50 micrograms. The study measured 4.22 nanograms. The other metals follow suit. Their study demonstrates there are no health concerns in using e-cigarettes or to a bystander. The study highlights the need for WHO to clean house. Certain administrative types are spending money to demonize a safe and effective way to quit smoking as seen by the rapidly growing e-cigarette market and dropping cigarette sales. The USC study is behind a paywall, but a supplemental data page is online. The page contains a table that compares cigarette and e-cigarette emissions to outdoor air. The e-cigarette is the cleanest of the three.
e-cigs, still a health problem
I find it absurd that there is an all out attempt to ban e-cigs. I will be 80 years old in January. I smoked a pack and a half of cigarettes starting at age 16, until about five years ago. E-cigs have saved me from bronchitis about five times a year since then. It is amusing that after all these years of putting people in prison for possession marijuana it is being legalized in many states. We can't even pass background checks for gun's that kill innocent children and adults every single day, but you urge government to regulate and maybe ban e-cigarette's? I challenge you to prove that there are harmful effects and THEN request regulation. Don't spend millions of tax dollars trying to prove that they are harmful. There is NO way that these devices can be considered tobacco. Nicotine is the only common element and it is considered no more harmful than caffeine, are you working to ban caffeine? How brain dead do you think the people are? There is NO tobacco involved.
I don't see the WHO posting any study results that that haven subjected to peer review along with open and honest discussion and opinions by both sides of the issue. This would call into question the real motivation for such a recommendation.
Disagree. The few who smoke -- whether e-cigs or the real thing -- haves no impact on overall public health. The most carcinogenic type of smoke is the kind that contains oil particles, and the leading cause in the US today is our insistence that we have a right to drive as much as we can afford to drive. Few smoke, most drive, and there is no way to pull a middle classer's hands from his steering wheel. The middle class has consistently fought every effort to build a comprehensive public transportation system, such as can be found in the more advanced nations. Oil and soot particles from excessive traffic fill our lungs and kill off forests (a real bummer for people who are partial to oxygen).
I'm guessing the attack on e-cigarettes is funded by the tobacco companies. They don't want to see their customers go. I've smoked a pack a day for the last 24 years. I switched to e-cigarettes one month ago (hooray!). It took willpower, as they don't quite satisfy some of the same things cigarettes do. I have stopped coughing phlegm, stopped my occasional and increasing wheezing, I have more energy, and I don't stink or expose my children to second hand smoke. I would like to eventually stop altogether, but switching to e-cigarettes has been had HUGE benefits for me and my family. Smoking nothing is best. Smoking e-cigarettes is MUCH better than smoking normal cigarettes. They do need more studies, but they people should be commended for making the switch because of the many benefits of doing so. Also, nicotine by itself isn't really that harmful. It's all of the other junk in cigarettes, including tar and CO2 (which binds to red blood cells and prevents oxygen from being distributed throughout your body). This will even help with people who are losing circulation in their feet and are in danger of amputation due to lack of oxygenation of appendages. C'mon people! Stop villianizing something that's such an obvious improvement.