Abstract: Electronic smoking devices (ESDs), including electronic nicotine delivery systems (more commonly known as e-cigarettes) and heated tobacco products (HTPs), are frequently marketed as “less harmful” alternatives to conventional cigarettes; however, this fails to account for the growing evidence regarding their systemic toxicity, addictive potential, and broader negative public health implications. This commentary draws on reviews of toxicological, clinical, epidemiological, and policy literature to examine and refute the commonly held arguments that characterize e-cigarettes and HTPs as “less harmful” alternatives to conventional cigarettes. The review concentrated on evidence pertaining to assertions that these products are considerably less harmful, that the elimination of combustion mitigates most health risks that some health authorities support them for harm reduction, and that nicotine is not a primary risk factor for disease. Evidence indicates that ESDs expose users to toxic metals, carbonyl compounds, reactive oxygen species, nicotine, and other harmful substances. Exposure to these substances is linked to cardiovascular and pulmonary dysfunction, systemic inflammation, oxidative stress, DNA damage, pathways that could lead to cancer, nicotine addiction, and poisoning. The risk is further compounded by real-world usage patterns, including dual-use with conventional cigarettes, high rates of youth uptake, aggressive digital marketing, and current regulatory gaps. This commentary asserts that the “less harmful” argument should not be used to disregard the risks of ESDs and other nicotine products or to weaken public health regulations. Public health regulatory policy must continue to prioritize precaution, prevention, and safeguarding children and adolescents from nicotine addiction.
Banogon et al. (Wed,) studied this question.