WHO: act quickly to protect children and prevent e-cigarette use

Taking action to control e-cigarettes has become an urgent need to protect children and non-smokers and minimize harm to public health. E-cigarettes, as consumer products, have not shown effectiveness in helping people quit smoking at the population level. On the contrary, concerning evidence has emerged regarding the adverse effects of e-cigarettes on public health.

E-cigarettes have been allowed to be sold on the open market and are actively marketed to young people. There are 34 countries that prohibit the sale of e-cigarettes, while 88 countries have no minimum age for purchasing e-cigarettes, and 74 countries have no regulations on these harmful products.

Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, said: "Children are being recruited and lured into using e-cigarettes at a young age, potentially leading to nicotine addiction. I urge countries to implement strict measures to prevent usage and protect their citizens, especially children and young people."

E-cigarettes containing nicotine are highly addictive and harmful to health. Although the long-term health effects are not fully understood, it has been established that they produce toxic substances, some of which are known to cause cancer, while others increase the risk of heart and lung diseases. The use of e-cigarettes may also affect the brain development of young people, leading to learning disabilities. Pregnant women exposed to e-cigarettes may have adverse effects on fetal development. The emissions from e-cigarettes also pose risks to bystanders.

Dr. Rüdiger Krech, Director of the WHO Health Promotion Department, stated: "E-cigarettes target children through social media and influencers, with at least 16,000 flavors available. Some of these products use cartoon characters and have trendy designs that attract the younger generation. The increasing rate of e-cigarette use among children and young people is alarmingly surpassing that of adults in many countries."

In all WHO regions, the rate of e-cigarette use among children aged 13 to 15 is higher than that of adults. In Canada, the e-cigarette use rate among the 16 to 19 age group doubled from 2017 to 2022, while the number of young users in England has tripled over the past three years.

Even brief exposure to e-cigarette content on social media may be associated with an increased intention to use these products and a more positive attitude towards e-cigarettes. Research consistently shows that young people who use e-cigarettes are nearly three times more likely to use traditional cigarettes in the future.

To prevent e-cigarette use and combat nicotine addiction, urgent measures are needed, combined with comprehensive tobacco control strategies that consider national circumstances.

In countries that prohibit the sale of e-cigarettes, enforcement of the ban should be strengthened, and ongoing monitoring and surveillance should support public health interventions and ensure strong enforcement;

In countries where e-cigarettes are commercialized as consumer products (sales, imports, distribution, and manufacturing), strict regulations should be implemented to reduce their appeal and harm to the population, including banning all flavors, limiting nicotine concentration and quality, and taxing them.

Smoking cessation strategies should be based on the best available evidence of effectiveness, combined with other tobacco control measures, and monitored and evaluated. Based on current evidence, it is not recommended that governments allow the sale of e-cigarettes as consumer products under the guise of pursuing smoking cessation goals.

Any government using e-cigarettes as part of smoking cessation strategies should control the conditions for obtaining products to ensure appropriate clinical conditions and regulate the products as drugs (including requiring market authorization as drugs). Even in such controlled forms, decisions to pursue smoking cessation goals should be made considering national circumstances and usage risks, and only after using other proven effective smoking cessation strategies.

The tobacco industry profits by harming health and uses these new products to gain a foothold at the government policy-making table to lobby against health policies. The tobacco industry funds and promotes false evidence claiming these products reduce harm while aggressively marketing them to children and non-smokers and continuing to sell billions of cigarettes.

Decisive and resolute action is needed, based on the growing evidence, to prevent children and adolescents from using e-cigarettes and the associated health harms.