Urgent action needed to protect children and prevent the uptake of e-cigarettes – PAHO/WHO

Geneva, 14 December 2023 (WHO) — Urgent measures are needed to control e-cigarettes to protect children, as well as non-smokers, and minimize harm to the health of the population. E-cigarettes as consumer products have not been shown to be effective in cessation of tobacco use at the population level. Instead, alarming evidence has emerged about the adverse effects on the health of the population.

E-cigarettes have been allowed on the open market and aggressively marketed to youth. Thirty-four countries prohibit the sale of electronic cigarettes, 88 countries do not have a minimum age at which electronic cigarettes can be purchased, and 74 countries do not have regulations for these harmful products.

«Children are being recruited and trapped at a young age to use e-cigarettes and may become addicted to nicotine,» said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. «I urge countries to implement strict measures to prevent its consumption and protect their citizens.» , especially its children and young people.”

Electronic cigarettes with nicotine are highly addictive and harmful to health. While the long-term health effects are not fully understood, it has been established that they generate toxic substances, some of which are known to cause cancer and others that increase the risk of heart and lung disorders. E-cigarette use can also affect brain development and cause learning disorders in young people. Fetal exposure to e-cigarettes may negatively affect fetal development in pregnant women. Exposure to emissions from e-cigarettes also poses risks to bystanders.

“E-cigarettes are targeting kids through social media and influencers, with at least 16,000 flavors. Some of these products use cartoon characters and have stylish designs that appeal to the younger generations. “There is an alarming increase in e-cigarette use among children and young people, with rates exceeding adult use in many countries,” Dr. Ruediger Krech, WHO Director of Health Promotion.

Children aged 13 to 15 years use e-cigarettes at a higher rate than adults in all WHO regions. In Canada, rates of e-cigarette use among 16- to 19-year-olds doubled between 2017 and 2022, and in England (United Kingdom) the number of young users tripled in the last three years.

Even brief exposure to e-cigarette content on social media may be associated with greater intention to use these products, as well as more positive attitudes toward e-cigarettes. Studies consistently show that youth who use e-cigarettes are almost three times more likely to use cigarettes in the future.

Urgent measures are needed to prevent e-cigarette use and counter nicotine addiction, together with a comprehensive approach to tobacco control, and in light of national circumstances.

• Where countries ban the sale of e-cigarettes, strengthen implementation of the ban and continue monitoring and surveillance to support public health interventions and ensure strict enforcement; and
• When countries allow the marketing (sale, import, distribution and manufacturing) of electronic cigarettes as consumer products, ensure strict regulations to reduce their attractiveness and their harm to the population, including banning all flavors, limiting concentration and the quality of nicotine, and tax them.

Smoking cessation strategies should be based on the best available evidence on effectiveness, together with other tobacco control measures and subject to monitoring and evaluation. Based on current evidence, it is not recommended that governments allow the sale of e-cigarettes as consumer products for the purpose of smoking cessation.

Any government implementing a smoking cessation strategy using e-cigarettes should monitor the conditions under which the products are accessed to ensure appropriate clinical conditions and regulate the products as medicines (including requiring marketing authorization as medicines). The decision to pursue a smoking cessation goal, even in a controlled manner, should be made only after considering national circumstances, along with the risk of acceptance, and after exhausting other proven smoking cessation strategies.

The tobacco industry profits from the destruction of health and is using these newer products to get a seat at the policy-making table with governments to lobby against health policies. The tobacco industry funds and promotes false evidence to argue that these products reduce harm, while at the same time heavily marketing these products to children and non-smokers and continuing to sell billions of cigarettes.

Strong and decisive measures are needed to prevent the use of e-cigarettes, based on the growing body of evidence of their use by children and adolescents and their harm to health.