A Risk Assessment Matrix for Public Health Principles: The Case for E-Cigarettes

Abstract

Besides nicotine replacement therapies, a realistic alternative for smoking cessation or for smoking substitution may come from electronic cigarettes (ECs), whose popularity has been steadily growing. As for any emerging behaviour associated with exposure to inhalational agents, there is legitimate cause for concern and many health organizations and policy makers have pushed for restrictive policy measures ranging from complete bans to tight regulations of these products. Nonetheless, it is important to reframe these concerns in context of the well-known harm caused by cigarette smoking. In this article, we discuss key public health principles that should be considered when regulating ECs. These include the concept of tobacco harm reduction, importance of relative risk and risk continuum, renormalization of smoking, availability of low-risk product, proportionate taxation, and reassessment of the role of non-tobacco flavours. These public health principles may be systematically scrutinized using a risk assessment matrix that allows: (1) to determine the measure of certainty that a risk will occur; and (2) to estimate the impact of such a risk on public health. Consequently, the ultimate goal of responsible ECs regulation should be that of maximizing the favourable impact of these reduced-risk products whilst minimizing further any potential risks. Consumer perspectives, sound EC research, continuous post-marketing surveillance and reasonable safety and quality product standards should be at the very heart of future regulatory schemes that will address concerns while minimizing unintended consequences of ill-informed regulation.

Five-Day Changes in Biomarkers of Exposure Among Adult Smokers After Completely Switching From Combustible Cigarettes to a Nicotine-Salt Pod System

“… 7 , 8 Accordingly, complete switching from combustible cigarettes to ENDS has been endorsed by some US and international health organizations as a route for potential harm reduction for adult smokers who are unable or unwilling to quit tobacco use. 9 …”

Cigalike electronic nicotine delivery systems e-liquids contain variable levels of metals

“…They are battery-operated and intended to deliver nicotine to the user via an inhaled aerosol formed by heating an e-liquid prefilled into a cartridge. The e-liquid typically has a base formulation comprised of propylene glycol, vegetable glycerin, flavorings, and nicotine 1 , 2 . ENDS, that may be perceived as less harmful than combustible cigarette smoking, were initially developed as an alternative to cigarettes and targeted current tobacco smokers 3 .…”

An Online Survey of New Zealand Vapers

“…Vaping (using an electronic vaporiser or e-cigarette (e-cig)) is a relatively new behavior that has spread throughout the world’s tobacco smokers [ 1 , 2 , 3 ]. The appeal of vaping, for people who either cannot or do not want to stop smoking, lies in reduced harm (and cost in some jurisdictions) [ 4 , 5 , 6 ] whilst maintaining a sufficiently similar, or superior, experience to smoking tobacco [ 7 , 8 ].…”