The Risk-Benefit Tradeoff of Electronic Cigarettes and Heated Tobacco Products as a Potential Harm Reduction Strategy

Cigarette smoking remains the leading cause of preventable death in the world.1 2 Smoking cessation is the most desirable outcome, but many smokers are unable or unwilling to quit.3 Over half of all smokers attempt to quit each year and only 7% are successful.4 5

Due to the difficulty of cessation, public health is exploring whether harm reduction is an acceptable alternative for current smokers.6 7 Harm reduction refers to a range of public health policies designed to lessen the negative consequences associated with various behaviors.8 Electronic cigarettes (ECs) are relatively new to the global market and do not reflect the pattern and general decline of overall tobacco use.9 After relatively slow growth, EC usage exploded in recent years.9 Initial EC marketing included advertising them as cessation devices.10 To date, the United States (US) Food and Drug Administration (FDA) has not approved ECs as cessation devices, however, more smokers have tried ECs for cessation than any of the seven FDA-approved medications for smoking cessation.11 ECs offer a replacement source of nicotine without the 7,000 chemicals found in cigarettes.12 13 High nicotine delivery and other reinforcing features of ECs have led to significant uptake among adolescents, but these features may support switching and harm reduction among adult combustible cigarette smokers.14 15 An additional tobacco product that is making its way into global…