title: Ethical considerations of e-cigarette use for tobacco harm reduction.
abstract: Due to their similarity to tobacco cigarettes, electronic cigarettes (e-cigarettes) could play an important role in tobacco harm reduction. However, the public health community remains divided concerning the appropriateness of endorsing a device whose safety and efficacy for smoking cessation remain unclear. We identified the major ethical considerations surrounding the use of e-cigarettes for tobacco harm reduction, including product safety, efficacy for smoking cessation and reduction, use among non-smokers, use among youth, marketing and advertisement, use in public places, renormalization of a smoking culture, and market ownership. Overall, the safety profile of e-cigarettes is unlikely to warrant serious public health concerns, particularly given the known adverse health effects associated with tobacco cigarettes. As a result, it is unlikely that the population-level harms resulting from e-cigarette uptake among non-smokers would overshadow the public health gains obtained from tobacco harm reduction among current smokers. While the existence of a gateway effect for youth remains uncertain, e-cigarette use in this population should be discouraged. Similarly, marketing and advertisement should remain aligned with the degree of known product risk and should be targeted to current smokers. Overall, the available evidence supports the cautionary implementation of harm reduction interventions aimed at promoting e-cigarettes as attractive and competitive alternatives to cigarette smoking, while taking measures to protect vulnerable groups and individuals.
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Franck
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.|Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada.
authors.forename: Kristian B
authors.initials: KB
authors.lastname: Filion
authors.affiliation: Biomedical Ethics Unit, McGill University Montreal, Montreal, QC, Canada.|Department of Social Studies and Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kimmelman
authors.affiliation: Department of Family Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Roland
authors.initials: R
authors.lastname: Grad
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada. mark.eisenberg@mcgill.ca.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. mark.eisenberg@mcgill.ca.|Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada. mark.eisenberg@mcgill.ca.|Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte Ste-Catherine Road, Suite H-421.1, Montreal, Quebec, H3T 1E2, Canada. mark.eisenberg@mcgill.ca.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
mesh_terms: D000073865:Cigarette Smoking / Q000009:adverse effects* / Q000191:economics; D003132:Commerce / Q000941:ethics; D003257:Consumer Product Safety; D000067088:Direct-to-Consumer Advertising / Q000941:ethics; D066300:Electronic Nicotine Delivery Systems / Q000191:economics / Q000941:ethics*; D040261:Harm Reduction / Q000941:ethics*; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012906:Smoke / Q000009:adverse effects*; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*; D000072137:Vaping / Q000009:adverse effects / Q000191:economics / Q000941:ethics*
chemical_list: D012906:Smoke
keywords: E-cigarettes; Ethics; Harm reduction