TABLE 1—

Opposing Perspectives on E-Cigarettes for Smokers, Bystanders, and Children

		PHE8	NASEM and Major US Agencies
Smokers	Risk of e-cigarettes compared with combustible products	Recognizes e-cigarettes are not “safe,” but safer	NASEM: Recognizes e-cigarettes are not “safe,” but commits only to endorsing as an alternative if smokers switch completely11
	Promotion of e-cigarette use	Endorses widespread availability of e-cigarettes as smoking harm reduction, ideally combined with behavioral intervention	NASEM: Finds insufficient evidence to promote broad-scale substitution of e-cigarettes for combustible products11
Bystanders	Risk of sidestream exposure to particulates and nicotine	Finds no evidence that second-hand vaping poses identifiable health risks to bystanders	NASEM: States e-cigarettes in indoor environments may involuntarily expose nonusers to nicotine and particulates, but at lower levels compared with combustibles11
		Concludes that harms of nicotine are “minor”	CDC: States “e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances including nicotine”12
			Surgeon general: Calls to “prevent involuntary exposure to nicotine and other aerosolized emissions from e-cigarettes”13(p188)
Children	E-cigarettes as a gateway to combustible cigarettes	Despite some experimentation with these devices among never smokers, e-cigarettes are attracting very few young people who have never smoked into regular use	NASEM: Cites substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youths and young adults11
		PHE report author (Bauld) describes the impact on youths as “negligible”14	FDA (Zeller): States “For kids who initiate on e-cigarettes, there is a great chance of intensive use of cigarettes”15

Note. CDC = US Centers for Disease Control and Prevention; FDA = US Food and Drug Administration; NASEM = National Academies of Science, Engineering and Medicine; PHE = Public Health England.