E-cigarettes: how risky are they?

20 January 2020 | Q&A

There are many different types of e-cigarettes in use (also known as Electronic Nicotine Delivery Systems (ENDS), with varying amounts of nicotine and harmful emissions.

ENDS emissions typically contain nicotine and other toxic substances that are harmful to both users and those exposed to the vapours secondhand. Some devices that claim to be nicotine-free have been found to contain nicotine.

There is no doubt that that they are harmful to health and are not safe, but it is too early to provide a clear answer on the long-term impact of using them or being exposed to them.

ENDS are particularly risky when used by adolescents. Nicotine is highly addictive and young people’s brains develop up to their mid-twenties. Exposure to nicotine can have long-lasting, damaging effects.

Young people who use ENDS are also more likely to use conventional cigarettes, cigars or hookahs.

ENDS increase the risk of heart disease and lung disorders. For pregnant women, ENDS pose significant risks as they can damage the growing fetus.

ENDS also expose non-smokers and bystanders to nicotine and other harmful chemicals.

The liquid in ENDS can burn skin and rapidly cause nicotine poisoning if swallowed or absorbed through the skin. There is a risk of the devices leaking, or of children swallowing the liquid, and ENDS have been known to cause serious injuries through fires and explosions.

There is growing evidence to show that ENDS use could cause lung damage.

On 17 September 2019, the United States Centers for Disease Control and Prevention activated an emergency investigation into links between ENDS use and lung injuries and deaths.

By 10 December 2019, the USA reported more than 2409 hospitalized cases and 52 confirmed deaths.

At least five other countries have initiated investigations to identify cases of lung injuries related to ENDS use.

This depends on a range of factors, including the amount of nicotine and other toxicants in the heated liquids, but we know that ENDS pose clear health risks and are by no means safe.

Yes. Nicotine is highly addictive, and ENDS involve the inhalation of a nicotine-infused aerosol.

Yes. The aerosols in ENDS typically contain toxic substances, including glycol which is used to make antifreeze. ENDS pose risks to users and non-users.

Countries can choose to ban ENDS.

ENDS are currently banned in over 30 countries worldwide, with more and more countries considering bans to protect young people. 

Yes. ENDS are harmful to health and, where they are not banned, they must be regulated.

WHO recommends that countries implement regulatory measures that best fit their domestic context.

Regulation should:

  • disrupt the promotion and uptake of ENDS products;
  • reduce the potential health risks to ENDS users and non-users;
  • prohibit false or unproven claims from being made about ENDS; and,
  • protect existing tobacco-control efforts.

About 15 000 unique flavours are used in ENDS, including flavours designed to attract young people, like bubble gum and cotton candy.

Governments should restrict ENDS advertising, promotion and sponsorship so young people, other vulnerable groups and non-smokers are not targeted.

The use of ENDS in indoor public and work places should be banned, given the health risks posed to non-users.

Taxing ENDS in a similar way to tobacco products offers a win–win for governments by protecting citizens through higher prices that deter consumption.

There is not enough evidence to support the use of these products for smoking cessation.

For tobacco users looking to quit, there are other proven, safer and licensed products, such as nicotine replacement therapies (such as patches and gums), as well as quit lines, mobile messaging and specialized tobacco dependence treatments.

WHO regularly monitors and reviews the evidence on ENDS and health and offers guidance to governments and the public.

This includes the biennial WHO Report on the Global Tobacco Epidemic, which tracks the status of the tobacco epidemic and interventions to combat it and other relevant resources.

WHO strives to build a safer, healthier world for everyone, everywhere.