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October 22, 2018

A recent report by Nicotine & Tobacco Research urges lawmakers not to treat electronic cigarettes and vaping devices the same as combustible cigarettes, because the more research measures “e-cigarettes as equivalent to cigarettes, the more the likely research may err in conclusions about these unique devices.”


Lead author Matthew Olonoff, a Ph.D. student at Northwestern University’s Feinberg School of Medicine, remarked that before “making policy changes, such as controlling nicotine or flavor options in e-cigarettes, [there is a] need to better understand what role these unique characteristics have.”


The authors used articles and studies to compare the differences between combustible cigarettes and vaping devices and noted key differences between the two, as well as differences between electronic cigarette devices. These differences include the variety of nicotine levels in electronic cigarettes, vaping versus combustion, variability in nicotine dosing, the role of marketing and technology in attracting users to e-cigarettes, and the ability to use vaping devices in places where combustible cigarettes are banned.


Increasingly, research indicates that the smoke in cigarettes causes the most harm, and tobacco harm reduction products, including e-cigarettes as well as smokeless tobacco, have proven to effectively deliver nicotine in a manner much less harmful than combustible cigarettes.


Numerous public health organizations—including Public Health England (PHE), Royal College of Physicians, National Academies of Sciences, Engineering, and Medicine, American Cancer Society, and U.S. Food and Drug Administration (FDA)—have acknowledged there is a reduced harm associated with e-cigarettes and vaping devices, compared to traditional tobacco products. PHE even found the use of e-cigarettes to be an estimated “95% safer than smoking.”


E-cigarettes are facing increased scrutiny from FDA, which is examining nicotine levels and the use of flavors in e-cigarette products. States and localities have also imposed bans and restrictions on e-cigarettes, which could lead to unintended consequences and limit the potential health benefits they provide.


Regulators are placing the blame for the recent uptick in youth vaping on the selection of “desirable” flavors, although very little published data substantiates this supposed correlation. Youth combustible cigarette smoking has been on a steady decline, and is now at an all-time low. Youth vaping rates dropped significantly in 2016 and remained flat in 2017, according to the Centers for Disease Control and Prevention.


More importantly, flavors have played an integral role for adult e-cigarette users who have used the devices to quit smoking combustible tobacco cigarettes. A survey of nearly 70,000 adult vapers in the United States found that many used flavors at the start of electronic cigarette initiation, and only 20 percent of respondents reported “using tobacco flavors” at the point of initiation. There is significant concern that if flavors are banned in e-cigarettes and vaping devices, many smokers will return to or begin smoking combustible tobacco cigarettes.


Additionally, researchers have analyzed the public health cost savings these products can provide. For example, an analysis of the potential benefits of 1 percent of Medicaid recipients switching from tobacco products to e-cigarettes could result in savings of “approximately $2.8 billion” over the next 25 years, and $2.8 billion more could be saved for every additional 1 percent of Medicaid enrollees who make the switch.


As the authors of the Nicotine & Tobacco Research report note, early regulations and bans on electronic cigarettes could heavily impact the potential public health gains the products provide to millions of tobacco smokers. Policymakers should understand that e-cigarettes and vaping devices are significantly different than combustible tobacco cigarettes, and they should consider the benefits of these devices when implementing regulations. Instead of trying to regulate and tax e-cigarettes, lawmakers should promote the use of tobacco harm reduction products.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute or Tobacco Harm Reduction 101.

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