International clampdown needed on e-cig use, says WHO

The World Health Organization on Tuesday called on countries to impose tougher regulations on electronic cigarettes out of concerns over their unknown health risks, recommending bans on indoor use as well as sales to minors.

More regulation of e-cigarettes are needed in light of the boom in popularity of such devices in recent years, with more than 400 brands and sales reaching about $3 billion in 2013, the United Nations health agency said in its report.

Marketed as a healthier alternative to conventional cigarettes, projections indicate e-cig sales will outpace sales of their tobacco counterpart over the next decade.

As such, the industry has attracted tobacco companies that have introduced their own devices in the past few years, raising concerns that their marketing campaigns, which have included TV and radio advertising, have mimicked those employed for tobacco cigarettes before they were banned, leading to increasing use among young people.

“The evidence is sufficient to caution children and adolescents, pregnant women and women of reproductive age about ENDS (electronic nicotine delivery systems) use because of the potential for fetal and adolescent nicotine exposure to have long-term consequences for brain development,” according to the report.

Proponents of e-cigarettes have argued that the devices are a less harmful alternative to tobacco, with many users saying they have helped them quit smoking. It is widely accepted that such devices, which use a battery to heat a nicotine solution that is inhaled as a vapor, are probably safer than tobacco cigarettes as none have been known to carry the estimated 4,000 chemicals that are found in conventional cigarettes when smoked. But many health experts say not enough is known about the ingredients inside an e-cigarette to determine if they pose a health risk.

As such, the regulatory recommendations within the WHO report include banning product makers from making health claims about their devices. Also, companies would not be able to market e-cigarettes in a way that make them appealing to nonsmokers or minors.

The recommendations come one day after the Centers for Disease Control and Prevention released an analysis regarding e-cig use among young people. Despite a decline in youth smoking in the past two decades, it found that more than a quarter million middle-school and high school students who had never smoked reported using e-cigarettes in 2013, a 232% increase from 2011.

Those who used an e-cigarette but had never smoked were twice as likely to use tobacco compared with those who did not use e-cigs, according to the study, with 43% of e-cig users reporting they intended to smoke conventional cigarettes with the next year compared with 21% who never used e-cigarettes.

“We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes or other tobacco products,” Dr. Tim McAfee, director of the CDC's Office on Smoking and Health, said in a statement. “Not only is nicotine highly addictive, it can harm adolescent brain development.”

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