E-cigarettes have a strong potential to improve population health by reducing or displacing cigarette use. International top tobacco experts urged the US Food and Drug Administration (FDA) to have a broad open-minded perspective when it comes to regulating vaporized nicotine products, especially e-cigarettes.1

Their publication synthesized much of the evidence published so far on e-cigarettes. They found that the use of these products can lead to reduced cigarette smoking overall with a potential reduction in deaths from cigarette smoking.

The investigators include lead author David T. Levy, PhD, of Georgetown University; K. Michael Cummngs, PhD, MPH, of the Medical University of South Carolina; Andrea C. Villanti, PhD, MPH, Ray Niaura, PhD, and David B. Abrams, PhD, from Truth Initiative; Geoffrey T. Fong, PhD, of the University of Waterloo in Canada; and Ron Borland, PhD, of Cancer Control Victoria, in Australia.

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“We’re concerned the FDA, which has asserted its right to regulate e-cigarettes, will focus solely on the possibility that e-cigarettes and other vapor nicotine products might act as gateway to cigarette use,” said Levy, a professor in the department of oncology at the Georgetown Lombardi Comprehensive Cancer Center in Washington, DC.

“We believe that the discussion to date has been slanted against e-cigarettes, which is unfortunate, because the big picture tells us that these products appear to be used mostly by people who already are or who are likely to become cigarette smokers,” added Levy.

The authors stated that smoking rates in the United States have fallen by half since they peaked in the 1960s, but smoking still leads to premature mortality.

Levy explained that the experts estimate that exclusive e-cigarette use has about 5% of the mortality risks of smoking. Further, evidence suggests that e-cigarettes have a strong potential to improve population health by reducing or displacing cigarette use in countries where cigarette prevalence is still high and smokers are interested in quitting.

Research from the United States, Canada, and England has found that cigarette smoking rates have fallen more in the last 2 years than they have in the previous 4 or 5 years, and that this trend has coincided with the increase in e-cigarette use.

“While e-cigarettes may act as a gateway to smoking, much of the evidence indicates that e-cigarette use encourages cessation from cigarettes by those people who would have otherwise smoked with or without e-cigarettes,” Levy said.

The authors anticipate that their suggested framework will be controversial due to an ongoing debate about whether e-cigarettes will complement or undermine tobacco control efforts.

“We don’t want to encourage e-cigarette use by youth and young adults who would not have otherwise smoked. However, the primary aim of tobacco control policy should be to discourage cigarette use while providing the means for smokers to more easily quit smoking, even if that means switching for some time to e-cigarettes rather than quitting all nicotine use,” the authors wrote in their article.

The authors also warned that heavy regulation and taxation of e-cigarettes will counteract the benefit that these products can provide.


1. Levy DT, Cummings KM, Villanti AC, et al. A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products [published online ahead of print April 25 2016]. Addiction. doi:10.1111/add.13394.