THR Statements – Tobacco Harm Control quotes from leading officials
Nearly 100 organizations agree that E-cigarettes are “safer than smoking.” All statements hyperlink to their websites.
(none of these organizations are funded or influenced by either the tobacco or vape industries)
World Health Organization EURO Office: “There is conclusive evidence that: Completely substituting electronic nicotine and non-nicotine delivery systems for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.”
International Agency for Research on Cancer: “The use of e-cigarettes is expected to have a lower risk of disease and death than tobacco smoking… E-cigarettes have the potential to reduce the enormous burden of disease and death caused by tobacco smoking if most smokers switch to e-cigarettes.”
Cochrane systematic evidence review: 61 scientific studies (including 34 randomized control trials) involving 16,759 participants in a dozen countries:
NOTE: This is the most prestigious scientific society in the field of tobacco control. The SRNT itself has no official statement. However, 15 past-Presidents of the SRNT have published a joint statement. All 15 agree, “Vaping can benefit public health, given substantial evidence supporting the potential of vaping to reduce smoking’s [death] toll. …Frequent vaping increases adult smoking cessation [and] completely substituting vaping for smoking likely reduces health risks, possibly substantially.”
Cancer Research UK: “While the long-term health consequences of e-cigarette use are uncertain, the evidence so far suggests that e-cigarettes are far less harmful than smoking. …There is also growing evidence to suggest that e-cigarettes can work successfully as an aid to cessation. …There is insufficient evidence to support a blanket indoor ban on e-cigarette use, either on the basis of renormalisation of smoking or harm to bystanders from second-hand vapour.” UPDATE: …Studies that seem to find harms are ”usually conducted on animals or cells in the lab, …and the concentrations of e-cigarette vapour used are often much higher than people would be exposed to in real life… The best evidence available in humans shows e-cigarettes are far less harmful than smoking. There is no good evidence that second-hand e-cigarette vapor is harmful to bystanders.”
UK Primary Care Respiratory Society: “People currently using an e-cigarette to support a [smoking] quit attempt and unwilling to use alternative NRT options should be supported to continue their quit attempt using their preferred strategy.”
British Heart Foundation: “Research suggests that e-cigarettes may be less harmful to the heart and circulatory system than tobacco in the short-term… We know they contain significantly fewer of the harmful chemicals which can cause diseases related to smoking.”
UK National Institute for Health and Care Excellence: “The evidence suggests that e-cigarettes are substantially less harmful to health than smoking but are not risk free. Many people have found them helpful to quit smoking cigarettes.”
UK Royal College of General Practitioners: “The evidence so far shows that e-cigarettes have significantly reduced levels of key toxicants compared to cigarettes, with average levels of exposure falling well below the thresholds for concern.”
Stroke Association UK: “Current evidence shows that the risk to health posed by e-cigarettes in the short term is likely to be considerably less compared to smoking.”
Action on Smoking and Health UK: “It has been estimated that e-cigarettes are 95% less harmful than ordinary cigarettes. There is negligible risk to others from second-hand e-cigarette vapour. …The lifetime cancer risk of vaping has been assessed to be under 0.5% of the risk of smoking. [But] Public understanding of the relative harms of e-cigarettes [vs smoking cigarettes] have worsened over time and are less accurate today than they were in 2014.” “The widespread use of snus [a smokeless oral tobacco product] by Swedish men, displacing tobacco smoking, is responsible for the incidence of tobacco-
related mortality in Swedish men being significantly lower than any other European country.”
UK National Centre for Smoking Cessation and Training: “Experts estimate that e-cigarettes are, based on what we know so far, around 95% safer than cigarettes. Smoking is associated with a number of very serious health risks to both the smoker and to others around them. Therefore, smokers who switch from smoking tobacco to e-cigarettes substantially reduce a major risk to their health. …Nicotine does not cause smoking related diseases, such as cancers and heart disease.”
UK Royal College of Psychiatrists: “Smoking rates among people with severe mental illness are much higher than in the general population… While we do not fully understand the long-term risks, psychiatrists should advise their patients that e-cigarettes are an effective option for some people to give up smoking, and are substantially safer than continued tobacco use. All mental health providers should have policies in place that facilitate the safe and effective use of e-cigarettes.”
Royal Pharmaceutical Society of Great Britain: “E-cigarette aerosols contain fewer numbers and lower levels of most toxicants than smoke from combustible tobacco cigarettes and are generally considered likely to be significantly less harmful than smoking tobacco… E-cigarettes are one of several harm reduction options in the short-term to encourage smokers to stop using tobacco products.”
UK Teratology Information Service (UK government Public Health Service): “There is strong evidence that smoking during pregnancy increases the chance of miscarriage, certain birth defects, premature birth and poor growth of the baby in the womb, which has been linked to health problems later in life. …Many healthcare professionals believe that vaping exposes the baby to fewer toxic chemicals than smoking. Vaping may therefore be an option for pregnant women who cannot stop smoking using other nicotine replacement products [e.g., nicotine patches, gum, mouth spray, nasal spray and lozenges].”
London Fire Brigade: “Smoking is the number one cause of fatal fires and one of the top causes of accidental fires in the home. …Fire chiefs now urge smokers to take up vaping to reduce the risk. Our message is simple: Quit smoking or risk dying in a fire. We would urge you to stop smoking completely, but fully appreciate this is your decision. If you still need that nicotine fix, vaping is a much safer alternative. …We have not had any reports of injuries or deaths caused by e-cigarettes.” [NOTE: (1) In the USA, smoking causes 18,100 residential fires and 590 fire deaths every year, (2) Li-ion battery fire risks are rare, and no more likely from ecigs than cell phones, laptops, and portable battery chargers.]
UK National Fire Chiefs Council: “There are an estimated 2.9 million adult vapers in Britain, almost all of whom are smokers and ex-smokers. In March 2016, it was reported that there were 113 fires caused by e-cigarettes in three years. Incident Recording System (IRS) data shows that there have been over 16,000 smoking-related fires over the same period. These figures indicate the higher risks associated with smoking. An expert independent evidence review published by Public Health England concluded that vaping devices are significantly less harmful to health than cigarettes and have the potential to help smokers quit smoking.” [NOTE: All Li-ion batteries have a rare fire risk; not just e-cigarettes.]
National Health Service Scotland consensus statement on e-cigarettes: “Smoking kills. Helping people to stop smoking completely is our priority. …There is now agreement based on the current evidence that vaping e-cigarettes is definitely less harmful than smoking tobacco.”
This statement was created and endorsed by: Action on Smoking & Health Scotland • Cancer Research UK • Chest Heart & Stroke Scotland • Chief Medical Officer for Scotland • NHS Ayrshire and Arran • NHS Greater Glasgow and Clyde • NHS Lothian • NHS Tayside • Roy Castle Lung Cancer Foundation • Royal College of General Practitioners • Royal College of Physicians of Edinburgh • Royal College of Physicians and Surgeons of Glasgow • Royal Environmental Health Institute of Scotland • Scottish Collaboration for Public Health Research and Policy • Scottish Consultants in Dental Health • Scottish Thoracic Society • UK Centre for Tobacco & Alcohol Studies • University of Edinburgh • University of Stirling
Health Information and Quality Authority (HIQA), Ireland: “Half of smokers in Ireland report making at least one quit attempt every year. The most popular cessation method is unassisted quitting (50%) followed by e-cigarettes (29%) and nicotine replacement therapy (12%). …While toxic chemicals may be present in e-cigarette vapour, they are at a lower concentration than in cigarette smoke. …Risk to bystanders from ‘passive vaping’ appears to be very low.”
Position Statement: “Vaping is not harmless but it is much less harmful than smoking. Vaping has the potential to help people quit smoking and contribute to New Zealand’s Smokefree 2025 goal.”
Organizations that support this statement include: NZ Ministry of Health; Health Promotion Agency/Te Hiringa Hauora (HPA); Action for Smokefree 2025 (ASH); National Training Service (NTS); New Zealand Medical Association (NZMA); All District Health Boards; Pharmacy Guild of New Zealand; New Zealand Heart Foundation; New Zealand College of Midwives; Parents Care Centre.
Asthma & Respiratory Foundation NZ: “The Foundation acknowledges that the use of e-cigarettes as part of a wraparound smoking cessation programme may assist some people. …The Foundation does recognise that for some current smokers of traditional cigarettes who have struggled to quit using current smoking cessation aids, the use of e-cigarettes or vaping products may help.”
Drug and Alcohol Nurses of Australasia: “People with drug and alcohol dependence have high
Australian Government, Department of Health, Therapeutic Goods Administration: “For people who have tried to achieve smoking cessation with approved pharmacotherapies but failed, and who are still motivated to quit smoking and have discussed e-cigarette use with their healthcare practitioner, nicotine containing e-cigarettes may be a reasonable intervention to recommend.”
Royal Australian College of Physicians: “The RACP acknowledges that e-cigarettes may have a potential role in tobacco harm reduction and smoking cessation for smokers unable or unwilling to quit.”
Royal Australian College of General Practitioners: “E-cigarettes can relieve cravings and symptoms of nicotine withdrawal as well as simulating the behavioural and sensory aspects of smoking. …It is reasonable to conclude that if used as a substitute rather than an addition, e-cigarettes are much less harmful than continuing to smoke.”
Statement endorsed by: Action on Smoking and Health Australia • Australian Association of Smoking Cessation Professionals • The Australian Dental Association • The Australian Practice Nurses Association • Cancer Council Australia • The National Heart Foundation of Australia • Lung Foundation Australia • Pharmaceutical Society of Australia • Quit Victoria • The Royal Australian and New Zealand College of Psychiatrists • The Royal Australian College of General Practitioners • Royal College of Nursing, Australia • SANE Australia • Thoracic Society of Australia and New Zealand
European Commission Directorate-General, Health & Consumer Protection: “In recent decades, the use of snus in Sweden has increased while the number of smokers in this country has decreased. …There is general agreement that the use of moist snuff is less dangerous than tobacco smoking. …It is undeniable that, for an individual, substitution of tobacco smoking by the use of moist snuff [“snus”] would decrease the incidence of tobacco related diseases.”
German Federal Institute for Risk Assessment: “According to current knowledge, e-cigarettes are less harmful than conventional tobacco products when used as intended.”
German Society of Addiction (Deutsche Suchtgesellschaft – Dachverband der Suchtfachgesellschaften): “In general, one can assume that the vapor from an e-cigarette is much less harmful than conventional cigarette smoke and that the e-cigarette can be used for nicotine withdrawal if guideline-based psychotherapeutic and/or drug treatments for nicotine withdrawal are ineffective or unwanted.”
French National Academy of Medicine: “It is established that the vaporette is less dangerous than the cigarette… It is therefore preferable for a smoker to vape. Since 2016, the High Authority for Health (HAS) considers it ‘as an aid to stop or reduce the consumption of tobacco by smokers.’ Santé Publique France indicates that at least 700,000 [French] smokers have quit using electronic cigarettes. …Smokers who were about to switch to vaporizing instead of tobacco should not hesitate…” [Google Translate]
French High Council for Public Health: “E-cigarettes can be considered a smoking cessation aid for smokers who would like to completely break their habit. [They] are a tool for reducing the risks of smoking.”
French National Academy of Pharmacy: “The World Health Organization’s [anti-e-cigarette] position is incomprehensible. Tobacco is responsible for 73,000 deaths in France. The e-cigarette helps people quit smoking. Its components are obviously less harmful than tobacco.” [NOTE: This is a Tweet from the Académie Nationale de Pharmacie. Not an official position statement.]
US National Academies of Sciences, Engineering and Medicine: “Conclusion 18-1. There is conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.” E-cigarettes “are likely to be far less harmful than combustible tobacco cigarettes.”
US Food & Drug Administration: E-cigarettes are “potentially less harmful forms of nicotine delivery for adults. …Many studies suggest e-cigarettes and noncombustible tobacco products may be less harmful than combustible cigarettes.” “Make no mistake. We see the possibility for ENDS products like e-cigarettes to provide a potentially less harmful alternative for currently addicted individual adult smokers who still want to get access to satisfying levels of nicotine without many of the harmful effects that come with the combustion of tobacco.”
The FDA says, “Existing studies have shown that daily ENDS use is associated with significant reductions in combusted cigarette use.”
FDA has now authorized, and confirmed the existence of, a category of non-medicine consumer nicotine products that are “appropriate for the protection of public health.” Strangely, this regulatory hurdle is far higher than that for new deadly cigarette products. So far, FDA has authorized 12 new and emerging nicotine products, confirming and validating the public health concept of Tobacco Harm Reduction (THR):
- 8 ultra-low nitrosamine (low carcinogen) tobacco “snus” products. The maker is now authorized to tell its customers, “Using [this] instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.”
- 1 heated tobacco product. The maker is now authorized to tell its customers, “Switching completely from conventional cigarettes to [this product] significantly reduces your body’s exposure to harmful or potentially harmful chemicals.”
- 3 nicotine vape (“e-cigarette”) products: “The manufacturer’s data demonstrates its tobacco-flavored products could benefit addicted adult smokers who switch to these products… by reducing their exposure to harmful chemicals,” said Mitch Zeller, J.D., Director of FDA’s Center for Tobacco Products.”
US Centers for Disease Control: “E-cigarettes expose users to fewer harmful chemicals than burned cigarettes.” “E-cigarettes have the potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products.”
US Substance Abuse and Mental Health Services Administration: “E-cigarettes may help non-pregnant smokers if used as a complete substitute for all cigarettes.”
American Cancer Society: “Based on currently available evidence, using current generation e-cigarettes is less harmful than smoking cigarettes.” And “although the long-term effects of ENDS are not known, current-generation ENDS are markedly less harmful than combustible tobacco products.” [NOTE: This was ACS’ official statement from 2018-2019. In November 2019, ACS stopped recommending e-cigarettes to adult smokers. Their stated reason for this change was “e-cigarette use by young people.” Still on ACS’ website: “e-cigarette contains [sic] some cancer-causing chemicals, although in significantly lower amounts than in cigarette smoke… [and] People who have already switched completely from smoking to e-cigarettes should not switch back to smoking.” [Obviously, they’re still less harmful.]
American Academy of Otolaryngology-Head and Neck Surgery: “E-cigarettes may possibly help adult tobacco users to transition from traditional combustible cigarettes and oral tobacco to less harmful vapor products to satisfy their nicotine addiction.”
US Campaign for Tobacco-Free Kids: “E-cigarettes could benefit public health if they help significantly reduce the number of people who use combustible cigarettes and die of tobacco-related disease.”
US Truth Initiative: “Researchers from Truth Initiative reviewed 686 peer-reviewed studies [and determined that] e-cigarettes pose substantially less harm than traditional cigarettes. …Overall, e-cigarettes expose users to fewer toxins than cigarettes, and cigarette smokers who switched to e-cigarettes had reduced blood pressure and improved lung function.” Further, “a smoker who switches completely to e-cigarettes from combustible cigarettes will substantially reduce exposure to toxic chemicals and health risk. There is also some evidence that more frequent e-cigarette use may increase an individual’s likelihood to quit.”
Canadian Lower-Risk Nicotine Use Guidelines (LRNUG): “Funded by Health Canada’s Substance Use and Addictions Program, the LRNUG has developed several resources to help guide people who use, or are thinking about using nicotine, on how to lower the risk associated with these products. …E-cigarettes with nicotine may be an effective cessation aid for people who use combustible tobacco. People who switch from combustible tobacco to e-cigarettes will reduce their exposure to numerous toxicants and carcinogens.” Quick Tips: “Using tobacco in forms that don’t burn, like smokeless tobacco or heat-not-burn products, will reduce your exposure to harmful combusted chemicals including carbon monoxide. [You can] further reduce your risk by switching to products that don’t have tobacco like NRT [e.g., nicotine patches or nicotine gum] or e-cigarettes.”
Canadian Lung Health Foundation: “If you don’t smoke, don’t start vaping… If you do smoke, switching completely to e-cigarettes may significantly reduce your exposure to toxic chemicals and carcinogens.”
Consejo de Ministros de la República Oriental del Uruguay [Uruguayan Council of Ministries]: “There are electronic devices for the administration of nicotine that use a technology by which dry tobacco is heated, with respect to which there are scientific data that indicate that they result in less exposure of users to toxic substances associated with traditional tobacco consumption.” [Google Translate]
Federation of Private Medical Practitioners’s Association, Malaysia: “As an option in reducing health risk associated with smoking cigarettes, current smokers should be counseled to switch to less harmful nicotine alternatives rather than having them continue cigarettes… The primary value of Tobacco Harm Reduction (THR) is to reduce the negative consequences associated with smoking cigarettes. By definition, THR offers an option for smokers who cannot or are unwilling to stop smoking, to switch to using other less harmful nicotine products.”
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