Health impact of electronic cigarettes and heated tobacco systems

Cigarette smoking is the leading cause of preventable disease and premature mortality worldwide. The goal of reducing the harm caused by smoking has traditionally been based on preventing smoking initiation and promoting smoking cessation. While these two approaches are, and will continue to be, keystones for reducing the prevalence of smoking, long-term smoking cessation has been proven to be a difficult task for far too many smokers. Compulsion to smoking is very difficult to break with many smokers typically cycling through multiple periods of remission and relapse; this contributes to the slow decline in smoking prevalence. Consequently, there is a pressing need for alternative tactics to reduce or prevent harm for those who continue to smoke. One of these tactics is tobacco harm reduction, a principle acknowledged in the World Health Organization’s Framework Convention on Tobacco Control. The goal of tobacco harm reduction is to prevent or reduce the harms to health caused by smoking for people unable or reluctant to stop, as an alternative strategy to the complete abstinence from nicotine use. Tobacco harm reduction is based on the well-established concept that smokers seek to obtain the effects of nicotine, while the real risks are produced by the toxic components in the smoke. In fact, nicotine is unlikely to contribute significantly to the development of smoking-related diseases