Electronic cigarettes should be regulated globally, and the devices should not be used in indoor public places or sold to minors, the World Health Organization said Tuesday.
Its report warns that it might take decades before there is conclusive evidence of whether e-cigarettes are linked to diseases such as cancer or other health risks.
Electronic nicotine delivery systems, of which e-cigarettes are the most prominent example, "represent an evolving frontier, filled with promise and threat for tobacco control," the WHO Framework Convention on Tobacco Control said in the report, to be presented at a conference in October.
Advertising for e-cigarettes shouldn't be allowed to make health claims – including claims that the devices help people quit traditional smoking – unless such claims are borne out by clinical trials, the report recommends. (A study based on data from Britain does support the idea, but more would be needed.)
The report also says that marketing for e-cigarettes shouldn't target children or people who don't already use nicotine. To that end, it says that fruit, candy-like and alcoholic-drink flavors for the devices should be banned unless studies prove they're not attractive to minors.
A push away from making e-cigarettes palatable for non-smokers speaks to the objections of Dr. Tom Frieden, head of the
Among other suggestions, the report says the products should deliver a standardized amount of pharmaceutical-grade nicotine and carry health warnings.
The report stresses that more evidence is needed before the makers of e-cigarettes can legitimately claim the devices help people stop smoking.
E-cigarettes "may have a role to play in supporting attempts to quit" smoking, but currently approved treatments should be used first, the report says. Switching entirely from smoking to e-cigarettes "is likely to be less toxic for the smoker," it says, although it's unknown how much their risk is reduced.
The group also cautions that the claim that the aerosol produced by the devices is merely "water vapor" is not correct. E-cigarettes, the report says, should not be used indoors in public places unless the vapor is proved to not be harmful to bystanders.
Nicotine overdose is a concern, it says: Although information is scarce, reports from the U.S. and Britain "indicate that the number of reported incidents involving nicotine poisoning has risen substantially as the use of [e-cigarettes and similar devices] has increased."
On Monday, the American Heart Assn. recommended that federal laws prohibit the sale of e-cigarettes to minors and that the devices be regulated along with traditional combustible cigarettes.
"E-cigarette use and acceptance of e-cigarettes has the potential to renormalize smoking behavior," it wrote in a policy statement, adding, "Unregulated e-cigarette use also has the potential to erode gains in smoking cessation and smoke-free laws."
The president of the American Vaping Assn., an industry group, issued a response Tuesday. Gregory Conley said in a statement that the industry had been "pursuing extensive studies" of e-cigarettes' "uses, pitfalls and benefits" and agrees that more research is necessary.
However, he touted e-cigarettes as a way to help people quit smoking. "We don't believe that e-cigarettes should be regulated as tobacco products," he said. "They are not tobacco products; they are anti-tobacco products."
The American Heart Assn. said Monday that to help traditional smokers quit, other methods should be used first, with e-cigarettes as a last resort.