Electronic Nicotine Delivery Systems(ENDS)

Fact sheet
October 2014

  • ENDS, of which electronic cigarettes are the most common prototype, deliver an aerosol by heating a solution that users inhale. The main constituents of the solution by volume, in addition to nicotine when nicotine is present, are propylene glycol, with or without glycerol and flavouring agents.
  • E-cigarettes and similar devices are frequently marketed by manufacturers as aids to quit smoking, or as healthier alternatives to tobacco, and require global regulation in the interest of public health.
  • E-cigarettes have been marketed in almost 8 000 different flavours, and there is concern they will serve as a gateway to nicotine addiction and, ultimately, smoking, particularly for young people. Experimentation with e-cigarettes is increasing rapidly among adolescents, with e-cigarette use in this group doubling from 2008 to 2012.
  • The use of ENDS is booming. It is estimated that in 2014 there were 466 brands and that in 2013 US$ 3 billion was spent on ENDS globally. Sales are forecasted to increase by a factor of 17 by 2030. The tobacco industry is taking a greater stake in this market and this is a concern for WHO.

Health concerns of e-cigarettes

  • E-cigarette aerosol is not merely "water vapour" as is often claimed in the marketing of these products. While they are likely to be less toxic than conventional cigarettes, e-cigarette use poses threats to adolescents and foetuses of pregnant mothers using these devices.
  • E-cigarettes also increase the exposure of non-smokers and bystanders to nicotine and a number of toxicants
  • There is currently insufficient evidence to conclude that e-cigarettes help users quit smoking or not. Therefore, WHO currently recommends that smokers should first be encouraged to quit smoking and nicotine addiction by using a combination of already-approved treatments.

Regulations on ENDS

When designing a regulatory strategy for ENDS, governments should bear in mind the following general regulatory objectives:

  • impede ENDS promotion to and uptake by non-smokers, pregnant women and youth;
  • minimize potential health risks to ENDS users and non-users;
  • prohibit unproven health claims from being made about ENDS; and
  • protect existing tobacco-control efforts from commercial and other vested interests of the tobacco industry.

Specific regulatory options for ENDS

  • Advertising: An appropriate government body must restrict e-cigarette advertising, promotion and sponsorship, to ensure that it does not target youth and non-smokers or people who do not currently use nicotine.
  • Indoor use: legal steps should be taken to end use of e-cigarettes indoors in public and work places. Evidence suggests that exhaled e-cigarette aerosol increases the background air level of some toxicants, nicotine and particles.
  • Ban on e-cigarettes with fruit, candy-like and alcohol-drink flavours until it can be proved they are not attractive to children and adolescents.

In order to implement the suggested general regulatory objectives as well as the specific regulatory options, Parties will need to consider the available national regulatory frameworks that could best provide solid regulatory grounds.