Health literacy videos to clear up confusion around e-cigarettes and heated tobacco products

The tobacco industry is trying to market heated tobacco products (HTPs) and electronic nicotine delivery systems (ENDS) as less toxic and safer alternatives to conventional cigarettes. In reality, these products are not trivial. HTPs are tobacco products and may actually expose users to higher levels of certain toxic substances than conventional smoking. ENDS contain nicotine – a highly addictive substance – and other toxic chemicals.

The lines between these products are rigorously blurred by the tobacco industry to confuse users and normalize the use of HTPs and ENDS, especially among young people. In response, the WHO has developed a series of short videos that provide hard-hitting introductions to the harms of these products, clearly distinguish them, and provide guidance on how to regulate HTPs and ENDS. The objective is to inform, so that everyone can live a life without nicotine or tobacco.

Deliberate attempts by the tobacco industry to confuse HTP and ENDS

The deliberate creation of confusion about the categories of these products poses great difficulties both for the general public and for regulators. HTPs differ from ENDS. HTPs heat tobacco to generate aerosol-containing nicotine and are not so-called vaping products, as the industry often calls them. ENDS heats a liquid that contains nicotine, but does not contain tobacco. Electronic delivery systems that claim to contain no nicotine are called electronic nicotine-free delivery systems (ENNDS).

It is important to point out that HTPs are tobacco products, which means that they pose different health risks. However, where appropriate, tobacco companies are promoting HTPs as “ENDS-like” electronic products to benefit from lighter regulation. Conversely, in countries where ENDS are banned, HTPs are presented as tobacco products that do not fall into the prohibited category.

A clear distinction between products is necessary to understand both the dangers associated with their use and the different regulations they require. For example, ENDS are often used to supplement smoking, which means people become two users rather than substituting for one another. This occurs especially in smoke-free environments where the use of ENDS is not prohibited.

In some countries, up to 70% of adult ENDS users also smoke cigarettes. Dual use may be more harmful than single product use – it sustains nicotine addiction and may increase the risk of respiratory disease.

Regulation needed to prevent youth use of new tobacco and nicotine products

The prevalence of e-cigarette use among young people is increasing in the WHO European Region at an alarming rate, according to data from countries monitoring it. For example, between 2014 and 2018, the prevalence among young people increased from 8.4% to 17.5% in Italy, and between 2011 and 2019, it increased from 9.1% to 18.0% in Latvia.

The WHO/Europe videos provide a brief overview of what policy makers and regulators can do to curb the trend of increasing use of HTPs and ENDS. In line with WHO tobacco control guidelines, these approaches range from banning flavors that appeal to children to banning use in indoor spaces where smoking is prohibited to banning the sale to minors.

The tobacco industry often claims that HTPs and ENDS help people quit smoking. The evidence on the potential role of ENDS in withdrawal is still inconclusive. To date, smoking cessation is most effective with nicotine replacement therapy or nicotine-free therapies. As for HTPs – because they are tobacco products themselves, they do not help smokers quit.

Additionally, there is concern that ENDS may act as gateways to conventional smoking. A recent global systematic review found that children and adolescents who use ENDS, even experimentally, are more than twice as likely to use cigarettes later. Thus, preventing the initiation of HTP and ENDS use is a crucial strategy to protect people’s health and well-being from new products as well as traditional smoking.

“With these videos, we are sharing very clear messages for the public and decision-makers to minimize confusion and accelerate action at country level,” says Dr Kremlin Wickramasinghe, Acting Head of the WHO European Office for the prevention and control of non-communicable diseases. .

“We have good examples in our Region of countries adopting and implementing comprehensive tobacco control policies and expanding their scope to cover new products, including HTPs and ENDS. It is high time to disseminate these good practices and share them with other Member States.