Pam Ling and I recently published “E-cigarettes increase harm and should be discouraged” in Nature Human Behavior that summarizes the current evidence on e-cigarettes. The Introduction sums up the paper:
Ever since they were introduced, arguments that e-cigarettes reduce tobacco harm have hinged on three assumptions: (1) nicotine aerosol from heating a liquid rather than burning tobacco substantially reduces disease risk; (2) smokers would quit or switch completely from cigarettes to e-cigarettes; and (3) e-cigarettes would not appeal to youth.
Yet the over 11,000 papers on e-cigarettes published by January 2026 demonstrate that all three assumptions are wrong: (1) e-cigarettes are associated with substantial disease risks, (2) as consumer products, e-cigarettes do not promote smoking cessation and (3) e-cigarettes expand nicotine addiction by attracting youth who are otherwise at low risk for smoking cigarettes. Therefore, e-cigarettes should not be promoted as reducing harm or for smoking cessation, and policies to discourage e-cigarette initiation, use, and dual use with cigarettes should expand. Legislation and regulations should include the elimination of flavours and limits on potency, including maintaining and implementing bans on sales.
The key points are:
- The “hard core” of smokers who “cannot or will not quit” has been melting away for decades.
- Multinational tobacco companies dominate the e-cigarette market and use them to hold on to customers.
- E-cigarettes have substantial health risks, sometimes indistinguishable from cigarettes, that are much higher than one would expect based on biomarkers of cigarette exposure.
- Dual use, which is common among adult e-cigarette users, carries higher risks than just smoking (or just using e-cigarettes).
- Nicotine causes harm well beyond its addictive effects.
- E-cigarettes are not associated with stopping smoking in the real world.
- Youth addition is important and no country that has maintained permissive policies on e-cigarettes has successfully limited use to adult smokers.
- E-cigarette waste represents a serious environmental hazard.
We conclude:
Members of the scientific and public health community should stop minimizing the dangers of nicotine use and claiming that that e-cigarettes have a role in promoting health, as this can trivialize the burden of nicotine addiction and adverse disease effects of nicotine and provide support to tobacco companies, and result in harms to health. As actually used at a population level, e-cigarettes do not help cigarette smokers to quit and do drive youth addiction.
Given current evidence, policy efforts should discourage
e-cigarette initiation, as well as sustained and dual use among both adults and youth. We also recommend the elimination of flavours for e-cigarettes, limitations on potency and availability, and maintaining and/or implementing bans on sales.
The journal also published a pro-e-cigarette paper, “To regulate vaping we need pragmatic, evidence-based policy” by Sarah E. Jackson, Lion Shahab, Ann McNeill, Nancy A. Rigotti, Chris Bullen and Jamie Brown. I urge people to read this paper and compare currency and quality of evidence they cite with that in our paper.
The full citation is: Ling, P.M., Glantz, S.A. E-cigarettes increase harm and should be discouraged. Nat Hum Behav 10, 831–833 (2026). https://doi.org/10.1038/s41562-026-02470-z. It is available here. If it is behind a paywall for you, email me and I will send you a PDF.
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