Based on our systematic reviews of literature published up to April 2016, we conclude with the following four observations:
1. Overall, there is encouraging evidence that vapour devices can be at least as effective as other nicotine replacements as aids to help tobacco smokers quit.
2. There is no evidence of any gateway effect whereby youth who experiment with vapour devices are, as a result, more likely to take up tobacco use. The available evidence is that tobacco use by youth has been declining while use of vapour devices has been increasing.
3. Second hand exposure to vapour is more transient than exposure to tobacco smoke. However, it has been shown to create measurable but small exposure to nicotine and no significant exposure to carcinogens such as found in tobacco smoke. It is unclear whether low level nicotine exposure poses any risk to health.
4. Vapour from e-cigarettes contains substantially fewer toxicants than does smoke from regular tobacco cigarettes, however there has been insufficient research regarding some significant carcinogens that may still be present.
In conclusion, we recommend that Canadian regulation of vapour devices be driven by best available evidence with a view to supporting improved public health outcomes. Policy should not be driven by ungrounded fears of a ‘gateway effect’ but, rather, be geared towards helping tobacco smokers quit and ensuring that only the safest devices are legally available, thereby reducing harm for both direct and second hand exposure.