Position statement on electronic cigarettes or electronic nicotine delivery systems.

• The International Union Against Tuberculosis and Lung Disease (The Union) has issued this position statement based on a careful review of the scientifi c evidence; the position statement will be reviewed by mid-2015. • The safety of electronic cigarettes (ECs) or electronic nicotine delivery systems (ENDS) has not been scientifi cally demonstrated. • Adverse health effects for third parties exposed (second-hand exposure) cannot be excluded because the use of electronic cigarettes leads to emission of fi ne and ultrafi ne inhalable liquid particles, nicotine and cancer-causing substances into indoor air. • The benefi ts of e-cigarettes have not been scientifi cally proven. To date, very few studies have assessed ECs/ENDS as a harm reduction and cessation aid, with confl icting fi ndings. • The Union is concerned that the marketing, awareness and use of ECs or ENDS is growing rapidly. • A range of current and proposed legislative and regulatory options exists; some countries (such as Brazil, Norway, and Singapore) have banned ECs/ ENDS completely. • ENDS could undermine the implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 12 (denormalisation of tobacco use); use of ENDS could also hamper the implementation of Article 8 (protection from exposure to tobacco smoke), as ENDS users in public places may claim that their electronic cigarette does not contain tobacco and/ or does not produce second-hand tobacco smoke. • The Union strongly supports the regulation of the manufacture, marketing and sale of electronic cigarettes or ENDS; the preferred option is to regulate ECs or ENDS as medicines. • If regulation as medicines is not feasible, the following measures should be considered, pending the availability of reliable evidence: — a comprehensive ban on all advertising, promotion and sponsorship; — promotion of ECs/ENDS for tobacco cessation to be prohibited; — display of ECs/ENDS in retail stores to be prohibited; — sale to minors (persons under the age of full legal responsibility) to be prohibited; — ECs/ENDS and their refi lls should not be sold in fl avours that are appealing to children; — packaging and labelling of EC/ENDS cartridges and disposable ECs/ENDS should include a list of all ingredients, stipulate the quantity of nicotine and include appropriate warning labels; — ECs/ENDS should not be used in public places, workplaces or on public transportation; — consumer safety standards for EC cartridges should be established, including ensuring manufacturing consistency and regulating the maximum quantity/dosage of nicotine they may contain.