E-cigarettes that contain nicotine should be regulated as tobacco products, including under state smoke-free laws, the American Heart Association says.
The group issued new policy recommendations on Monday that recommend a U.S. ban on e-cigarettes for minors, strict laws on marketing and advertising the products and a ban on flavourings.
"They should be included in smoke-free laws," Dr. Elliott Antman, president of the American Heart Association, said in a video statement. "An important reason for this is it's not clear if the vapour from electronic cigarettes is safe. We do know that nicotine can have harmful effects not only on the user of an electronic cigarette, but also those who are exposed to high concentrations of nicotine in the vapours if they are in an enclosed space."
The group reviewed current evidence in areas such as regulation, design and operation of the devices, preventing youth access, advertising to youth, public health, safety, nicotine content, health effects, secondhand exposure and counselling for cessation.
The policy statement is published in the heart journal Circulation.
Health Canada says e-cigarettes with nicotine or e-cigarettes with a health claim are not authorized for sale in Canada.
The paper’s authors say the sale of e-cigarettes is prohibited in Australia, Brazil, Mexico, Panama, Singapore and Switzerland and allowed in most others, including the United States.
Aruni Bhatnagar, the paper’s lead author and chair of cardiovascular medicine at the University of Louisville, said e-cigarettes have caused a major shift in the tobacco-control landscape.
Proponents of e-cigarettes say the products offer a public health benefit if individuals who smoke conventional cigarettes either switch or greatly cut back their cigarette smoking habit.
The authors say the use of e-cigarettes could be problematic at a population level, such as if they fuel and promote nicotine addiction, particularly among children and their use re-normalizes smoking behaviour.
The group said it will continue to monitor the impact of the technology on population health, cardiovascular disease and stroke.