Cigarettes kill an estimated 480,000 Americans each year. An estimated 46 million Americans smoke cigarettes, the most hazardous and most addictive of tobacco products. Despite our best efforts, these numbers have been consistent, year to year, for more than a decade. Switching from cigarettes to a smokeless tobacco product or an e-cigarette can reduce a smoker’s risk of potentially fatal tobacco-attributable cancer, heart and lung disease by 98 percent or better. This approach is called “tobacco harm reduction” (THR). Adding a THR component to current tobacco-control programming is the only policy option likely to substantially reduce tobacco-attributable illness and death in the United States over the next 20 years. The e-cigarette family of products offers the most promising set of harm reduction methods because of their relative safety compared to cigarettes, their efficacy in helping smokers cut down or quit and their unattractiveness to teens and other non-smokers. They also promise to be less addictive than cigarettes and easier to quit.

This primer provides evidence in favor of e-cigarettes as a THR modality and a review of the arguments against them. Many in tobacco control oppose any consideration of e-cigarettes because of their dislike of the “tobacco industry”; because they fear that THR will attract large numbers of teens to nicotine addiction; because the case in favor of e-cigarettes has not been proven to their satisfaction; and possibly because of likely harm to the major pharmaceutical firms that now support much tobacco-control research and programming. This primer closes with recommendations for actions state and local lawmakers should and should not consider with respect to THR and e-cigarettes.