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Following two previous reports produced for Public Health England (PHE) on ecigarettes (EC) in 2014, this report updates and expands on the evidence of the implications of EC for public health. It covers the EC policy framework, the prevalence of EC use, knowledge and attitudes towards EC, impact of EC use on smoking behaviour, as well as examining recent safety issues and nicotine content, emissions and delivery. Two literature reviews were carried out to update the evidence base since the 2014 reports and recent survey data from England were assessed.

EC use battery power to heat an element to disperse a solution of propylene glycol or glycerine, water, flavouring and usually nicotine, resulting in an aerosol that can be inhaled by the user (commonly termed vapour). EC do not contain tobacco, do not create smoke and do not rely on combustion. There is substantial heterogeneity between different types of EC on the market (such as cigalikes and tank models). Acknowledging that the evidence base on overall and relative risks of EC in comparison with smoking was still developing, experts recently identified them as having around 4% of the relative harm of cigarettes overall (including social harm) and 5% of the harm to users.