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A man uses an E-cigarette, an electronic substitute in the form of a rod, slightly longer than a normal cigarette, in this illustration picture taken in Paris, March 5, 2013. A changeable filter contains a liquid with nicotine and propylene glycol. When the user inhales as he would when smoking, air flow is detected by a sensor and a micro-processor activates an atomizer which injects tiny droplets of the liquid into the flowing air, producing a vapour. The E cigarette is powered by a rechargeable battery. REUTERS/Christian Hartmann (FRANCE - Tags: HEALTH SOCIETY SCIENCE TECHNOLOGY) - RTR3ELV8

© Christian Hartmann / Reuters/REUTERS

What do the World Health Organization and the public health department of Canada's largest city have in common? Both recently called loudly for public bans on e-cigarette use and new rules to prevent their marketing and sale to minors. Toronto Public Health got immediate action: Last week, City Council voted to prohibit "vaping" (as puffing on an e-cigarette is known) from city workplaces and related outdoor areas. Given the growing evidence that vaping is not some blissfully benign cousin to smoking, the WHO and Toronto are sounding an important warning.

For those who are not in the loop about an industry worth $3-billion globally, e-cigarettes are battery-powered devices that use a heating element to vaporize a flavoured liquid that may or may not contain nicotine. Users puff on their e-cig to fire the heating element, an action that mimics smoking regular cigarettes, and inhale the flavoured vapour. Some e-cigarettes are designed to look like a normal cigarette, but most are metallic and resemble something out of a science-fiction movie. Proponents say they are a harm-reduction strategy – a much healthier way of getting your nicotine fix without inhaling the carcinogens created by the combustion of tobacco.

E-cigarettes are still a relatively new phenomenon. As the WHO points out, it's too early to say whether any of the compounds in the vaporized liquid can cause long-term health problems or might be linked to diseases that take a while to show themselves, such as cancer.

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But new studies are beginning to show that the vapour contains some of the carcinogens and other toxins associated with tobacco smoke, albeit in much lower quantities; that it can cause throat and mouth irritation; and that it can embed tiny metal particles from the device itself in the lungs of users. And when nicotine is added, look out. Nicotine is not a carcinogen but it is a poison, one often used in pesticides. Users can and do suffer nicotine poisoning from overpuffing a device that, unlike a cigarette, never goes out. And the liquid itself can fatally poison a child just by getting on her skin.

The WHO has been monitoring a growing number of nicotine poisoning around the world. It is also watching a steady growth in the use of e-cigarettes, and it is concerned about the threat from both direct and second-hand contact with the vapour.

As well, the WHO says there is no evidence that vaping is an effective way to quit smoking and that, without regulation and prohibition, "children (and generally non-smokers) will initiate nicotine use with [e-cigarettes] at a rate greater than expected if [they] did not exist."

The U.S. announced this year that it intends to regulate e-cigarettes. So far, Health Canada has said nothing. National governments have been slow to react. Thankfully, the WHO and Toronto have taken steps that, at the very least, will get people to take a second look at what they are putting into their lungs.

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