This review aims to examine the tobacco and nicotine industry’s “harm reduction” narrative through historical, toxicological, behavioral, and environmental dimensions, and to critically evaluate whether electronic cigarettes can genuinely be considered a harm-reduction tool within tobacco control.

This review was designed as a critical narrative and analytical synthesis. A structured literature search was conducted in the PubMed, Scopus, and Web of Science databases to identify English-language studies published between 2010 and 2025. The search strategy included the terms “electronic cigarettes,” “vaping,” “electronic nicotine delivery systems (ENDS),” “heated tobacco products,” “nicotine pouches,” “harm reduction,” “dual use,” “youth initiation,” and “tobacco industry.” To capture respiratory health outcomes, additional keywords such as “lung,” “pulmonary,” “airway,” “respiratory,” “EVALI,” and “vaping-associated lung injury” were incorporated.

Studies reporting findings in favor of harm reduction, particularly those funded by or affiliated with the tobacco or nicotine industry, were critically appraised and systematically contrasted with independent research to assess potential sources of bias and divergence in interpretation.

Historically, tobacco has been legitimized through narratives suggesting it is a “less harmful” or even “protective” product—an approach that is currently replicated for e-cigarettes, heated tobacco products, snus, and nicotine pouches. Although some toxic chemicals in e-cigarette aerosol appear lower than those in combustible cigarettes, device and liquid heterogeneity, the high addiction potential of nicotine salts, and the biological effects of flavorings sustain significant uncertainty regarding their true toxicological profile. Cohort studies and meta-analyses indicate that e-cigarette use does not increase smoking cessation success; rather, it promotes dual use and prolonged nicotine dependence. Among youth, e-cigarette use increases the likelihood of subsequent cigarette smoking by approximately 3.5–4 times, and passive exposure—especially among children—poses measurable health risks. Additionally, disposable e-cigarettes, lithium batteries, and mixed material components contribute to a growing source of electronic waste and environmental toxicity.

Current evidence does not support the widespread adoption of e-cigarettes as a reliable harm-reduction tool within tobacco control. Given the absence of product standardization, increased addiction risk, rising youth uptake, persistence of dual use, and mounting environmental burden, policy development should prioritize independent, methodologically robust evidence over industry-driven optimistic claims. Overall, the review highlights the need for precautionary regulatory approaches that prioritize youth protection, environmental safeguards, and independence from industry influence.

Keywords: electronic cigarettes, tobacco harm reduction, heated tobacco products, nicotine dependence, dual use, e-cigarette lung