E-cigarettes should be banned indoors over fears that they can be as toxic to bystanders as normal cigarettes, the World Health Organisation has said. 
 
 Despite releasing vapour instead of smoke, the devices still pollute the air with harmful chemicals, health experts warned. 
 
 Many smokers use e-cigarettes as a way to quit, as they deliver the nicotine hit but without the carcinogens associated with breathing in smoke. There are no laws currently banning their use inside. 
 
 But a report by the WHO questioned the safety of e-cigarettes, officially known as electronic nicotine delivery systems (ENDS). 
 
 "The fact that ENDS exhaled aerosol contains on average lower levels of toxicants than the emissions from combusted tobacco does not mean that these levels are acceptable to involuntarily exposed bystanders,” said the report. 
 
 "In fact, exhaled aerosol is likely to increase, above background levels, the risk of disease to bystanders, especially in the case of some ENDS that produce toxicant levels in the range of that produced by some cigarettes." 
 
 Some early studies have shown that e-cigarettes can be more effective than over-the-counter products like gum or nicotine patches. 
 
 But the report recommends preventing manufacturers from marketing e-cigs as "smoking cessation aids" until they provide robust scientific evidence to back the claim. 
 
 "Although anecdotal reports indicate that an undetermined proportion of ENDS users have quit smoking using these products, their efficacy has not been systematically evaluated yet,” the report added. 
 
 "Only a few studies have examined whether the use of ENDS is an effective method for quitting tobacco smoking." 
 
 The WHO also advised banning sales to under-18s and said vending machines should be removed "in almost all locations.” 
 
 The report was welcomed by health officials. 
 
 Professor John Ashton of the Faculty of Public Health said: “Most adult smokers start smoking before the age of 18. That's why many public health experts are concerned that the advertising of electronic cigarettes could make it seem normal again to think smoking is glamorous, when it is anything but. 
 
 “We also don’t know enough yet about the harms and side effects of electronic cigarettes, and it will take years before we can be sure what they are.” 
 
 However anti-smoking campaigners said that e-cigarettes were ‘considerably less-harmful’ than tobacco and warned against restricting their sale and use. 
 
 Hazel Cheeseman, director of policy and research at Action on Smoking and Health, said there was "no evidence of any harm to bystanders from use of these devices" and said regulation needed to be proportionate. 
 
 She said: "Smoking kills 100,000 people in the UK alone. Smokers who switch to using electronic cigarettes in whole or in part are likely to substantially reduce their health risks. 
 
 "Although we cannot be sure that electronic cigarettes are completely safe, as the WHO acknowledges, they are considerably less harmful than smoking tobacco and research suggests that they are already helping smokers to quit.” 
 
 The ingredients in e-cigarettes vary but they generally include nicotine and chemicals to vaporise the nicotine such as propylene glycol. 
 
 Previous studies have shown that inhaling nicotine, even without tobacco smoke, may contribute to heart disease. 
 
 Some e-cigarettes have also been found to give off formaldehyde, a known carcinogen, at higher levels than normal cigarettes. Silicate particles, a cause of lung disease, are also present in some e-cigarette vapour. 
 
 A study published last year by the Bavarian Health and Food Safety Authority found that vaping worsened indoor air quality by increasing the concentration of nicotine, particulates and aluminium. 
 
 The Department of Health is not considering banning e-cigarettes indoors but said it was planning to prohibit the sale to under 18s. 
 
 Electronic cigarettes are currently regulated as consumer products in the UK. But by 2016 they will be regulated by the Medicines and Healthcare Products Regulatory Agency. 
 
 “More and more people are using e-cigarettes and we want to make sure they are properly regulated so we can be sure of their safety,” said a Department of Health spokesman. ||||| GENEVA/LONDON The World Health Organization (WHO) called for stiff regulation of electronic cigarettes as well as bans on indoor use, advertising and sales to minors, in the latest bid to control the booming new market. 
 
 In a long-awaited report that will be debated by member states at a meeting in October in Moscow, the United Nations health agency on Tuesday also voiced concern about the concentration of the $3 billion market in the hands of big tobacco companies. 
 
 "In a nutshell, the WHO report shows that e-cigarettes and similar devices pose threats to public health," Douglas Bettcher, director of the agency's department on non-communicable diseases, told a news briefing in Geneva. 
 
 The uptake of e-cigarettes, which use battery-powered cartridges to produce a nicotine-laced vapour, has rocketed in the past two years, but there is fierce debate about the risks. 
 
 Because they are so new, there is a lack of long-term scientific evidence to support their safety, and some fear they could lead to nicotine addiction and tobacco smoking. 
 
 "We must emphasise that the onus of responsibility for showing safety, for answering many of these questions, must be on the companies and the industries owning them," Bettcher said. 
 
 "The reports finds, at this point in time anyway, that there is insufficient evidence to conclude that e-cigarettes help users to quit smoking or not. The jury is still out," he said. 
 
 The European Union has already agreed to requirements around advertising and packaging to ensure the safety and quality of e-cigarettes. The U.S. Food and Drug Administration has proposed banning sales to anyone under 18 but no curbs on advertising. 
 
 Activists welcomed the WHO recommendations. 
 
 "As Big Tobacco corners the e-cigarette market, it is using e-cigarettes as a global PR scheme to gloss over its tarnished image, positioning itself as a 'solution' to the problem it drives. In reality, the e-cigarette industry is taking advantage of the regulatory vacuum to employ the Big Tobacco playbook to hook a new generation on its products," said John Stewart of the U.S.-based group Corporate Accountability International. 
 
 REGULATORY OPTIONS 
 
 The WHO launched a public health campaign against tobacco a decade ago. The WHO Framework Convention on Tobacco Control, which entered into force in 2005, has been ratified by 179 states, although not the United States. 
 
 There are 466 brands of e-cigarettes, and the industry represents "an evolving frontier filled with promise and threat for tobacco control", the WHO said in the report. 
 
 It urged a range of regulatory options including banning vending machines in most locations and preventing e-cigarette makers from making health claims, such as that they help people quit smoking, until there is hard evidence. 
 
 Smokers should use a combination of already approved treatments for kicking the habit, it said. 
 
 While e-cigarettes are likely to be less toxic than conventional ones, the WHO dismissed the idea that e-cigarettes merely produced "water vapour", arguing they exposed bystanders and non-smokers to nicotine and other toxic substances. 
 
 Dr. Armando Peruga, of the WHO's Tobacco Free Initiative, said the contents of e-cigarettes vary but that the aerosol expelled by their users contains nicotine, which is known to alter brain development, and other toxins. 
 
 "There are brands for example that contain formaldehyde, which is a cancer-causing element, at the same level as some cigarettes," Peruga told reporters. 
 
 "Depending on the brand, some studies have found that they contain heavy metals, for example cadmium which is completely a cancer-causing agent," Peruga said. Others have been found to contain nickel or acrolein, a respiratory irritant, he said. 
 
 Their use also posed a threat to adolescents and the foetuses of pregnant women, the WHO said. 
 
 BACON TO BUBBLE GUM 
 
 One concern is that e-cigarettes may tempt children, and the report called for a ban on flavours until there was proof they did not attract adolescents. E-cigarettes can be customised with flavours ranging from bacon to bubble gum. 
 
 Scientists are divided on the risks and potential benefits of e-cigarettes. 
 
 One group of researchers warned the WHO in May not to classify them as tobacco products, arguing that doing so would jeopardise an opportunity to slash disease and deaths caused by smoking. 
 
 Opposing experts argued a month later that the WHO should hold firm to its plan for strict regulations. 
 
 Major tobacco companies including Imperial Tobacco (IMT.L), Altria Group (MO.N), Philip Morris International (PM.N) and British American Tobacco (BATS.L) are increasingly launching their own e-cigarette brands as sales of conventional products stall in Western markets. 
 
 Two major national producers, China Tobacco and Indian Tobacco Company, have recently become producers, Bettcher said. 
 
 A Wells Fargo analyst report in July projected that U.S. sales of e-cigarettes would outpace conventional ones by 2020. 
 
 A BAT spokesman said overly restrictive regulations could prevent smokers from being aware of a less risky alternative to smoking, and "this can only be bad thing for public health". 
 
 (Additional reporting by Martinne Geller in London; Editing by Angus MacSwan, David Clarke and Jane Baird)
– More support for those who think it's too early to jump on the e-cigarette bandwagon: The vapor-producing devices may still pose a threat to users' and bystanders' health, says WHO, which suggests stronger regulations on the relatively new industry in a report released today, reports Reuters. The health organization also asks for a ban on puffing away on the battery-driven units indoors, as well as on advertising and flavored e-cigs that could lure underage users. Although e-cigs "are likely less toxic than conventional ones," writes Stephanie Nebehay at Reuters, WHO researchers say that nicotine and other chemicals emitted by e-cigs are still a health hazard, especially for teens and pregnant women. Those chemicals can include formaldehyde, aluminum, and silicate particles, reports the Telegraph. The WHO report is lobbying against e-cig vending machines and says manufacturers shouldn't be able to tout their products as "smoking cessation aids" until more research is completed to back that claim up. The main debate right now seems to be between those who think that e-cigs can help cut down on tobacco-related deaths and those who argue that using e-cigs could lead to the real thing for youngsters—especially with flavors such as bacon, bubble gum, and even Thin Mint. "Many public health experts are concerned that the advertising of electronic cigarettes could make it seem normal again to think smoking is glamorous," a health official tells the Telegraph. (The FDA proposes a ban on sales to minors, but hasn't moved against flavors.)