Electronic cigarettes: a systematic review of available studies on health risk assessment

Zulkifli, Aziemah; Ez, Abidin; Nz, Abidin; Nordin, Amer Siddiq Amer; Sm, Praveena; Ismail, Sharifah Norkhadijah Syed; Rasdi, Irniza; Karuppiah, Karmegam; Aa, Rahman

doi:10.1515/reveh-2015-0075

Cited by 26 publications

(33 citation statements)

References 28 publications

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“…A 2016 report by the WHO stated that there is not enough research to quantify the relative risk of NVPs over combustible products , and WHO has previously urged countries to restrict the sale, promotion and use of electronic cigarettes . Additionally, some recent reviews have also demonstrated the inconclusive evidence about the health risks associated with NVPs use . Therefore, our data may be indicating that HPs in England (and in the other countries) may be conflicted about the role of NVPs in smoking cessation due to the opposing positions of various NGO and public health organizations.…”

Section: Discussionmentioning

confidence: 78%

Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey

et al. 2019

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Background and Aims: Debate exists about whether health professionals (HPs) should advise smokers to use nicotine vaping products (NVPs) to quit smoking. The objectives were to examine in four countries: (1) the prevalence of HP discussions and recommendations to use an NVP; (2) who initiated NVP discussions; (3) the type of HP advice received about NVPs; and (4) smoker’s characteristics related to receiving advice about NVPs. Design: Cross-sectional study using multivariable logistic regression analyses on weighted data from the 2016 ITC Four Country Smoking and Vaping Survey (ITC 4CV1). Setting: Four countries with varying regulations governing the sale and marketing of NVPs: ‘most restrictive’ (Australia), ‘restrictive’ (Canada) or ‘less restrictive’ (England and United States). Participants: A total of 6615 adult smokers who reported having visited an HP in the last year (drawn from the total sample of 12 294 4CV1 respondents, of whom 9398 reported smoking cigarettes daily or weekly). Respondents were from the United States (n = 1518), England (n = 2116), Australia (n = 1046), and Canada (n = 1935). Measurements: Participants’ survey responses indicated if they were current daily or weekly smokers and had visited an HP in the past year. Among those participants, further questions asked participants to report (1) whether NVPs were discussed, (2) who raised the topic, (3) advice received on use of NVPs and (4) advice received on quitting smoking. Findings: Among the 6615 smokers who visited an HP in the last year, 6.8% reported discussing NVPs with an HP and 2.1% of smokers were encouraged to use an NVP (36.1% of those who had a discussion). Compared with Australia (4.3%), discussing NVPs with an HP was more likely in the United States [8.8%, odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.41–3.29] and Canada (7.8%, OR = 1.87, 95% CI = 1.26–2.78). Smokers in Australia were less likely to discuss NVPs than smokers in England (6.2%), although this was not statistically significant (OR = 1.47, 95% CI = 0.98–2.20). Overall, the prevalence of HPs recommending NVPs was three times more likely in the United States than in Australia (OR = 3.07, 95% CI = 1.45–6.47), and twice as likely in Canada (OR = 2.28, 95% CI = 1.06–4.87) than in Australia. Australia and England did not differ (OR = 1.76, 95% CI = 0.83–3.74). Just over half (54%) of respondents brought up NVPs themselves; there were no significant differences among countries. Conclusions: Discussions in Australia, Canada, England, and the United States between smokers and health professionals about nicotine vaping products appear to be infrequent, regardless of the regulatory environment. A low percentage of health professionals recommended vaping products. This was particularly evident in Australia, which has the most restrictive regulatory environment of the four countries studied.

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Section: Discussionmentioning

confidence: 78%

Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey

et al. 2019

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“…Reviews have been published on ENDS in general 10–21 or on specific topics, including: health effects 22–58 ; impact on smoking cessation 29,40–43,45,47,48,51,59–73 ; product features 22,39,41–43,45,47,74–77 ; potential to induce dependence 28,45,47,78,79 ; consumer perceptions 26,48,80,81 ; patterns of use 8,26,43,48,51,82–90 ; and policies. 8,48,91–98 Two conducted a bibliometric review of the ENDS literature 86,99 and 46% of the reviews were systematic.…”

Section: Contextmentioning

confidence: 99%

“…8,48,91–98 Two conducted a bibliometric review of the ENDS literature 86,99 and 46% of the reviews were systematic. 11,13,15,16,22–28,33,34,36,39,46,48,53–58,60,61,66,68,70–75,79–82,85,86,88–90,93,97,100–104 The dramatically changing product landscape warrants frequent updates and synthesis of the rapidly growing evidence to inform prudent practice, policy, and regulation. 9,105,106 This comprehensive review presents a current synthesis of empirical studies on ENDS across a broad range of topics.…”

Section: Contextmentioning

confidence: 99%

Overview of Electronic Nicotine Delivery Systems: A Systematic Review

Glasser

Collins

Pearson

et al. 2017

American Journal of Preventive Medicine

420

332

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Context Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. Evidence acquisition The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. Evidence synthesis There were 686 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. Conclusions Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.

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“…[33,34] Additional information on the potential health effects of the metals in EC can be found in several recent reviews. [33][34][35][36][37] The ability to map individual components and identify multiple elements in each atomizer structure.is a major advantage of SEM/EDS technology. This method also gives information on the relative abundance of each element.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the elements and metals in multiple generations of electronic cigarette atomizers

Williams

Bozhilov

Talbot

2019

Environmental Research

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Background: Since their release in 2004, electronic cigarettes (ECs) and their atomizers have undergone significant evolution. Objective: The purpose of this study was to evaluate and compare the elemental/ metal composition of atomizers in cartomizer and tank style ECs produced over a 5year period. Methods: Popular cartomizer and tank models of ECs were dissected and photographed using a stereoscopic microscope and elemental analysis of EC atomizers was done using scanning electron microscopy coupled with energy dispersive x-ray spectroscopy. Results: Eight elements/metals were found in most products across and within brands purchased at different times. These included chromium, nickel, copper, silver, tin, silicon, aluminum, and zinc. Iron and lead were found in some but not all products, while manganese, cobalt, molybdenum, titanium, and tungsten were only found in a few of the products. The metals used in various components were often similar in cartomizer and tank models. Filaments were usually chromium and nickel (nichrome), although in some newer products, the filament also contained iron, copper, and manganese. The thick wire in earlier products was usually copper coated with silver, while in some newer products, the thick wire was predominantly nickel. In all products, the wick was silica, and sheaths, when present, were fiberglass (silicon, oxygen, calcium, aluminum, magnesium). Wire-to-wire joints were either brazed or clamped with brass (copper and zinc), and air-tube-to-thick wire joints, when present, were usually soldered with tin. Tank style products generally lacked a thick wire and sheaths. Conclusion: In general, atomizer components in ECs were remarkably similar over time and between brands. Certain elements/metals were consistently found in most models from all generations, and these should be studied carefully to determine if their transfer to aerosols affects user's health and if their accumulation in trash affects the environment.

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Electronic cigarettes: a systematic review of available studies on health risk assessment

Cited by 26 publications

References 28 publications

Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey

Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey

Overview of Electronic Nicotine Delivery Systems: A Systematic Review

Analysis of the elements and metals in multiple generations of electronic cigarette atomizers

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