Electronic cigarettes and health outcomes: umbrella and systematic review of the global evidence

Abstract

Objective To review and synthesise the global evidence regarding the health effects of electronic cigarettes (e‐cigarettes, vapes). Study design Umbrella review (based on major independent reviews, including the 2018 United States National Academies of Sciences, Engineering, and Medicine [NASEM] report) and top‐up systematic review of published, peer‐reviewed studies in humans examining the relationship of e‐cigarette use to health outcomes published since the NASEM report. Data sources Umbrella review: eight major independent reviews published 2017–2021. Systematic review: PubMed, MEDLINE, Scopus, Web of Science, the Cochrane Library, and PsycINFO (articles published July 2017 – July 2020 and not included in NASEM review). Data synthesis Four hundred eligible publications were included in our synthesis: 112 from the NASEM review, 189 from our top‐up review search, and 99 further publications cited by other reviews. There is conclusive evidence linking e‐cigarette use with poisoning, immediate inhalation toxicity (including seizures), and e‐cigarette or vaping product use‐associated lung injury (EVALI; largely but not exclusively for e‐liquids containing tetrahydrocannabinol and vitamin E acetate), as well as for malfunctioning devices causing injuries and burns. Environmental effects include waste, fires, and generation of indoor airborne particulate matter (substantial to conclusive evidence). There is substantial evidence that nicotine e‐cigarettes can cause dependence or addiction in non‐smokers, and strong evidence that young non‐smokers who use e‐cigarettes are more likely than non‐users to initiate smoking and to become regular smokers. There is limited evidence that freebase nicotine e‐cigarettes used with clinical support are efficacious aids for smoking cessation. Evidence regarding effects on other clinical outcomes, including cardiovascular disease, cancer, development, and mental and reproductive health, is insufficient or unavailable. Conclusion E‐cigarettes can be harmful to health, particularly for non‐smokers and children, adolescents, and young adults. Their effects on many important health outcomes are uncertain. E‐cigarettes may be beneficial for smokers who use them to completely and promptly quit smoking, but they are not currently approved smoking cessation aids. Better quality evidence is needed regarding the health impact of e‐cigarette use, their safety and efficacy for smoking cessation, and effective regulation. Registration Systematic review: PROSPERO, CRD42020200673 (prospective).

An analysis of key stakeholder policy perspectives in the proposed e‐cigarette regulations in New Zealand

“…For example, British American Tobacco's submission stated concern about risks to health if regulation caused consumers to mix e‐liquids unsafely whilst actively and knowingly marketing combustible cigarettes, the “single most deadly consumer product in history” 33 . Furthermore, the industry largely ignored any associated health harms from e‐cigarette use, such as nicotine addiction, injuries, poisoning and respiratory problems, with many long‐term effects still unknown 16 …”

“…Some public health organisations support the use of e‐cigarettes for smoking cessation and argue that e‐cigarettes are a relatively safe alternative to smoking 12,13 when people transition entirely away from smoked tobacco 14 . However, the World Health Organization states that the efficacy of e‐cigarettes for smoking cessation remains inconclusive 15 and multiple health impacts from e‐cigarette use have been identified 16 . These differing perspectives are revealed in the broad range of e‐cigarette policies implemented across jurisdictions.…”

Elektronische Zigaretten – Schadensminimierung oder Schadensverlängerung?

“…Tatsächlich stellte ein Leitartikel im Lancet im Jahr 2019 fest, dass "keine solide Beweisgrundlage" die Marketingbehauptung untermauert, dass E-Zigaretten gesünder als Standardzigaretten seien [20]. Diese Einschätzung wird durch ein kürzlich veröffentlichtes, sehr umfangreiches systematisches Review für das australische Gesundheitsministerium gestützt [21].…”

Study protocol of the OurFutures Vaping Trial: A cluster randomised controlled trial of a school-based eHealth intervention to prevent e-cigarette use among adolescents

“…A major recent review found e-cigarettes can also cause a range of acute health problems, including ecigarette or vaping use-associated lung injury (EVALI), seizures, poisoning and burns (11). E-cigarette use has also been associated with mental health problems, such as depression and suicidal ideation in adolescence (although causality has not been established) (12).…”

“…Alarmingly, young people who use ecigarettes are three times more likely to take up tobacco smoking when compared to people who have never used e-cigarettes, putting them at risk of the substantial harm and burden of disease that tobacco smoking can cause (13). Whilst e-cigarettes may help some individuals to quit smoking, the health risks signi cantly outweigh any bene ts (11). Despite this knowledge, perceived harm of e-cigarettes by adolescents is low (14), and they are now the most commonly used nicotine product among youth (15).…”