Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review

Abstract

Electronic cigarettes are a recent development in tobacco harm reduction. They are marketed as less harmful alternatives to smoking. Awareness and use of these devices has grown exponentially in recent years, with millions of people currently using them. This systematic review appraises existing laboratory and clinical research on the potential risks from electronic cigarette use, compared with the well-established devastating effects of smoking tobacco cigarettes. Currently available evidence indicates that electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who switch from tobacco to electronic cigarettes. Research will help make electronic cigarettes more effective as smoking substitutes and will better define and further reduce residual risks from use to as low as possible, by establishing appropriate quality control and standards.

Keywords: e-liquid; e-vapor; electronic cigarettes; harm reduction; nicotine; safety; tobacco.

Figure 1.

Examples of electronic cigarette devices currently available on the market.

Figure 2.

Methodology for literature research and selection of studies.

Figure 3.

Toxic emissions score, adjusted for nicotine, for electronic cigarette and popular cigarette brands. (Reproduced with permission from Laugesen [2009])