A Comparative Health Risk Assessment of Electronic Cigarettes and Conventional Cigarettes

Abstract

Background: Although some studies have identified hazardous substances in electronic cigarette (EC) liquids and emissions, there is limited information about the health risks of using ECs. Methods: In this study, the U.S. Environmental Protection Agency (EPA) health risk assessment model and findings of a literature review were used to determine and profile hazards. Focus was put on the toxicants reported in the literature on conventional cigarette (CC) smoke that most strongly associated with adverse health effects. To evaluate their health risks, dose-response relationships and standard-use conditions were used to estimate average hazard exposures and to calculate the overall health risks of ECs and CCs, benchmarked against international guideline levels for each hazard. Results: Four hazards (acrolein, diethylene glycol, propylene glycol and cadmium) reported in EC emissions and seven hazards (acetaldehyde, acrolein, formaldehyde, cadmium, CO, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), N'-nitrosonornicotine (NNN)) reported in CC emissions had maximum exposure levels higher than the guideline levels. Two hazards (acrolein, propylene glycol) in EC emissions and five hazards (acetaldehyde, acrolein, formaldehyde, cadmium, NNN) in CC emissions had average exposure levels higher than the guideline levels. Conclusions: Based on the conditions of use, ECs should be a safer nicotine-delivery product than CCs.

Keywords: comparative risk; electronic cigarettes; risk assessment; tobacco control; toxicology.

Figure 1

Risk comparison of maximum/average hazards’ exposure levels to guideline levels.