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.

Conflict of interest statement

Conflict of interest statement: Riccardo Polosa is a Professor of Medicine and is supported by the University of Catania, Italy. He has received lecture fees and research funding from GlaxoSmithKline and Pfizer, manufacturers of stop smoking medications. He has also served as a consultant for Pfizer and Arbi Group Srl (Milano, Italy), the distributor of Categoria™ e-Cigarettes. His research on electronic cigarettes is currently supported by LIAF (Lega Italiana AntiFumo).

Konstantinos Farsalinos is a researcher at Onassis Cardiac Surgery Center. He has never been funded by the pharmaceutical or the tobacco industry. For some of his studies, the institution has received financial compensation from electronic cigarette companies for the studies’ cost. His salary is currently being paid by a scholarship grant from the Hellenic Society of Cardiology.

Figures

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])