E-cigarettes: the evidence

woman vaping in a restaurant

A review of the public health consequences of e-cigarettes has found their use is likely to result in a net public health benefit over the next 30 years… but there are caveats

The National Academies of Sciences, Engineering and Medicine (NASEM) Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems has released a consensus report, ‘Public Health Consequences of e-Cigarettes’, a comprehensive review of the health effects of the devices.

It found that there is “substantial” evidence that never-smoking youth and young adults who use e-cigarettes are more likely to later try traditional combustible cigarettes than those who have never tried e-cigarettes, or vaping.

However, “evidence regarding the risk of becoming a combustible cigarette smoker is not as strong,” the report states.

It says that the strength of the evidence to support vaping as an effective aid in quitting smoking is “limited,” but this is largely due to a dearth of randomised clinical trials, and the fact that the reulsts of longitudinal observational studies vary.

“However, the Committee found moderate evidence that e-cigarettes with nicotine are more effective for smoking cessation than those without, and that more frequent use of e-cigarettes is more effective,” the report states.

There was not sufficient evidence available to assess how vaping compares as a quitting aid when compared to FDA-approved treatments.

As for the nicotine intake from the devices, the evidence strongly showed that it is “highly variable,” depending on the characteristics of the products used and how they are operated by the vaper.

“Among experienced adult e-cigarette users, evidence is substantial that exposure to nicotine can be comparable to that from combustible cigarettes.”

Most e-cigarette products contain several “potentially toxic” substances, but levels and intake again vary.

The Committee also looked at whether vaping is associated with long-term health effects, and found that there was no evidence to show it was; however it suggests that this is likely due to the fact that the devices have not been on the market for very long – since 2006 in the US.

However it did identify biological effects, such as a heart rate increase after nicotine intake from e-cigarettes, and “moderate evidence” for increased cough and wheeze in adolescents who use them.

There was “limited evidence” that some aerosols can be mutagenic or cause DNA damage, with implications around carcinogenic risk from long-term use.

Ultimately, the Committee found that “using a range of plausible assumptions about e-cigarette effects on smoking initiation, smoking cessation, and the relative harm of e-cigarettes compared with combustible cigarettes, a population dynamic model used by the Committee suggests that, under likely scenarios, the use of e-cigarettes will result in a net public health benefit over the next 30 years (2050)”.

The devices are not without biological effects in humans, but they are likely to pose “significantly less” risk to people than combustible cigarettes, the Committee concluded.

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  1. pagophilus

    Net public benefit compared to the status quo, but I’m waiting for the government to have the balls to put an end date on the sale of tobacco and eventually an end date on smoking.

    • Jarrod McMaugh

      I generally agree that the government is addicted to tobacco sales as people are to smoking.

      The problem is, prohibition causes more harm than benefit.

      There is already good evidence of black market tobacco increasing in market share. Prohibition will just strengthen this.

      • pagophilus

        People look at ambiguous information from the distant past in the US and say prohibition doesn’t work. You can find information that goes both ways on this. However, look at the arctic/sub-arctic countries e.g. Greenland. Alcohol used to be rationed. When they deregulated it in 1980 sales doubled overnight. Now when you visit you find drunk Greenlanders asleep on the grass at 9AM, at 1:30PM, at any time of day, plus observe them on the coastal ferries and see what deregulating alcohol has done. (They have the same issues with alcohol metabolism that our indigenous people do.)

        So control of some sort, or prohibition if you like, should be tried again rather than trotting out what happened long ago in the US and trying to put a spin on it one way or another.

        • Jarrod McMaugh

          G’Day Leo

          I appreciate that Prohibition is often the first thing people think of when the word prohibition is mentioned – that is, Prohibition is the policy from the US during the earlier part of the 20th century to restrict alcohol.

          I’m not referring specifically to that policy, but rather the general use of the term for prohibition in general.

          Harm from prohibition of many substances is real. Whether it is greater than the harm of regulated supply or deregulated access is hard to quantify – maybe it’s the same amount of harm but affecting different portions of the population….

          Back to the point, for all substances, there is a nadir of all harm caused. It is not found with prohibition; it is not found with unregulated access. Somewhere close to prohibition (ie tight regulation) is the point of least harm. We don’t have it with most illicit substances, we don’t have it with tobacco (yet) or alcohol, we may well have it with prescribed opioids….

          My point being, prohibition is probably not the answer, and neither is unregulated access to tobacco (or any substance)

          • Asylumsix

            Look at marijuana prohibition or well drugs that contain THC in general, lots of people use them daily and they are forced to get it form people that may sell other drugs. No regulation, could be sprayed/laced with all sorts of stuff, prohibition just didn’t work.

            Now take a look at states where they’ve legalized it, opioid use has gone down proving my point.

            Not even prohibition but too high of taxes has led to people purchasing tobacco from shady sources and who knows what the hell is in that..

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