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Prev Med. 2014 Dec;69:248-60. doi: 10.1016/j.ypmed.2014.10.009. Epub 2014 Oct 16.

A systematic review of health effects of electronic cigarettes.

Author information

1
Research Centre for Prevention and Health, Glostrup Hospital, DK-2600 Glostrup, Denmark. Electronic address: charlotta.pisinger@regionh.dk.
2
Medicinsk Afdeling, Frederikssund Hospital, DK-3600 Frederikssund, Denmark.

Abstract

OBJECTIVE:

To provide a systematic review of the existing literature on health consequences of vaporing of electronic cigarettes (ECs).

METHODS:

Search in: PubMed, EMBASE and CINAHL.

INCLUSION CRITERIA:

Original publications describing a health-related topic, published before 14 August 2014. PRISMA recommendations were followed. We identified 1101 studies; 271 relevant after screening; 94 eligible.

RESULTS:

We included 76 studies investigating content of fluid/vapor of ECs, reports on adverse events and human and animal experimental studies. Serious methodological problems were identified. In 34% of the articles the authors had a conflict of interest. Studies found fine/ultrafine particles, harmful metals, carcinogenic tobacco-specific nitrosamines, volatile organic compounds, carcinogenic carbonyls (some in high but most in low/trace concentrations), cytotoxicity and changed gene expression. Of special concern are compounds not found in conventional cigarettes, e.g. propylene glycol. Experimental studies found increased airway resistance after short-term exposure. Reports on short-term adverse events were often flawed by selection bias.

CONCLUSIONS:

Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of ECs. However, they can hardly be considered harmless.

KEYWORDS:

E-cigarette; ENDS; Electronic cigarette; Electronic nicotine delivery device; Electronic nicotine delivery system

PMID:
25456810
DOI:
10.1016/j.ypmed.2014.10.009
[Indexed for MEDLINE]
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