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E-Cigarettes: Use, Effects, Risks, and Policy Implications

Annual Review of Public Health

E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications

Stanton A. Glantz - Center for Tobacco Control Research and Education and Department of Medicine, University of California, San Francisco, California 94143, USA; email:

and David W. Bareham - Lincolnshire Community Health Services NHS Trust, Louth, LN11 0EU, United Kingdom; email:

Summary of Health Effects

Although e-cigarettes deliver lower levels of carcinogens than do conventional cigarettes, and therefore may pose less cancer risk to users (albeit not zero cancer risk), they still expose users to high levels of ultrane particles and other toxins that may substantially increase cardiovascular and noncancer lung disease risk. The similarities between the effects of e-cigarettes and those
of conventional cigarettes on determinants of cardiovascular and lung disease make it likely that e-cigarettes will impose similar long-term cardiovascular and pulmonary risks as those associated with conventional cigarettes. Cardiovascular and noncancer pulmonary diseases account for about two-thirds of smokers’ premature deaths from tobacco-induced diseases (Figure 4), so it would not be surprising if e-cigarettes impose half (or more) of the overall long-term risks as those from conventional cigarettes.

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Because e-cigarettes have been on the market for only a few years, the long-term population health effects are not known. Nevertheless, it is already clear that e-cigarettes are prolonging and extending the tobacco epidemic by reducing smoking cessation and expanding the tobacco market by attracting youth who would otherwise be unlikely to initiate tobacco use with conventional cigarettes. On the basis of the short-term effects that have been identied to date, e-cigarettes likely have cardiovascular and noncancer lung disease risks similar to those associated with smoking conventional cigarettes. Under most reasonable alternative use pattern scenarios, this is a high enough risk to lead to a net population harm even if some smokers switch to e-cigarettes (47, 69, 80). To minimize harm, e-cigarettes as well as the timing and location of their promotion and use should be regulated like other tobacco products.

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