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Electronic Cigarettes -  an evidence update

Public Health England, 2015

Author(s): McNeil A, Brose LS, Calder R, Hitchman SC, Hayek P, McRobbie H


1. Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes (EC) to stop smoking and stop smoking services should support smokers using EC to quit by offering them behavioural support.

2. Encouraging smokers who cannot or do not want to stop smoking to switch to EC could help reduce smoking related disease, death and health inequalities.

3. There is no evidence that EC are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it. Despite some experimentation with EC among never smokers, EC are attracting very few people who have never smoked into regular EC use.

4. Recent studies support the Cochrane Review findings that EC can help people to quit smoking and reduce their cigarette consumption. There is also evidence that EC can encourage quitting or cigarette consumption reduction even among those not intending to quit or rejecting other support. More research is needed in this area.

5. When used as intended, EC pose no risk of nicotine poisoning to users, but e­liquids should be in 'childproof' packaging. The accuracy of nicotine content labelling currently raises no major concerns.

6. There has been an overall shift towards the inaccurate perception of EC being as harmful as cigarettes over the last year in contrast to the current expert estimate that using EC is around 95% safer than smoking.

7. · Whilst protecting non-smoking children and ensuring the products on the market are as safe and effective as possible are clearly important goals, new regulations currently planned should also maximise the public health opportunities of EC.


The effect of e-cigarette aerosol emissions on respiratory health: a narrative review. August 2, 2019

Author(s): Riccardo Polosa, Renée O’Leary, Donald Tashkin, Rosalia Emma, Massimo Caruso

Introduction: Due to the uptake in the use of e-cigarettes (ECs), evidence on their health effects is needed to inform health care and policy. Some regulators and health professionals have raised concerns that the respirable aerosols generated by ECs contain several constituents of potential toxicological and biological relevance to respiratory health.

Expert opinion: Growing evidence supports the relative safety of EC emission aerosols for the respiratory tract compared to tobacco smoke.

Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA

Harm Reduction Journal (2018) 15:33

Author(s): Christopher Russell, Neil McKeganey , Tiffany Dickson and Mitchell Nides


Understanding the role that flavors play in the population’s use of e-cigarettes and the impact that flavored e-cigarette products have on the population’s use of more harmful tobacco products, like conventional cigarettes, has been identified by the US Food and Drug Administration (FDA) as a public health research priority. The purpose of the study was to assess the first e-cigarette flavor and current e-cigarette flavors used by a large non-probabilistic sample of adult frequent users of e-cigarettes in the USA and assess how flavor preferences vary by cigarette smoking status and time since first e-cigarette purchase.


Adult frequent e-cigarette users in the USA who have completely switched from smoking cigarettes to using e-cigarettes are increasingly likely to have initiated e-cigarette use with non-tobacco flavors and to have transitioned from tobacco to non-tobacco flavors over time. Restricting access to non-tobacco e-cigarette flavors may discourage smokers from attempting to switch to e-cigarettes.

Percentage of Adults Aged 18–24 Years Who Currently Smoke Cigarettes or Who Currently Use Electronic Cigarettes, 2014-2018

CENTER FOR DISEASE CONTROL:  National Health Interview Survey, United States, 2014–2018. MMWR Morb Mortal Wkly Rep 2019; 68:870

Author(s): Jane Williford; Benjamin Zablotsky, PhD

From 2014 to 2018, the percentage of adults aged 18–24 years who currently smoked cigarettes decreased from 16.7% to 7.8%. The percentage of adults in this age group who currently used electronic cigarettes increased from 5.1% to 7.6%.


Frequency of Use and Smoking Status of U.S. Adolescent E-Cigarette Users in 2015, April 7, 2018

Author(s): Konstantinos Farsalinos MD, Venera Tomaselli PhD, Riccardo Polosa PhD

What Was Studied:

This study analyzed the frequency of e-cigarette use and its association with smoking status among U.S. adolescents.

The National Youth Tobacco Survey 2015 was analyzed in 2017, focusing on frequency of past 30-day e-cigarette use according to smoking status of participants. Smoking status was classified as never smoker, ever/not a past 30-day smoker, and past 30-day smoker. Infrequent and frequent smoking and e-cigarette use was defined as use for <20 and ≥20 of the past 30 days, respectively.


Past 30-day e-cigarette use was reported by:

54.5% (95% CI=47.8%, 61.0%) of past 30-day smokers

26.5% (95% CI=23.2%, 30.1%) of ever/not past 30-day smokers

4.6% (95% CI=4.0%, 5.2%) of never smokers (p<0.001).

No past 30-day e-cigarette use was reported by 94.5% of never smokers.

Past 30-day e-cigarette use was reported by 50.4% (95% CI=43.6%, 57.3%) of infrequent and 64.7% (95% CI=54.4%, 73.8%) of frequent past 30-day smokers (p<0.001).

Frequent e-cigarette use was reported by 0.3% of never smokers.

Author’s Conclusions

E-cigarette use is more prevalent among ever and past 30-day smoking adolescents compared with never smoking adolescents. Frequent e-cigarette use is rare among never smoking adolescents.