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.