REVIEW PAPER
Electronic cigarettes: patterns of use, health effects, use in smoking cessation and regulatory issues
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1
St Vincent’s Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia
 
2
The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, Australia
 
3
The University of Melbourne, Melbourne, Australia
 
4
St Vincent’s Hospital, Melbourne, Australia
 
 
Submission date: 2014-04-01
 
 
Acceptance date: 2014-10-27
 
 
Publication date: 2014-12-15
 
 
Corresponding author
Muhammad Aziz Rahman   

St Vincent’s Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, Australia
 
 
Tobacco Induced Diseases 2014;12(December):21
 
KEYWORDS
ABSTRACT
Background:
Electronic cigarettes (e-cigarettes) are battery-powered devices that vaporize a liquid solution to deliver a dose of inhaled nicotine to the user. There is ongoing debate regarding their regulation.

Methods:
This comprehensive narrative review aimed to discuss key issues including usage patterns, health effects, efficacy in smoking cessation and regulatory concerns with a view to informing future regulation and research agendas.

Material and Methods:
PubMed, Scopus and Web of Science databases were searched using the terms (electronic cigarettes OR e-cigarettes) for articles in English, relevant to humans and published during January 2009-January 2014.

Results:
The literature search revealed 37 relevant articles. Findings suggest that e-cigarettes are mostly used by middle-aged current smokers, particularly males, to help them for quitting or for recreation. E-cigarettes contain very low levels of multiple toxic substances such as formaldehyde and acrolein, but these levels are many times lower than those found in cigarettes. They were found to have effectiveness in aiding smoking cessation to a limited degree. Debate continues regarding regulating their use for cessation versus heavy restrictions to control recreational use on the basis that it perpetuates nicotine addiction.

Conclusions:
The cytotoxicity and long term health effects of e-cigarettes are unknown. Nevertheless the e-cigarette market continues to expand, largely driven by middle-aged smokers who claim to be using e-cigarettes in an attempt to reduce or quit smoking. E-cigarettes may have some potential as smoking cessation aids and, in the researchers’ view, should therefore be subject to further research and regulation similar to other nicotine replacement therapies.

 
REFERENCES (43)
1.
Foulds J, Veldheer S, Berg A: Electronic cigarettes (e-cigs): views of aficionados and clinical/public health perspectives. Int J Clin Pract. 2011, 65 (10): 1037-1042.
 
2.
Riker CA, Lee K, Darville A, Hahn EJ: E-cigarettes: promise or peril?. Nurs Clin North Am. 2012, 47 (1): 159-171.
 
3.
Dawkins L, Turner J, Roberts A, Soar K: ‘Vaping’ profiles and preferences: an online survey of electronic cigarette users. Addiction. 2013, 108 (6): 1115-1125.
 
4.
Romagna G, Allifranchini E, Bocchietto E, Todeschi S, Esposito M, Farsalinos KE: Cytotoxicity evaluation of electronic cigarette vapor extract on cultured mammalian fibroblasts (ClearStream-LIFE): comparison with tobacco cigarette smoke extract. Inhal Toxicol. 2013, 25 (6): 354-361.
 
5.
Noel JK, Rees VW, Connolly GN: Electronic cigarettes: a new ‘tobacco’ industry?. Tob Control. 2011, 20 (1): 81.
 
6.
Bialous SA, Sarma L: Electronic cigarettes and smoking cessation: a quandary?. Lancet. 2014, 383 (9915): 407-408.
 
7.
Varkey B: Electronic cigarettes: the good, the bad and the unknown. Curr Opin Pulm Med. 2014, 20 (2): 125-126.
 
8.
Etter JF: Should electronic cigarettes be as freely available as tobacco? Yes. BMJ. 2013, 346: f3845.
 
9.
Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N: Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013, 382 (9905): 1629-1637.
 
10.
Chapman S: Should electronic cigarettes be as freely available as tobacco cigarettes? No. BMJ. 2013, 346: F3840.
 
11.
Etter JF: Commentary on Goniewicz et al. (2014): if wisely regulated, electronic cigarettes can make cigarettes obsolete. Addiction. 2014, 109 (3): 508-509.
 
12.
Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, Prokopowicz A, Jablonska-Czapla M, Rosik-Dulewska C, Havel C, Jacob P, Benowitz N: Levels of selected carcinogens and toxicants in vapor from electronic cigarettes. Tob Control. 2014, 23 (2): 133-139.
 
13.
McAuley TR, Hopke PK, Zhao J, Babaian S: Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality. Inhal Toxicol. 2012, 24 (12): 850-857.
 
14.
Schivo M, Avdalovic MV, Murin S: Non-cigarette tobacco and the lung. Clin Rev Allergy Immunol. 2014, 46 (1): 34-53.
 
15.
Cobb NK, Abrams DB: E-cigarette or drug-delivery device? Regulating novel nicotine products. New Engl J Med. 2011, 365 (3): 193-195.
 
16.
Dutra LM, Glantz SA: Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study. JAMA Pediatr. 2014, 168 (7): 610-617.
 
17.
Etter JF, Bullen C: Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction. 2011, 106 (11): 2017-2028.
 
18.
Siegel MB, Tanwar KL, Wood KS: Electronic cigarettes as a smoking-cessation: tool results from an online survey. Am J Prev Med. 2011, 40 (4): 472-475.
 
19.
Cho JH, Shin E, Moon SS: Electronic-cigarette smoking experience among adolescents. J Adolesc Health. 2011, 49 (5): 542-546.
 
20.
King BA, Alam S, Promoff G, Arrazola R, Dube SR: Awareness and ever-use of electronic cigarettes among U.S. adults, 2010-2011. Nicotine Tob Res. 2013, 15 (9): 1623-1627.
 
21.
Pearson JL, Richardson A, Niaura RS, Vallone DM, Abrams DB: e-Cigarette awareness, use, and harm perceptions in US adults. Am J Public Health. 2012, 102 (9): 1758-1766.
 
22.
Pepper JK, Reiter PL, McRee AL, Cameron LD, Gilkey MB, Brewer NT: Adolescent males’ awareness of and willingness to try electronic cigarettes. J Adolesc Health. 2013, 52 (2): 144-150.
 
23.
Sutfin EL, McCoy TP, Morrell HE, Hoeppner BB, Wolfson M: Electronic cigarette use by college students. Drug Alcohol Depend. 2013, 131 (3): 214-221.
 
24.
Cressey D: Regulation stacks up for e-cigarettes. Nature. 2013, 501 (7468): 473.
 
25.
Borland R: Electronic cigarettes as a method of tobacco control. BMJ. 2011, 343: d6269.
 
26.
Goniewicz ML, Zielinska-Danch W: Electronic cigarette use among teenagers and young adults in Poland. Pediatrics. 2012, 130 (4): e879-e885.
 
27.
Lee S, Grana RA, Glantz SA: Electronic cigarette use among Korean adolescents: a cross-sectional study of market penetration, dual use, and relationship to quit attemptsand former smoking. J Adolesc Health. 2014, 54 (6): 684-690.
 
28.
Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R: EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One. 2013, 8 (6): e66317.
 
29.
Chorti M, Poulianiti K, Jamurtas A, Kostikas K, Tzatzarakis M, Vynias D, Koutedakis Y, Flouris A, Tsatsakis A: Effects of active and passive electronic and tobacco cigarette smoking on lung function. Toxicol Lett. 2012, 211 (Supplement): S64.
 
30.
Flouris AD, Chorti MS, Poulianiti KP, Jamurtas AZ, Kostikas K, Tzatzarakis MN, Wallace HA, Tsatsakis AM, Koutedakis Y: Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function. Inhal Toxicol. 2013, 25 (2): 91-101.
 
31.
Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK: Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide. Chest. 2012, 141 (6): 1400-1406.
 
32.
Bahl V, Lin S, Xu N, Davis B, Wang YH, Talbot P: Comparison of electronic cigarette refill fluid cytotoxicity using embryonic and adult models. Reprod Toxicol. 2012, 34 (4): 529-537.
 
33.
Stanbrook MB: Regulate e-cigarettes as drug-delivery devices. CMAJ. 2013, 185 (16): 1379.
 
34.
Office of Information and Regulatory Affairs US Government: “Tobacco Products” Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act. 2013, [cited 01 October 2014]; Available from: http://www.reginfo.gov/public/....
 
35.
Kuehn BM: FDA: electronic cigarettes may be risky. JAMA. 2009, 302 (9): 937.
 
36.
Benowitz NL, Goniewicz ML: The regulatory challenge of electronic cigarettes. JAMA. 2013, 310 (7): 685-686.
 
37.
Torjesen I: E-cigarettes are to be regulated as medicines from 2016. BMJ. 2013, 346: f3859.
 
38.
European Commission: Questions & Answers: New rules for tobacco products. 2014, [cited 01 October 2014]; Available from: http://europa.eu/rapid/press-r....
 
39.
Department of Health Australian Government: Electronic Cigarettes. 2013, [cited 01 October 2014]; Available from: http://www.tga.gov.au/consumer....
 
40.
Goniewicz ML, Kuma T, Gawron M, Knysak J, Kosmider L: Nicotine levels in electronic cigarettes. Nicotine Tob Res. 2013, 15 (1): 158-166.
 
41.
Huang J, Tauras J, Chaloupka FJ: The impact of price and tobacco control policies on the demand for electronic nicotine delivery systems. Tob Control. 2014, 23 (Suppl 3): iii41-iii47.
 
42.
Kostova D, Ross H, Blecher E, Markowitz S: Is youth smoking responsive to cigarette prices? Evidence from low- and middle-income countries. Tob Control. 2011, 20 (6): 419-424.
 
43.
Kostova D, Chaloupka FJ, Shang C: A duration analysis of the role of cigarette prices on smoking initiation and cessation in developing countries. Eur J Health Econ. 2014, [Epub ahead of print].
 
 
CITATIONS (52):
1.
Alcohol and nicotine interactions: pre-clinical models of dependence
Josephine R. Tarren, Selena E. Bartlett
The American Journal of Drug and Alcohol Abuse
 
2.
Concurrent E-Cigarette Use During Tobacco Dependence Treatment in Primary Care Settings: Association With Smoking Cessation at Three and Six Months
Laurie Zawertailo, Dmytro Pavlov, Anna Ivanova, Ginnie Ng, Dolly Baliunas, Peter Selby
Nicotine & Tobacco Research
 
3.
The Use of E-Cigarettes Among U.S. Immigrants: The 2014 National Health Interview Survey
Yang Wang, Fernando A. Wilson, Jamie Larson, Li-Wu Chen
Public Health Reports
 
4.
E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis
Muhammad Aziz Rahman, Nicholas Hann, Andrew Wilson, George Mnatzaganian, Linda Worrall-Carter, Bernard Le Foll
PLOS ONE
 
5.
Use of electronic cigarettes among secondary and high school students from a socially disadvantaged rural area in Poland
Dorota Kaleta, Piotr Wojtysiak, Kinga Polańska
BMC Public Health
 
6.
Global approaches to regulating electronic cigarettes
Ryan David Kennedy, Ayodeji Awopegba, Elaine De León, Joanna E Cohen
Tobacco Control
 
7.
An Open Trial of Electronic Cigarettes for Smoking Cessation Among Methadone-Maintained Smokers
Michael D. Stein, Celeste Caviness, Kristin Grimone, Daniel Audet, Bradley J. Anderson, Genie L. Bailey
Nicotine & Tobacco Research
 
8.
Clinical Effects of Cigarette Smoking: Epidemiologic Impact and Review of Pharmacotherapy Options
IfeanyiChukwu O. Onor, Daniel L. Stirling, Shandrika R. Williams, Daniel Bediako, Amne Borghol, Martha B. Harris, Tiernisha B. Darensburg, Sharde D. Clay, Samuel C. Okpechi, Daniel F. Sarpong
International Journal of Environmental Research and Public Health
 
9.
Electronic cigarette: A recent update of its toxic effects on humans
Shu-Jie Huang, Yan-Ming Xu, Andy T. Y. Lau
Journal of Cellular Physiology
 
10.
Acrolein and Human Disease: Untangling the Knotty Exposure Scenarios Accompanying Several Diverse Disorders
Philip C. Burcham
Chemical Research in Toxicology
 
11.
A decade of e-cigarettes: Limited research & unresolved safety concerns
Mohammad Abul Kaisar, Shikha Prasad, Tylor Liles, Luca Cucullo
Toxicology
 
12.
Electronic Cigarette Use Among High School Students and Its Association With Cigarette Use And Smoking Cessation, North Carolina Youth Tobacco Surveys, 2011 and 2013
Li-Ling Huang, Sarah D. Kowitt, Erin L. Sutfin, Tanha Patel, Leah M. Ranney, Adam O. Goldstein
Preventing Chronic Disease
 
13.
Then and now: Consumption and dependence in e-cigarette users who formerly smoked cigarettes
Matthew Browne, Daniel G. Todd
Addictive Behaviors
 
14.
E-cigarette Use and Smoking Cessation Among South Korean Adult Smokers: A Propensity Score–Matching Approach
Baksun Sung
Asia Pacific Journal of Public Health
 
15.
E-cigarette use among Serbian adults: prevalence and user characteristics
Biljana Kilibarda, Viktor Mravcik, Marcus Sebastian Martens
International Journal of Public Health
 
16.
Perioperative Assessment of the Maxillofacial Surgery Patient
Laura Romito
 
17.
Awareness of Electronic Cigarettes among the General Population and Medical Experts
Joo Youn Kim, Sung Woo Seo, Ji Eun Choi, Sungkyu Lee
Journal of the Korean Society for Research on Nicotine and Tobacco
 
18.
Overview of Electronic Nicotine Delivery Systems: A Systematic Review
Allison M. Glasser, Lauren Collins, Jennifer L. Pearson, Haneen Abudayyeh, Raymond S. Niaura, David B. Abrams, Andrea C. Villanti
American Journal of Preventive Medicine
 
19.
Electronic cigarette use in restaurants and workplaces where combustible tobacco smoking is not allowed: an Internet survey in Japan
Kosuke Kiyohara, Takahiro Tabuchi
Tobacco Control
 
20.
E-cigarette use in Serbia: Prevalence, reasons for trying and perceptions
Biljana Kilibarda, Srmena Krstev, Minja Milovanovic, K. Foley
Addictive Behaviors
 
21.
Nicotine and electronic cigarette (E-Cig) exposure decreases brain glucose utilization in ischemic stroke
Ali E. Sifat, Bhuvaneshwar Vaidya, Mohammad A. Kaisar, Luca Cucullo, Thomas J. Abbruscato
Journal of Neurochemistry
 
22.
New Tobacco and Tobacco-Related Products: Early Detection of Product Development, Marketing Strategies, and Consumer Interest
Yvonne CM Staal, Suzanne van de Nobelen, Anne Havermans, Reinskje Talhout
JMIR Public Health and Surveillance
 
23.
Ronan Lordan, Alexandros Tsoupras, Ioannis Zabetakis
 
24.
Prices, use restrictions and electronic cigarette use—evidence from wave 1 (2016) US data of the ITC Four Country Smoking and Vaping Survey
Kai‐Wen Cheng, Frank Chaloupka, Ce Shang, Anh Ngo, Geoffrey Fong, Ron Borland, Bryan Heckman, David Levy, K. Cummings
Addiction
 
25.
New Tobacco and Tobacco-Related Products: Early Detection of Product Development, Marketing Strategies, and Consumer Interest (Preprint)
Yvonne Staal, de van, Anne Havermans, Reinskje Talhout
 
26.
Young people's perspectives of e-cigarette use in the home
Andrew Kirkcaldy, Hannah Fairbrother, Kate Weiner, Penny Curtis
Health & Place
 
27.
Perception of Harms and Benefits of Electronic Cigarettes Among Adult Malaysian Men: A Comparison by Electronic Cigarette Use and Smoking Status
Caryn Chan, Rahman Ab, Hiong Guat, Hum Lei, Kiau Bee, Noor Robson, Shamsul Draman, Miaw Ling, Hock Kuang, Muhammad Yusoff, Mira Kartiwi, Rahman Ab, Mohamed Nik
Asia Pacific Journal of Public Health
 
28.
Smoking - Prevention, Cessation and Health Effects
Narendra Maddu
 
29.
Regulatory Policies for Alcohol, other Psychoactive Substances and Addictive Behaviours: The Role of Level of Use and Potency. A Systematic Review
Jürgen Rehm, Jean-François Crépault, Omer Hasan, Dirk Lachenmeier, Robin Room, Bundit Sornpaisarn
International Journal of Environmental Research and Public Health
 
30.
The oral health impact of electronic cigarette use: a systematic review
Irene Yang, Shelly Sandeep, Jeannie Rodriguez
Critical Reviews in Toxicology
 
31.
High-intensity binge drinking is associated with cigarette smoking and e-cigarette use among US adults aged 40–64 years: Findings from the 2017 BRFSS survey
Qian Wang
Tobacco Induced Diseases
 
32.
What should every dental health professional know about electronic cigarettes?
K Briggs, C Bell, O Breik
Australian Dental Journal
 
33.
The effect of e-cigarettes on smoking cessation and cigarette smoking initiation: An evidence-based rapid review and meta-analysis
Ying-Ying Zhang, Fan-Long Bu, Fei Dong, Jian-Hua Wang, Si-Jia Zhu, Xiao-Wen Zhang, Nicola Robinson, Jian-Ping Liu
Tobacco Induced Diseases
 
34.
Are we with e-cigarette as a friend or against it as a foe?
Radwa Elhefny, Mohamed Ali, Assem Elessawy, Esam El-Rab
Egyptian Journal of Bronchology
 
35.
Effectiveness of Electronic Cigarettes in Smoking Cessation: A Systematic Review and Meta-analysis
Igor Grabovac, Moritz Oberndorfer, Jismy Fischer, Winfried Wiesinger, Sandra Haider, Thomas Dorner
Nicotine & Tobacco Research
 
36.
Characteristics and User Engagement of Anti-Vaping Posts on Instagram: Observational Study (Preprint)
Yankun Gao, Zidian Xie, Li Sun, Chenliang Xu, Dongmei Li
JMIR Public Health and Surveillance
 
37.
Characteristics of and User Engagement With Antivaping Posts on Instagram: Observational Study (Preprint)
Yankun Gao, Zidian Xie, Li Sun, Chenliang Xu, Dongmei Li
 
38.
Reasons for Trying E-cigarettes and Risk of Continued Use
Krysten Bold, Grace Kong, Dana Cavallo, Deepa Camenga, Suchitra Krishnan-Sarin
Pediatrics
 
39.
Handbook of Indoor Air Quality
Philip Hopke, Cong Liu
 
40.
Electronic Cigarettes or Vaping: Are There Any Differences in the Profiles, Use and Perceptions between a Developed and a Developing Country?
Muhammad Rahman, Bindu Joseph, Naima Nimmi
International Journal of Environmental Research and Public Health
 
41.
Associations between e-cigarette use and e-cigarette flavors with cigarette smoking quit attempts and quit success: Evidence from a US large, nationally representative 2018-2019 survey
Yoonseo Mok, Jihyoun Jeon, David Levy, Rafael Meza
 
42.
Oral microbiome of electronic cigarette users: A cross‐sectional exploration
Irene Yang, Jeannie Rodriguez, Wright Young, Yi‐Juan Hu
Oral Diseases
 
43.
Cytotoxic and Inflammatory Effects of Electronic and Traditional Cigarettes on Oral Gingival Cells Using a Novel Automated Smoking Instrument: An In Vitro Study
Liza Ramenzoni, Andreas Schneider, Stephan Fox, Michael Meyer, Mirko Meboldt, Thomas Attin, Patrick Schmidlin
Toxics
 
44.
Electronic cigarettes versus nicotine-replacement therapy for smoking cessation: A systematic review and meta-analysis of randomized controlled trials
Jing Li, Xu Hui, Jiani Fu, Muhammad Ahmed, Liang Yao, Kehu Yang
Tobacco Induced Diseases
 
45.
E-cigarettes and smoking cessation among adolescent smokers
Li-Yin Lin, Yu-Ning Chien, Yi-Hua Chen, Russell Shean, Chi-Yi Wu, Shih-Chang Huang, Hung-Yi Chiou
Scientific Reports
 
46.
Handbook of Indoor Air Quality
Philip Hopke, Cong Liu
 
47.
E-Cigarette Use among Male Smokers in Al-Ahsa, Kingdom of Saudi Arabia: A Cross-Sectional Study
Rajeh Al, Ilias Mahmud, Imam Al, Muhammad Rahman, Shehri Al, Salman Alomayrin, Nawaf Alfazae, Yousif Elmosaad, Ibrahim Alasqah
International Journal of Environmental Research and Public Health
 
48.
Associations Between E-cigarette Use and E-cigarette Flavors With Cigarette Smoking Quit Attempts and Quit Success: Evidence From a U.S. Large, Nationally Representative 2018–2019 Survey
Yoonseo Mok, Jihyoun Jeon, David Levy, Rafael Meza
Nicotine & Tobacco Research
 
49.
Adolescents and Electronic Vapor Product Use: A Dangerous Unknown
Sarah Yale, Vanessa McFadden, Theresa Mikhailov
Adolescents
 
50.
Genotoxicity and mutagenicity assessment of electronic cigarette liquids
Hajed M. Al-Otaibi, Aisha MS. Baqasi, Hani A. Alhadrami
Annals of Thoracic Medicine
 
51.
Chemical characterization and health risks associated with e-cigarettes: A comprehensive review
Sanchez-Rosario Ramon, Pratt Karla, Aquino Mónica, Vega Pedro, Sanchez Sergio H, Peña-Calderon Doris
Advances in Toxicology and Toxic Effects
 
52.
E-cigarette use among university students in Palestine: Prevalence, knowledge, and determinant factors
Mustafa Ghanim, Maha Rabayaa, Mohammad Abuawad, Munther Saeedi, Johnny Amer, Mohammed Nasser Alhajj
PLOS ONE
 
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