Electronic Cigarette Harms: Aggregate Evidence Shows Damage to Biological Systems

22 September 2023

By Stephen L. Haman, Nipapun Kungskulnit, Naowarut Charoenca, Vijj Kasemsup, Suwanna Ruangkanchanasetr, Suwanna Ruangkanchanaset: MDPI


Evidence of the harms of e-cigarettes has been unfolding slowly and has been documented in many reviews and reports worldwide. A narrative review of new evidence is presented since, as research has continued, newly aggregated evidence of the dangers of electronic cigarettes on the brain, heart, and lungs is vital to inform decisions on restricting the use of e-cigarettes. Several biomedical research databases were searched for electronic cigarette health effects, emphasizing reviews, systematic reviews, and meta-analyses. Over 50 review studies, primarily in 2022 and 2023, illustrate some of the latest information on e-cigarette harms. Results show studies of respiratory, neurological, and cardiovascular effects. Researchers call for expanding studies through new methods to elaborate on initial findings of multiple harms emerging in clinical investigations. Since the use of electronic cigarettes for adult cessation is not sanctioned in most countries, it is clear that health authorities see significant costs to the health of the general population if the promotion and use of electronic cigarettes occur worldwide. Regulatory action to control electronic cigarettes should consider the substantial evidence of electronic cigarette harm.
Keywords: unsafe; electronic cigarettes; e-cigarettes; health effects


In 2020, the Tobacco Control Research and Knowledge Management Center (TRC) published “Hidden Dangers of E-Cigarettes”, a book reviewing 75 research reports on the harms of e-cigarettes through 2018 [1]. Much past research was in vitro or in vivo studies or centered on smoking cessation.
In 2022, an extensive review by Australian researchers was published, which included evidence from six independent reviews on the health effects of e-cigarettes from 2018 to 2021 [2]. This review incorporated information from “the 2018 United States (US) National Academies of Sciences, Engineering and Medicine (NASEM) review; the 2018 Public Health England review with an evidence update in 2020; the literature review by the Commonwealth Scientific and Industrial Research Organization (CSIRO) of Australia; the 2020 Irish Health Research Board literature map; the European Union Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) 2021 Opinion on electronic cigarettes; and the US Preventive Services Task Force (USPSTF) 2021 recommendations and evidence synthesis on interventions for tobacco cessation. This Australian systematic review of the National Center for Epidemiology and Population Health for the Australian Department of Health”. It is over 300 pages with 821 references and is a valuable reference for public health concerns about e-cigarette use. Its evidence synthesis of 189 studies has a scope and inclusion period more expansive than we present here.
The aim of this review, which uses the terms electronic cigarettes or e-cigarettes interchangeably, is not to restate evidence in the extensive Australian review but to focus on research evidence from even more recent investigations and reviews up to early 2023, where new evidence of the dangers of e-cigarettes has been provided. This narrative review highlights adverse effects on the respiratory, cardiovascular, and neurological systems and actions necessary to prevent e-cigarette harm.
Worldwide evidence of e-cigarette use shows a 46.6% increase in e-cigarette use in the United States from 2020 to 2022. Based on this rapid increase, the Centers for Disease Control (CDC) called for “comprehensive restrictions on the sale of all flavored tobacco products that include e-cigarettes, menthol cigarettes, and flavored cigars in all jurisdictions.” They emphasized that this strategy, coupled with longstanding evidence-based strategies to prevent youth tobacco use, is expected to reduce youth initiation and use and disparities in tobacco product use [3]. In Thailand, where there is a ban on e-cigarette imports and sales, and in countries with restrictions on the age of sale, advertising, product flavoring, or other sales provisions, there is lower use [4,5].

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