Health Effects of Electronic Cigarettes: An Umbrella Review and Methodological Considerations

Abstract

E-cigarettes are often marketed as a safer alternative to combustible cigarettes. However, their health effects, especially those associated with long-term use, remain largely uncertain. We conducted an umbrella review of the cardiopulmonary and carcinogenic risks of e-cigarette use, distinguishing between short-term and long-term health effects. The search for systematic reviews was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool. Seventeen systematic reviews, including five meta-analyses, were included in our umbrella review. There was a clear underreporting of e-cigarette devices and e-liquid types, e-cigarette and cigarette exposure, and the health and smoking status of study participants. Overall, the findings suggest that short-term use of e-cigarettes may be associated with acute cardiopulmonary risks, although to a lesser extent than cigarette use. Long-term e-cigarette use may have pulmonary/respiratory benefits in those who switch from chronic cigarette smoking, particularly in individuals with asthma and chronic obstructive pulmonary disease (COPD). Evidence on intermediate and long-term carcinogenic effects is lacking. This umbrella review underscores the urgent need for systematic reviews with better adherence to established reporting guidelines, consistent definitions of duration of e-cigarette use, a focus on newer devices, and accounting for the impacts of former or current smoking.

Examining indirect effects of advertising exposure on young adults’ cannabis and nicotine vaping.

“…Such changes have occurred in the context of expanded access to and marketing of vaping products (Cho et al, 2022) and the spread of adult-use cannabis legalization (Krauss et al, 2017;Shih et al, 2019;Whitehill et al, 2020). This rise in vaping prevalence among young people is concerning because vaping poses a number of health risks, including nicotine and cannabis dependence, and potentially other unknown long-term health consequences (Budney et al, 2015;Spindle et al, 2018; The National Academies of Sciences Engineering and Medicine, 2018;Travis et al, 2022). Studies also show that co-use of nicotine and cannabis (i.e., concurrent use of both drugs within the same period of time) is common among young adults and is associated with increased risks for negative health and related outcomes (Agrawal et al, 2012;Cohn et al, 2019;Ramo et al, 2012Ramo et al, , 2013Schauer & Peters, 2018;Tucker et al, 2019).…”