E-cigarettes began to be used in Australia from the mid-2000s. With lower concentrations of many harmful chemicals in their emissions compared to cigarette smoke (see Section 18.104.22.168), the promise of reduced harm for those who replaced tobacco with e-cigarettes seemed feasible.1-3 However, e-cigarettes are now extensively used by non-smokers including never-smokers, in particular teenagers and young adults under the age of 30 (see Section 18.3). Many people who smoke are now dual users of conventional and e-cigarettes.
Poor compliance with regulation (see Section 18.13) has resulted in widespread illegal sales of e-cigarettes in Australia.
E-cigarettes sold in Australia and internationally contain many chemicals that have the potential to harm human health.6 These include nicotine, which causes dependency (see Section 18.4.2), flavouring chemicals with potential inhalation toxicity, contaminants such as toxic metals, and toxic products of chemical reactions that occur during the heating of the e-liquid (see Section 18.5.3). A heavy e-cigarette user may inhale such chemicals hundreds of times per day, every day, for a duration of years or even decades. For most of these chemicals, the toxicity associated with this type of long-term exposure is unknown. There is insufficient evidence to support the safety of long-term e-cigarette use.
This section describes the known health effects of e-cigarette use and some of the potential mechanisms by which e-cigarette use may be affecting these health outcomes. The information here concentrates on health effects seen in people who have not smoked cigarettes, with some information for use by current and former tobacco smokers where relevant. Due to their relatively recent introduction onto the market, most of the known health effects of e-cigarettes have arisen from short term use. As e-cigarettes contain some of the same toxic chemicals present in cigarette smoke, there is concern that health effects will manifest in the future as a result of long-term use, in a similar manner to those caused by tobacco products. These may include cancer, cardiovascular disease, chronic obstructive pulmonary disease and periodontitis, as discussed in this section.
A large amount of research is published each month on this topic, and several agencies in Australia and internationally have conducted reviews of the evidence.6-12 Readers are directed in particular to comprehensive reports published early in 2018 by the US National Academies of Science, Engineering and Medicine,9, 10 the review conducted by the Australian National University,7 and the subsequent statement by the Chief Executive Officer of Australia’s National Health and Medical research Council.11
This section summarises evidence on the relationship between e-cigarette use and:
Relevant news and research
For recent news items and research on this topic, click here. ( Last updated January 2023)
1. Farsalinos KE and Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Therapeutic Advances in Drug Safety, 2014; 5(2):67–86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25083263
2. Oh AY and Kacker A. Do electronic cigarettes impart a lower potential disease burden than conventional tobacco cigarettes? Review on E-cigarette vapor versus tobacco smoke. Laryngoscope, 2014; 124(12):2702–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25302452
3. Goniewicz ML, Gawron M, Smith DM, Peng M, Jacob P, 3rd, et al. Exposure to nicotine and selected toxicants in cigarette smokers who switched to electronic cigarettes: A longitudinal within-subjects observational study. Nicotine & Tobacco Research, 2017; 19(2):160–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27613896
4. Brown CJ and Cheng JM. Electronic cigarettes: product characterisation and design considerations. Tobacco Control, 2014; 23 Suppl 2(Suppl 2):ii4-10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24732162
5. Herrington JS, Myers C, and Rigdon A. Analysis of nicotine and impurities in electronic cigarette solutions and vapor. Restek, 2017. Available from: http://www.restek.com/Technical-Resources/Technical-Library/Foods-Flavors-Fragrances/fff_FFAN2127-UNV.
6. National Health and Medical Research Council. Inhalation toxicity of non-nicotine e-cigarette constituents: risk assessments, scoping review and evidence map. 2022. Available from: https://www.nhmrc.gov.au/file/18287/download?token=Z5D5_sam.
7. Banks E, Yazidjoglou A, Brown S, Nguyen M, Martin M, et al. Electronic cigarettes and health outcomes: systematic review of global evidence. Report for the Australian Department of Health. Canberra: National Centre for Epidemiology and Population Health, 2022. Available from: https://nceph.anu.edu.au/research/projects/health-impacts-electronic-cigarettes#health_outcomes.
8. McNeill A, Simonavičius E, Brose L, Taylor E, East K, et al. Nicotine vaping in England: 2022 evidence update. A report commissioned by the Office for Health Improvement and Disparities. London: Office for Health Improvement and Disparities, 2022. Available from: https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update.
9. National Academies of Sciences Engineering and Medicine. Public health consequences of e-cigarettes. The National Academies Press, Washington, DC 2018. Available from: http://nationalacademies.org/hmd/Reports/2018/public-health-consequences-of-e-cigarettes.aspx.
10. Byrne S, Brindal E, Williams G, Anastasiou K, Tonkin A, et al. E-cigarettes, smoking and health. A Literature Review Update. CSIRO, Australia, 2018. Available from: https://researchnow.flinders.edu.au/en/publications/e-cigarettes-smoking-and-health-a-literature-review-update.
11. National Health and Medical Research Council. CEO statement on electronic cigarettes. 2022. Available from: https://www.nhmrc.gov.au/health-advice/all-topics/electronic-cigarettes/ceo-statement
12. SCHEER (The Scientific Committee on Health Environmental and Emerging Risks). Scientific Opinion on electronic cigarettes. 2021. Available from: https://ec.europa.eu/health/publications/electronic-cigarettes_en.