Jan. 23, 2018


New Report One of the Most Comprehensive Studies on Health Effects of E-Cigarettes; Finds That Using E-Cigarettes May Lead Youth to Start Smoking, Adults to Stop Smoking

WASHINGTON – A new congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine takes a comprehensive look at evidence on the human health effects of e-cigarettes. Although the research base is limited given the relatively short time e-cigarettes have been used, the committee that conducted the study identified and examined over 800 peer-reviewed scientific studies, reaching dozens of conclusions about a range of health impacts. 

Evidence suggests that while e-cigarettes are not without health risks, they are likely to be far less harmful than conventional cigarettes, the report says. They contain fewer numbers and lower levels of toxic substances than conventional cigarettes, and using e-cigarettes may help adults who smoke conventional cigarettes quit smoking. However, their long-term health effects are not yet clear. Among youth -- who use e-cigarettes at higher rates than adults do -- there is substantial evidence that e-cigarette use increases the risk of transitioning to smoking conventional cigarettes. 

E-cigarettes are a diverse group of products containing a heating element that produces an aerosol from a liquid that users can inhale via a mouthpiece, and include a range of devices such as “cig-a-likes,” vape tank systems, and vape mods.  Millions of Americans use e-cigarettes, and e-cigarette use is generally greatest among young adults and decreases with age.  Use varies substantially across demographic groups, including age, gender, race, and ethnicity.  For example, among youth and adults, use is typically greater among males than females.

Whether e-cigarettes have an overall positive or negative impact on public health is currently unknown, the report says. More and better research on e-cigarettes’ short- and long-term effects on health and on their relationship to conventional smoking is needed to answer that question with clarity.

“E-cigarettes cannot be simply categorized as either beneficial or harmful,” said David Eaton, chair of the committee that wrote the report, and dean and vice provost of the Graduate School of the University of Washington, Seattle. “In some circumstances, such as their use by non-smoking adolescents and young adults, their adverse effects clearly warrant concern. In other cases, such as when adult smokers use them to quit smoking, they offer an opportunity to reduce smoking-related illness.”

The report offers conclusions about e-cigarette use and a range of health impacts, including the following, and it notes the strength of the evidence for each conclusion.

Exposure to nicotine

Exposure to toxic substances

Dependence and abuse liability

Harm reduction

Use by youth and young adults

Secondhand exposure


Respiratory effects

Injuries and poisonings

Reproductive and developmental effects

Until more definite scientific data are available, population modeling can help estimate the balance of potential benefits and harms. Under the assumption that e-cigarette use increases the rate at which adults quit conventional smoking, modeling projects that use of e-cigarettes will generate a net public health benefit, at least in the short run. The harms caused by the higher rate of conventional cigarette smoking among youth who had used e-cigarettes will take decades to appear. For long-range projections, the net public health benefit is substantially less, and under some scenarios the net impact is harmful.

Maximizing the potential health benefits associated with e-cigarettes, the report says, will require determining with more precision whether and under what conditions e-cigarettes help people quit smoking; discouraging e-cigarette use among youth through education and access restrictions; and increasing the devices’ safety through data-driven engineering and design.

The study was sponsored by the U.S. Food and Drug Administration.  The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine.  They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.  For more information, visit nationalacademies.org.  A committee roster follows.

Social Media:
Follow us on Twitter: @theNASEM and @NASEM_health
Follow us on Instagram: @theNASEM
Follow us on Facebook: @NationalAcademies
Follow the conversation using: #eCigHealthEffects

Download the report at www.nationalacademies.org/eCigHealthEffects
Report Highlights
Conclusions by Level of Evidence
Conclusions by Outcome

Dana Korsen, Media Relations Officer
Andrew Robinson, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu

Copies of Public Health Consequences of E-Cigarettes are available from the National Academies Press on the Internet at www.nap.edu or by calling 202-334-3313 or 1-800-624-6242.  Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

#       #       #


Health and Medicine Division
Board on Population Health and Public Health Practice

Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems

David L. Eaton* (chair)
Dean and Vice Provost
Graduate School
Professor of Environmental and Occupational Health Sciences
School of Public Health
University of Washington

Anthony Alberg
Professor and Chair
Department of Epidemiology and Biostatistics
Arnold School of Public Health
University of South Carolina

Maciej Goniewicz
Associate Professor of Oncology
Department of Health Behavior
Roswell Park Comprehensive Cancer Center
Buffalo, N.Y.

Adam Leventhal
Associate Professor
Department of Preventive Medicine
Division of Health Behavior Research
Keck School of Medicine
University of Southern California
Los Angeles

José E. Manautou
Professor of Pharmacology and Toxicology, and
Interim Chair
Department of Pharmaceutical Sciences
School of Pharmacy
University of Connecticut

Sharon McGrath-Morrow
Department of Pediatrics
School of Medicine
Johns Hopkins University

David Mendez
Associate Professor
Department of Health Management and Policy
School of Public Health
University of Michigan
Ann Arbor

Richard Miech
Research Professor
Survey Research Center
Institute for Social Research
University of Michigan
Ann Arbor

Ana Navas-Acien
Professor of Environmental Health Sciences
Mailman School of Public Health
Columbia University
New York City

Kent E. Pinkerton
Professor of Pediatrics
School of Medicine, and
Professor of Anatomy, Physiology, and Cell Biology
School of Veterinary Medicine
University of California

Nancy A. Rigotti
Professor of Medicine
Harvard Medical School, and
Tobacco Research and Treatment Center, and
Associate Chief
Division of General Internal Medicine
Massachusetts General Hospital

David A. Savitz*
Professor of Epidemiology
School of Public Health, and
Professor of Obstetrics and Gynecology and Pediatrics
Warren Alpert Medical School
Brown University
Providence, R.I.

Gideon St.Helen
Assistant Professor of Medicine
Division of Clinical Pharmacology
Department of Medicine
University of California
San Francisco


Kathleen R. Stratton
Staff Officer

*Member, National Academy of Medicine