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Public Health Consequences of E-Cigarettes

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Millions of Americans use e-cigarettes. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults. Given their relatively recent introduction, there has been little time for a scientific body of evidence to develop on the health effects of e-cigarettes.

Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research.


Suggested Citation

National Academies of Sciences, Engineering, and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press.

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Publication Info

680 pages | 6 x 9
  • Prepublication: 978-0-309-46831-2
  • Paperback (forthcoming): 978-0-309-46834-3

Table of Contents

skim chapter
Front Matter i-xxii
Summary 1-18
1 Introduction 19-34
2 Committee Approach 35-42
Section I E-Cigarette Devices, Constituents, and Exposures 43-44
3 E-Cigarette Devices, Uses, and Exposures 45-70
4 Nicotine 71-122
5 Toxicology of E-Cigarette Constituents 123-172
6 Research Needs: E-Cigarette Devices, Constituents, and Exposures 173-176
Section II Effects of E-Cigarettes on Health 177-178
7 Modes of Action 179-204
8 Dependence and Abuse Liability 205-262
9 Cardiovascular Disease 263-296
10 Cancers 297-318
11 Respiratory Diseases 319-356
12 Oral Diseases 357-362
13 Developmental and Reproductive Effects 363-372
14 Injuries and Poisonings 373-378
15 Research Needs: Effects of E-Cigarettes on Health 379-382
Section III Public Health Implications of E-Cigarettes 383-386
16 Combustible Tobacco Cigarette Smoking Among Youth and Young Adults 387-422
17 Smoking Cessation Among Adults 423-462
18 Harm Reduction 463-496
19 Modeling of E-Cigarette Use 497-514
20 Research Needs: Public Health Implications of E-Cigarettes 515-518
21 Concluding Observations 519-522
Appendix A Questions from the Center for Tobacco Products of the Food and Drug Administration Submitted for the Committee's Consideration 523-526
Appendix B Search Strategy and Quality Assessment 527-552
Appendix C Glossary of Terms Related to E-Cigarettes 553-556
Appendix D Cytotoxicity Tables 557-584
Appendix E Public Meeting Agenda 585-586
Appendix F Committee Biosketches 587-590



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