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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

774 pages |6 x 9
  • Paperback: 978-0-309-46834-3
  • Ebook: 978-0-309-46837-4

Table of Contents

skim chapter
Front Matter i-xxiv
Summary 1-16
Summary Annex Report Conclusions by Level of Evidence 17-22
1 Introduction 23-42
2 Committee Approach 43-52
Section I: E-Cigarette Devices, Constituents, and Exposures 53-54
3 E-Cigarette Devices, Uses, and Exposures 55-88
4 Nicotine 89-154
5 Toxicology of E-Cigarette Constituents 155-216
6 Research Needs: E-Cigarette Devices, Constituents, and Exposures 217-220
Section II: Effects of E-Cigarettes on Health 221-222
7 Modes of Action 223-254
8 Dependence and Abuse Liability 255-338
9 Cardiovascular Disease 339-380
10 Cancers 381-404
11 Respiratory Diseases 405-454
12 Oral Diseases 455-460
13 Developmental and Reproductive Effects 461-472
14 Injuries and Poisonings 473-480
15 Research Needs: Effects of E-Cigarettes on Health 481-486
Section III: Public Health Implications of E-Cigarettes 487-492
16 Combustible Tobacco Cigarette Smoking Among Youth and Young Adults 493-540
17 Smoking Cessation Among Adults 541-588
18 Harm Reduction 589-630
19 Modeling of E-Cigarette Use 631-652
20 Research Needs: Public Health Implications of E-Cigarettes 653-656
21 Concluding Observations 657-660
Appendix A: Questions from the Center for Tobacco Products of the Food and Drug Administration Submitted for the Committee's Consideration 661-664
Appendix B: Search Strategy and Quality Assessment 665-696
Appendix C: Glossary of Terms Related to E-Cigarettes 697-702
Appendix D: Cytotoxicity Tables 703-740
Appendix E: Public Meeting Agenda 741-744
Appendix F: Committee Biosketches 745-750



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