Abstract:
Introduction: The use of electronic cigarettes (ECs) is controversial. Among the issues of concern is safety: some people think ECs are safer alternatives to conventional cigarettes (CCs), while others are concerned about the possible health effects of using ECs. Although many studies have identified hazards in EC emissions, there is only limited information about exposure levels and the likely health risks of using ECs. Methods: This study aimed to characterise the health risks of using ECs and compare them with the risks of using CCs by utilizing the U.S. EPA health risk assessment model. Hazards were identified and profiled (toxicological and exposure) using document review. The risk from exposure to hazards was thus identified and the overall health risks of using ECs and CCs were compared, and then benchmarked with international guideline levels for each hazard to evaluate whether the detected hazards might pose a significant health risk to users or not, given comparable exposures. Results: Exposures to toxicants of concern identified in EC emissions (acetaldehyde, acrolein, formaldehyde, diethylene glycol, propylene glycol, cadmium, nickel, NNK, and NNN) are almost all far lower than in CC emissions, indicating EC use under standard use conditions is likely to be far safer than smoking. As most hazards’ exposure levels in EC emissions are lower than the defined guideline levels, ECs are also likely to be of low risk to health. Conclusions & Recommendations: The health risks of using ECs are lower than CCs. In a few studies of some ECs, some toxicant levels exceeded levels regarded as safe by international standards. However, studies of ECs lack standardisation in the assessment methods for EC product performance, usage patterns and exposure. Future studies should adhere to a standard methodology to enable ready comparisons. Regulation of EC manufacture and sales is needed to prevent the sale of low quality ECs. Lastly, health professionals and the general public need more information on ECs as safer alternatives to cigarette smoking.
