Nicotine, carcinogen and toxicant exposure in long-term e-cigarette and nicotine replacement therapy users: a cross-sectional study
Abstract
E-cigarettes (1), which produce an aerosol by heating a solvent (e-liquid) usually containing nicotine through a battery-powered heating element, are becoming increasingly popular. Unlike smoked tobacco, e-cigarettes can deliver nicotine to the respiratory tract without combustion (2). Despite this possible advantage, health concerns for e-cigarettes remain about potential cytotoxicity; delivery of carcinogens (3), including carbonyls (4, 5), tobacco-specific N-nitrosamines (TSNAs) (6), and heavy metals (4); effects on cardiovascular and respiratory function and inflammatory effects (7); and nicotine delivery (8). Data on the long-term effects of e-cigarettes are needed to accurately assess risk and inform health professionals encountering e-cigarette users (9). Most studies to date have examined toxin concentrations in e-liquids or aerosols (4, 6) using cell-line or animal models (7). However, these models may not provide accurate information because user characteristics, together with device characteristics and their interactions, determine actual body-level exposure and thus potential health consequences (10). Three studies that have assessed such exposure found lower levels for carcinogens, including TSNAs, in recent former smokers of e-cigarettes than in a historic sample of smokers of combustible cigarettes (11); these studies also found reductions in toxins over a 2- or 4-week period in smokers switching to e-cigarettes with or without concurrent use of combustible…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 180 participants or records.
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