A systematic review of health effects of electronic cigarettes

Prev Med. 2014 Dec:69:248-60. doi: 10.1016/j.ypmed.2014.10.009. Epub 2014 Oct 16.


Objective: To provide a systematic review of the existing literature on health consequences of vaporing of electronic cigarettes (ECs).

Methods: Search in: PubMed, EMBASE and CINAHL.

Inclusion criteria: Original publications describing a health-related topic, published before 14 August 2014. PRISMA recommendations were followed. We identified 1101 studies; 271 relevant after screening; 94 eligible.

Results: We included 76 studies investigating content of fluid/vapor of ECs, reports on adverse events and human and animal experimental studies. Serious methodological problems were identified. In 34% of the articles the authors had a conflict of interest. Studies found fine/ultrafine particles, harmful metals, carcinogenic tobacco-specific nitrosamines, volatile organic compounds, carcinogenic carbonyls (some in high but most in low/trace concentrations), cytotoxicity and changed gene expression. Of special concern are compounds not found in conventional cigarettes, e.g. propylene glycol. Experimental studies found increased airway resistance after short-term exposure. Reports on short-term adverse events were often flawed by selection bias.

Conclusions: Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of ECs. However, they can hardly be considered harmless.

Keywords: E-cigarette; ENDS; Electronic cigarette; Electronic nicotine delivery device; Electronic nicotine delivery system.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Animals
  • Conflict of Interest
  • Cytotoxins / pharmacology
  • Electronic Nicotine Delivery Systems / adverse effects*
  • Glycols / analysis
  • Humans
  • Metals, Heavy / analysis
  • Mice
  • Particulate Matter / adverse effects
  • Steam / adverse effects*
  • Steam / analysis*
  • Volatilization


  • Cytotoxins
  • Glycols
  • Metals, Heavy
  • Particulate Matter
  • Steam