E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications

Annu Rev Public Health. 2018 Apr 1:39:215-235. doi: 10.1146/annurev-publhealth-040617-013757. Epub 2018 Jan 11.


Since e-cigarettes appeared in the mid-2000s, some practitioners, researchers, and policy makers have embraced them as a safer alternative to conventional cigarettes and an effective way to stop smoking. While e-cigarettes deliver lower levels of carcinogens than do conventional cigarettes, they still expose users to high levels of ultrafine particles and other toxins that may substantially increase cardiovascular and noncancer lung disease risks, which account for more than half of all smoking-caused deaths, at rates similar to conventional cigarettes. Moreover, rather than stimulating smokers to switch from conventional cigarettes to less dangerous e-cigarettes or quitting altogether, e-cigarettes are reducing smoking cessation rates and expanding the nicotine market by attracting youth.

Keywords: cancer; cardiovascular disease; lung disease; smoking cessation; smoking initiation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Cigarette Smoking / adverse effects
  • Cigarette Smoking / epidemiology*
  • Electronic Nicotine Delivery Systems*
  • Humans
  • Nicotine / adverse effects
  • Policy*
  • Smoking Cessation / methods*
  • Smoking Prevention


  • Nicotine