The health effects of vaping and e-cigarettes: consensus recommendations

Erika Kouzoukas; Carolina Navas; Laurie Zawertailo; Chantal Fougere; Simon L Bacon; Nicholas Chadi; William K Evans; Ann McNeill; Osnat Melamed; Theo J Moraes; Onyenyechukwu Nnorom; Robert Schwartz; Lion Shahab; Miranda Ween; Peter Selby

doi:10.1016/j.drugpo.2025.105117

The health effects of vaping and e-cigarettes: consensus recommendations

Int J Drug Policy. 2026 Feb:148:105117. doi: 10.1016/j.drugpo.2025.105117. Epub 2025 Dec 23.

Authors

Affiliations

¹ INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
² INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
³ Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada; Montreal Behavioural Medicine Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC, Canada.
⁴ Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Department of Pediatrics, University of Montreal, Montreal, QC, Canada.
⁵ Department of Oncology, McMaster University, Hamilton, ON, Canada; Ontario Health (Cancer Care Ontario), Clinical Lead, Smoking Cessation, Primary and Community-based Care, ON, Canada.
⁶ Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁷ INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
⁸ Division of Respiratory Medicine, Department of Pediatrics, SickKids & University of Toronto, Toronto, ON, Canada.
⁹ INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁰ Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Behavioural Science and Health, Institute of Population Health, University College London, London, UK.
¹² Department of Thoracic Medicine, Royal Adelaide Hospital, South Australia, Australia; School of Medicine, University of Adelaide, South Australia, Australia.
¹³ INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Electronic address: peter.selby@camh.ca.

PMID: 41443121
DOI: 10.1016/j.drugpo.2025.105117

Abstract

Objective: To develop evidence-informed recommendations on the health effects of e-cigarettes to guide healthcare practitioners and the public to balance individual and population harm reduction.

Methods: Systematic and umbrella reviews investigating the health effects of e-cigarette use were conducted (September 2017 - January 2024). An international panel of subject matter experts (n = 23) and people in Canada with lived experience (n = 7) participated in a two-day, hybrid meeting, and used a consensus-based approach to develop recommendations. A guidance resource and four accompanying knowledge products were tested for usability with end users.

Results: Consensus was reached on 14 recommendations spanning four health effects: carcinogen exposure, cardiovascular health, respiratory health, and nicotine dependence. Quality of evidence was voted as ranging from high/moderate to moderate/low, and strength of most recommendations was voted as strong.

Conclusions: Guidance has been informed by best available evidence and expertise, providing direction to support decision-making. The use of established methods to evaluate divergent published literature combined with consensus-building methods among a range of stakeholders on vaping is possible. As higher quality evidence continues to emerge, recommendations will require iterative refinement.

Keywords: Consensus; E-cigarettes; Guidance; Nicotine; Public health; Vapes.

Publication types

Practice Guideline

MeSH terms

Canada
Consensus
Electronic Nicotine Delivery Systems*
Harm Reduction*
Humans
Systematic Reviews as Topic
Tobacco Use Disorder
Vaping* / adverse effects