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Health Effects of Electronic Cigarettes: An Umbrella Review and Methodological Considerations

Author

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  • Nargiz Travis

    (Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20057, USA)

  • Marie Knoll

    (Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20057, USA)

  • Christopher J. Cadham

    (Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA)

  • Steven Cook

    (Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA)

  • Kenneth E. Warner

    (Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA)

  • Nancy L. Fleischer

    (Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA)

  • Clifford E. Douglas

    (Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA)

  • Luz María Sánchez-Romero

    (Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20057, USA)

  • Ritesh Mistry

    (Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA)

  • Rafael Meza

    (Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA)

  • Jana L. Hirschtick

    (Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA)

  • David T. Levy

    (Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20057, USA)

Abstract

E-cigarettes are often marketed as a safer alternative to combustible cigarettes. However, their health effects, especially those associated with long-term use, remain largely uncertain. We conducted an umbrella review of the cardiopulmonary and carcinogenic risks of e-cigarette use, distinguishing between short-term and long-term health effects. The search for systematic reviews was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool. Seventeen systematic reviews, including five meta-analyses, were included in our umbrella review. There was a clear underreporting of e-cigarette devices and e-liquid types, e-cigarette and cigarette exposure, and the health and smoking status of study participants. Overall, the findings suggest that short-term use of e-cigarettes may be associated with acute cardiopulmonary risks, although to a lesser extent than cigarette use. Long-term e-cigarette use may have pulmonary/respiratory benefits in those who switch from chronic cigarette smoking, particularly in individuals with asthma and chronic obstructive pulmonary disease (COPD). Evidence on intermediate and long-term carcinogenic effects is lacking. This umbrella review underscores the urgent need for systematic reviews with better adherence to established reporting guidelines, consistent definitions of duration of e-cigarette use, a focus on newer devices, and accounting for the impacts of former or current smoking.

Suggested Citation

  • Nargiz Travis & Marie Knoll & Christopher J. Cadham & Steven Cook & Kenneth E. Warner & Nancy L. Fleischer & Clifford E. Douglas & Luz María Sánchez-Romero & Ritesh Mistry & Rafael Meza & Jana L. Hirs, 2022. "Health Effects of Electronic Cigarettes: An Umbrella Review and Methodological Considerations," IJERPH, MDPI, vol. 19(15), pages 1-23, July.
  • Handle: RePEc:gam:jijerp:v:19:y:2022:i:15:p:9054-:d:871364
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    References listed on IDEAS

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    1. Matthew J Page & Larissa Shamseer & Douglas G Altman & Jennifer Tetzlaff & Margaret Sampson & Andrea C Tricco & Ferrán Catalá-López & Lun Li & Emma K Reid & Rafael Sarkis-Onofre & David Moher, 2016. "Epidemiology and Reporting Characteristics of Systematic Reviews of Biomedical Research: A Cross-Sectional Study," PLOS Medicine, Public Library of Science, vol. 13(5), pages 1-30, May.
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    3. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    Cited by:

    1. Nargiz Travis & Marie Knoll & Steven Cook & Hayoung Oh & Christopher J. Cadham & Luz María Sánchez-Romero & David T. Levy, 2023. "Chemical Profiles and Toxicity of Electronic Cigarettes: An Umbrella Review and Methodological Considerations," IJERPH, MDPI, vol. 20(3), pages 1-15, January.
    2. Stephen L. Hamann & Nipapun Kungskulniti & Naowarut Charoenca & Vijj Kasemsup & Suwanna Ruangkanchanasetr & Passara Jongkhajornpong, 2023. "Electronic Cigarette Harms: Aggregate Evidence Shows Damage to Biological Systems," IJERPH, MDPI, vol. 20(19), pages 1-19, September.

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