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Chemical Profiles and Toxicity 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 20007, USA)

  • Marie Knoll

    (Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20007, USA)

  • Steven Cook

    (Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA)

  • Hayoung Oh

    (Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20007, USA)

  • Christopher J. Cadham

    (Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA)

  • Luz María Sánchez-Romero

    (Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20007, USA)

  • David T. Levy

    (Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20007, USA)

Abstract

Background: Electronic cigarettes (ECs) are often marketed as a safer alternative to combustible tobacco products. The global EC market has rapidly expanded since their introduction, creating an urgent need for research describing the toxicity and chemical composition of ECs. We conducted an umbrella review to summarize the evidence from existing systematic reviews (SRs). Methods: The search for SRs was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool. Results: Twenty-five SRs were included in our umbrella review. Chemical profiles widely varied across studies included in the reviews, which was mainly attributed to the lack of standardized protocols investigating the constituents, and differences in EC devices and e-liquids tested. Metals were more abundant in some EC aerosols than cigarettes, while carbonyls were typically found at lower levels. There was consistent evidence of in vitro toxicity from EC aerosol and e-liquid exposure. AMSTAR-2 revealed important limitations across reviews. Conclusions: While most reviews concluded that ECs were likely less harmful than cigarettes, there was hesitancy to draw clear conclusions due to variable analytical procedures and inconsistent findings among the included studies. Future SRs with improved methodology and reporting are needed to adequately inform tobacco regulatory actions.

Suggested Citation

  • 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.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:3:p:1908-:d:1042017
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    References listed on IDEAS

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    1. Omar Andrés Bravo-Gutiérrez & Ramcés Falfán-Valencia & Alejandra Ramírez-Venegas & Raúl H. Sansores & Guadalupe Ponciano-Rodríguez & Gloria Pérez-Rubio, 2021. "Lung Damage Caused by Heated Tobacco Products and Electronic Nicotine Delivery Systems: A Systematic Review," IJERPH, MDPI, vol. 18(8), pages 1-13, April.
    2. Sungroul Kim & Maciej L. Goniewicz & Sol Yu & Bokyeong Kim & Ribhav Gupta, 2015. "Variations in Label Information and Nicotine Levels in Electronic Cigarette Refill Liquids in South Korea: Regulation Challenges," IJERPH, MDPI, vol. 12(5), pages 1-10, May.
    3. Stefanie Scheffler & Hauke Dieken & Olaf Krischenowski & Christine Förster & Detlev Branscheid & Michaela Aufderheide, 2015. "Evaluation of E-Cigarette Liquid Vapor and Mainstream Cigarette Smoke after Direct Exposure of Primary Human Bronchial Epithelial Cells," IJERPH, MDPI, vol. 12(4), pages 1-11, April.
    4. 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.
    5. 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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    Cited by:

    1. Alejandro Svarch-Pérez & María Vanessa Paz-González & Carlota Ruiz-Juárez & Juan C. Olvera-Chacón & Angelina Larios-Solís & Santiago Castro-Gaytán & Eugenia Aldeco-Pérez & Jorge Carlos Alcocer-Varela, 2024. "Methods for a Non-Targeted Qualitative Analysis and Quantification of Benzene, Toluene, and Xylenes by Gas Chromatography-Mass Spectrometry of E-Liquids and Aerosols in Commercially Available Electron," IJERPH, MDPI, vol. 21(10), pages 1-11, September.

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