E-cigarette studies, research and reports
Throughout this web site I've mentioned a number of studies,
presentations, commentary from health professionals, special reports and
various research carried out on e-cigarettes and vaping.
The following is
a summary of all the research mentioned and some additional sources, brief descriptions of the
reports and links to
the actual study papers and statements.
Please note: I've started to list the research chronologically
(i.e research/commentary publish date), so if you haven't visited this page for some time, you
may find ecig studies you haven't seen in listings further down the page
as I add items as I become aware of them.
Nicotine Delivery Systems (PDF)
A report from WHO examining what it states is emerging evidence on the health impacts
of electronic nicotine delivery systems (ENDS) use. It says ecigs "represent an evolving frontier,
filled with promise and threat for tobacco control". It also
states, "The evidence and recommendations presented in this report are therefore subject to rapid change".
Published August 2014.
NOTE: This report has been criticised by Dr. Konstantinos Farsalinos,
says the organisation continues to "maintain an overcautious approach and present one-sided evidence".
Clive Bates says it is a
modest improvement on WHO's previous extremist views, but still involves
a hugely disproportionate regulatory response. Professor Gerry Stimson, Emeritus Professor at Imperial College London, says WHO is once again exaggerating the risks of e-cigarettes.
Of Ecigs In Quitting Smoking
A cross-sectional population study (5863 people) of the effectiveness of e-cigarettes as a quit smoking aid has found
ecig users were more likely to report abstinence than either those who used other nicotine replacement therapies or no aid.
Published August 2014.
On Ecigarettes For Policy Makers
A briefing on e-cigarettes and related policy issues by Clive Bates, who was previously involved with ASH (Action on Smoking and Health). In the UK. Mr. Bates points out vaping could save up to a billion lives in the 21st Century.
Published July 2014
Benefits Outweigh Potential Harm
A Queen Mary University (UK) study has found that despite gaps in knowledge, current evidence
concerning e-cigarettes doesn't justify the devices being more strictly regulated than, or even as strictly as,
tobacco cigarettes. The study presents evidence from 115 references.
Published July 2014.
Attitudes Towards Vaping
Two thirds physicians surveyed last year felt electronic
cigarettes are a helpful aid for smoking cessation and 35% recommended them to their patients.
Published July 2014
Big Survey 2014 Results
Data from a survey of more than 10,000 vapers carried out by Electronic
Cigarette Forum (ECF) is gradually being released. The 75 question
survey had a 97% completion rate. Published July 2014.
Of Nicotine Eliquids Under CLP Recommended (PDF)
A report by toxicology consultants, which has been verified by Professor Riccardo Polosa, Professor Bernd Mayer and Dr Jacques Le Houeze states eliquids with typical nicotine concentrations
should be reclassified as CLP category 4 (the lowest); the same
classification as washing up liquids. Currently nicotine eliquids have
been classified as CLP category 2 or 3; alongside strychnine and
formaldehyde. CLP is the set of regulations covering classification, labelling and packaging
of substances and mixtures in the EU. Published July 2014.
And Inhalation Toxins (PDF)
A summary of a study headed by by Dr. Konstantinos Farsalinos evaluating sweet-flavored eliquids for the presence of Diacetyl and Acetyl Propionyl.
Published June 2014.
Letter "Misleading, Without Scientic Foundation"
A letter to the World Health Organisation in May (see earlier entry
below) signed by 53 nicotine specialists and health professionals was
criticised by anti-ecig crusader Stanton Glantz and a number of others.
The 53 original signatories have returned fire; deconstructing Glantz's
arguments. Published June 2014.
Function - Tobacco vs. Ecigarettes (PDF)
A recent study found that while smoking causes a delay in myocardial relaxation, ecig use had no immediate effects.
Published June 2014.
Of E-cigarette Use On Exhaled Nitric Oxide
A study recently published in Toxicology and Applied Pharmacology that concluded
based on nitric oxide (FeNO) levels, e-cigarettes are not safer than tobacco cigarettes
and lung function is impaired has been labelled "arbitrary and completely wrong" by Dr. Konstantinos
Farsalinos. Published June 2014.
Vs. Nicotine Inhaler
A study comparing e-cigarettes with nicotine inhalers in terms of perceived benefits, harms, appeal, and role in
quitting has found more subjects would use ecigs to make a quit attempt.
Vaping devices gained a much higher total satisfaction score than inhalers. Published May 2014
From Specialists In Nicotine Science And Public Policy (PDF)
Dozens of health professionals, including Australia's Dr. Coral Gartner,
have signed an open letter to Dr Margaret Chan, the Director General of
the World Health Organisation (WHO) with their concerns regarding the
body ignoring the importance of tobacco harm reduction strategies such
the use as electronic cigarettes. The letter states among other points that it is counterproductive to ban the advertising of e-cigarettes and other low
risk alternatives to smoking. The communication states these products
could be among the most significant health innovations of the 21st
century and could save hundreds of millions of lives. Published May
E-cigarette Briefing (PDF)
ASH Scotland current views on vaping and ecigarettes. Published May 2014.
Boost Quitting Success Rates
A survey carried out by University College London has found smokers are approximately 60% more likely to report succeeding quitting smoking
if they use e-cigarettes than if they use willpower alone or nicotine replacement therapies such as patches or gum.
Published May 2014 in the journal Addiction.
Voltage Vaping And Carbonyl Compounds
A recent study measured twelve carbonyl compounds in ecig vapors where battery output voltage was gradually increased from 3.2 to 4.8 V.
It found vapour did contain some toxic and carcinogenic carbonyl compounds; but
these varied between eliquids and were at much lower levels than cigarette smoke when lower voltages are used. High voltages significantly increased toxic compounds.
Published May 2014.
Vapor And MRSA
A study presented in May at the 2014 American Thoracic Society International Conference
states while e-cigarette vapor appears to boost the virulence of
dangerous and medication-resistant bacteria such as MRSA, it's to a
lesser degree than cigarette smoke.
A "Much Safer Source Of Nicotine" (PDF).
A report commissioned by Public Health England states electronic cigarettes offer "vast potential health benefits", but
requires appropriate regulation, careful monitoring, and risk management. "However the opportunity to harness this potential
into public health policy, complementing existing comprehensive tobacco control
policies, should not be missed." Published May 2014.
Not A Gateway To Children Smoking (PDF)
In another report commissioned by Public Health England, the authors
state they could not identify any evidence to suggest that non smoking children who tried e-cigarettes were more likely to then try tobacco.
Published May 2014.
Benefit Asthmatic Smokers
A study of asthmatic smokers has found those who used electronic
cigarettes regularly showed objective and subjective improvements in asthma
outcomes, and goes on to state: "This study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods."
Published in International Journal of Environmental Research and Public Health,
Release In E-cigarette Vapor
A study to be published in Nicotine and Tobacco Research states e-cigarette vapor can be the source of carcinogens,
but the devil is in the detail according to Dr. Konstantinos Farsalinos.
Published May 2014
E-Cigarette Awareness and Perceived Harmfulness
A study on awareness and perceived harmfulness of ecigarettes among U.S. adults
has found 77% of respondents were aware of e-cigarettes and off this,
only 51% believed e-cigarettes were less harmful than cigarettes. The
study was published in American Journal of Preventive Medicine, May
2014. (The study results have caused concern in the vaping community and
among some pro-vaping health professionals that misinformation campaigns
are having an impact on public perception).
Evaluation And Risk Assessment Of Electronic Cigarettes
A systematic review by Dr. Konstantinos E. Farsalinos and Riccardo Polosa
states currently available evidence indicates electronic cigarettes are
by far a less harmful alternative to smoking and significant health
benefits are expected in smokers who make the switch from tobacco to
ecigs. Published April 2014.
Of Electronic Cigarettes In Great Britain (PDF)
An ASH survey shows electronic cigarette use among adults in Britain has tripled over the past two years and according to the associated study's lead
author (and as with the study that follows this item); there is no evidence to suggest ecigarettes are renormalizing smoking.
Published April 2014.
In Ecig Use In England (PPT)
A study by researchers from University College London
has found the use of ecigarettes by those who have never smoked is negligible.
Evidence also indicates ecigs are not ‘renormalizing’ smoking - and they may be contributing to a reduction in smoking prevalence.
Published April 2014.
Among The Least Harmful Nicotine Delivery Products
A study that sought to estimate the harm level of various forms of nicotine delivery products rated cigarettes as the most harmful (overall weighted score of 100) and ENDS (electronic nicotine delivery systems) were rated among the least harmful.
Published in European Addiction Research, April 2014.
Position Statement (PDF)
In a position statement released by the Australian Association of Smoking Cessation Professionals
(AASCP), the body provides some support for ecigarettes and states the
final decision to use the devices "belongs to the individual
smoker, who should weigh up the risk and benefits and make a decision
for their circumstances." It also mentions there is no evidence to
support concerns ecigs are a gateway to smoking or normalise smoking.
Published April 2014.
Nicotine Not The Great Satan?
It appears some of nicotine's bad reputation may be unfounded. As has
been suspected for some time, it seems it's a combination of chemicals
that make tobacco so addictive - in fact it's been shown to be
"almost impossible" to get laboratory animals hooked on nicotine
on its own. Of course, humans may be another story; but perhaps the
degree of addiction is amplified when nicotine is consumed through
smoking. Furthermore, nicotine also appears to have some therapeutic
properties. Published March 2014.
College Of Physicians' Stance
Switching completely from tobacco to e-cigarettes achieves much the same with
regard to health as does quitting smoking and all nicotine use
completely says the Royal College Of Physicians. The body goes on to say
even in the absence of regulation, the risks to ecig users and others is low.
Published March 2014.
Moral And Ethical Duty" To Provide Ecigarettes
In an open letter published on The Montreal Gazette; the medical director of the Smoking Cessation Clinic at the Montreal Chest Institute and other health professionals
have voiced their support for the authorization of the sale of ecigs in Canada. In his letter, Dr. Gaston Ostiguy mentions
states there is a "moral and ethical duty to provide these products to addicted smokers."
Gateway Effect Claims Deconstructed
A study by Professor Stanton Glantz and Dr Lauren Dutra on teenage smoking
and ecig use has been thoroughly debunked by Clive Bates, who called the
document "false, misleading and damaging". Mr. Bates was
previously director of Action on Smoking and Health (ASH-UK). Published
Does Not Cause Lipoid Pneumonia
In March 2014, another story started doing the rounds of the media
relating to a person who had contracted lipoid pneumonia and glycerol
based eliquids were pointed to as the culprit. Dr. Konstantin
Farasalinos details why glycerol cannot cause lipoid pneumonia.
Impact Of EU Ban On Higher Nicotine E-cigarettes On Smoking.
The EU Tobacco Products Directive (TPD), which will limit nicotine
eliquid levels to 20mg/ml, will curb the use of e-cigarettes says a
report from London Economics. It estimates the TPD will result in the deaths of an additional 105,000 people a year in
Europe. Published February 2014.
Effectiveness Of E-Cigarettes: A Population Study
This study found e-cigarette users were more likely still to be abstinent than either those who used NRT (Nicotine Replacement Therapies) bought over-the-counter or used no aid at all.
Published February 2014 (abstract).
Effects Of Nicotine On Human Health
According to the American Council On Science And Health, the relative risk of mortality from lifetime use of various tobacco and nicotine products is comparatively low. "Electronic cigarette vapor appears chemically incapable of causing cancer
as cigarette smoke has done." The report, Nicotine And Health, was published in January 2014.
Contaminants In Ecig Eliquids And
Workplace Health Risks (PDF)
A study that reviewed available data on chemistry of ecig aerosols and eliquids found no evidence to suggest vaping produces inhalable exposures to contaminants
that justify concerns relating to the health and safety of workplaces. Published January 2014.
Longitudinal Study Of Ecig Users
A study carried out by has concluded electronic cigarettes may contribute to relapse prevention in former smokers and smoking cessation in current smokers.
It also found in dual users who were still smoking at the point of follow-up had decreased their tobacco cigarette consumption by 5.3 cigarettes a day.
Published January 2014.
Not a study or formal report as such, but I found this interview with nicotine expert Dr Jacques Le Houezec quite enlightening.
Dr. Le Houezec busts a few myths surrounding nicotine and offers some
advice on storage and related issues - valuable info for vapers.
Do Not Stiffen Arteries (PDF)
Researchers from Onassis Cardiac Surgery Center in Greece have found that while smoking just 2 tobacco cigarettes caused significant stiffening of the aorta, no difference was observed after the use of e-cigarettes by both smokers and
vapers. Published December 2013.
Importance Of Flavours In Eliquids
A study headed by
Dr. Konstantinos Farsalinos finds flavours play a major role in the overall
experience of dedicated vapers and support the hypothesis that flavoured
eliquids are important contributors in reducing or eliminating the
smoking of tobacco cigarettes. Published December 2013.
Hand Vapor Study (PDF)
A new study (Published in Oxford Journal, December 2013) shows while e-cigarettes are a source of
second-hand exposure to nicotine; it's far, far less than that
associated with second hand cigarette smoke. Additionally, e-cigarette
second-hand vapor did not contain combustion related toxicants tested
for. Lead author was Maciej Goniewic from the Roswell Park Cancer Institute in Buffalo, N.Y.
Smoking Kills, and So Might E-Cigarette Regulation
Gilbert Ross MD, is medical and executive director of the American Council on Science and Health. In this special report on The American, he states "simple common sense would dictate that inhaling the fewer, less harmful ingredients of e-cigarettes as compared to inhaling the thousands of chemicals in the smoke from burnt
tobacco, many of which have been shown to be carcinogenic, is highly likely to be healthier."
Published November, 2013.
When Less Is More (PDF)
Presentation slides from Clive Bates (of the Counterfactual) concerning
the dangers of over-regulating ecigarettes. Mr Bates urges positivity about the
vast potential about ecigs, to put the (minor) risks in perspective and
regulate as though the 1 billion who are predicted to die from tobacco
related illnesses in the 21st century matter most. Presented at The
E-Cigarette Summit, Royal Society, London in November 2013.
on Safety of Electronic Cigarettes (PDF)
Dr. Konstantinos Farsalinos' comprehensive presentation on existing data relating to the safety of ecigarettes.
Presented at The E-Cigarette Summit, Royal Society, London in November
Safety in the Context of E-Cigarette Use (PDF)
Contrary to popular belief, the fatal overdose level for nicotine may be
far higher than the generally accepted 50 to 60 mg (adult) says Dr. Jacques Le Houezec.
This research was presented at the The E-Cigarette Summit, Royal Society,
London in November 2013.
Longitudinal Study Of Electronic Cigarette Users
A study of 477 ecigarette users by researchers from the University of
Auckland and University of Geneva has arrived at the conclusion that
"E-cigarettes may contribute to relapse prevention in former smokers and smoking cessation in current
smokers" Published October 2013.
Not A Gateway To Smoking
The study is yet to be published, but according to research presented at
the annual meeting of the American Association for Cancer Research
(October 2013), the use of ecigarettes by teens does not lead on to
smoking tobacco in the vast majority of cases.
To Have Low Cytotoxicity (PDF).
The results of testing of 20 e-liquids has revealed the majority of the vapor samples were found to have no adverse effects on cardiac cells.
Even on the several that did have some effect (two of which were tobacco
derived), the worst was 3 times less toxic compared to cigarette smoke.
Published October 2013 in the International Journal of Environmental Research And Public Health.
Nicotine Levels Selection and Patterns of Electronic Cigarette Use
Another study from Dr. Konstantinos E. Farsalinos that concludes nicotine levels seem to play a
crucial role in achieving and maintaining smoking cessation in a group of motivated subjects.
The study involved 111 participants who had completely substituted smoking with
electronic cigarette use for at least 1 month. Published September 2013
coronary circulation and oxygen supply (PDF)
Recent research indicates electronic cigarette use does not affect the oxygenation of the heart. Lead by principle investigator Dr Konstantinos Farsalinos; results of the research were presented at the European Society of Cardiology annual congress in Amsterdam
in August, 2013.
No Health Concerns
A study by Professor Igor Burstyn of Drexel University School of Public Health
based on a review available data has confirmed chemicals generally found in ecig eliquids pose no health concerns.
Published August 2013 (PDF).
The UK's Medicines and Healthcare Products Regulatory Agency (MHRA)
carried out extensive research on ecigarettes, arriving at the
conclusion there was little concern that e-cigarettes can harm users by delivering toxic nicotine levels
and little evidence of non-smokers taking up electronic cigarettes. The
link above takes you to the general page on nicotine containing products
and the findings mentioned are contained in 3 documents (all PDF) here,
Published in June 2013.
Use - Siegel Vs. Chapman
Dr. Michael Siegel, a Professor in the Department of Community Health Sciences, Boston University School of Public
Health has challenged Australia's Dr. Simon Chapman on the topic of dual
use. Dr. Chapman maintains there are no health benefits associated with smoking
reduction. Dr. Siegel counters this claim - and has some particularly
harsh words relating to Chapman's attitude towards electronic cigarettes
and dual use. Published June 2013.
Efficiency and Safety of an Electronic Cigarette as Tobacco Cigarettes Substitute
In a 12-month trial of ecigarettes to evaluate smoking reduction/abstinence in 300 smokers not intending to quit; complete abstinence from tobacco smoking was documented in 10.7% and 8.7% at week-12 and after a year respectively.
For the group receiving the higher dose nicotine cartridges, the tobacco
cigarette cessation rate was 13% after a year. The study was published on PLOS One on June 24, 2013.
Evaluation of Electronic Cigarette Use And Liquid Consumption
This 2013 study challenges an EU proposal that would result in eliquids containing more than 4 milligrams of nicotine per milliliter
being banned unless approved as medicinal products. The link above will
take you to the International Journal of Environmental Research and Public
Health abstract. Commentary from one of the study researchers, Dr Konstantinos
Farsalinos, can be viewed here.
Cytotoxicity evaluation of
ecig vapor extract
A 2013 study designed to evaluate the cytotoxic potential of 21 eliquids compared to the effects of cigarette smoke
found ecig vapor is significantly less cytotoxic compared to tobacco. At
this stage, the study notes are paid-access only, but comments on the
study by Dr. Michael Siegel, can be viewed
here. Additional commentary from the study's lead author, Dr Konstantinos Farsalinos,
can be accessed
Vaping profiles and preferences
1,347 vapers were surveyed in an effort to characterize e-cigarette use, users and effects. Results generally showed respondents found ecigarettes to be satisfying to use; cause few side effects; considered healthier than smoking, resulted in improve cough/breathing and lowered levels of craving. The survey was hosted at the University of East London.
Published March 2013.
Levels of selected carcinogens and toxicants in vapour from electronic cigarettes
have been found to be 9 to 450 times less than tobacco cigarettes in 12
brands studied; leading the researchers to conclude "substituting tobacco cigarettes with e-cigarettes may substantially reduce exposure to selected tobacco-specific toxicants".
The study was first published online on March 6, 2013.
- therapeutic medical device.. or not?
An in-depth look at the politics behind the push for e-cigarette
regulation and the case for electronic cigarettes being neither a
tobacco product or a medical device; therefore not requiring such
of ecigarettes on schizophrenic smokers
Researchers from the CTA-Villa Chiara Psychiatric Rehabilitation Clinic and Research
center in Italy determined the use of ecigs decreased tobacco cigarette
consumption in schizophrenia sufferers who were smokers - and without
significant side effects. Published January 2013.
Electronic cigarettes: achieving a balanced perspective
This 2012 paper argues that while more research is needed on the cost–benefit of ecigs and appropriate regulation, the harms so far have been overstated relative to the potential benefits. The paper mentions a study that found of more than 2000 former smokers in this survey, 96% reported that the e-cigarette helped them to stop smoking.
UK Ecigarette Briefing
Given there is little real-world evidence of e-cigarettes causing harm
to date; particularly when compared to smoking, UK anti-tobacco group
ASH believes if properly regulated, ecigarettes should be made available as part of a harm reduction approach to tobacco.
The briefing contains various statistics related to vaping and points
out between 2009 - 2011, Google searches using the terms ‘electronic cigarette’ increased
by fifty fold in the UK. The briefing is in PDF format.
Vapor And Cigarette Smoke Comparison
High nicotine e-liquids were vaporized in a series of experiments and
the emissions compared to tobacco smoke. The study results indicate
"no apparent risk to human health from e-cigarette emissions based on the compounds analyzed".
Passive Vaping A Reality?
This study sought to identify and quantify the chemicals released on a closed environment from the use of
e-cigarettes - the findings? There's little to be concerned about with
regard safety. This
research again confirms the type and quantity of
chemicals released are by far less harmful to human health compared to regular
tobacco cigarettes. In fact, it "could be more unhealthy to breath air
in big cities compared to staying in the same room with someone who is vaping."
Indoor Vapor Air Quality Study
Data at Clarkson University’s Center for Air Resources and reviewed by
an independent toxicologist indicates electronic cigarettes produce very small exposures
to byproducts relative to tobacco cigarettes. The study has been peer
reviewed and will appear the Journal of Inhalation Toxicology.
harmless inhaled or exhaled
Report from Health New Zealand stating e-cigarette vapors do not contain
substances known to cause death in the quantities found.
for Research on Nicotine and Tobacco (PDF)
This research acknowledges that no drug is safe, but the emissions associated with the
e-cigarette brand tested appear to be "several magnitudes safer" than tobacco smoke emissions.
Cigarettes As a Smoking-Cessation Tool
The findings of this study indicate "e-cigarettes may hold promise as a smoking-cessation method"
and that further research should be carried out.
Cigarettes Do Not Damage The Heart
Electronic cigarettes appear to have no acute adverse effects on cardiac
function according to research by cardiologist Dr Konstantinos
Farsalinos. He says based on currently available data, ecigs are safer and substituting tobacco with electronic cigarettes
could in fact be beneficial to health.
Principles to Guide AAPHP Tobacco Policy
The American Association of Public Health Physicians recommends electronic cigarettes as a
safer smoke-free tobacco/nicotine product.
University Ecig Study Challenged
Dr. Michael Siegel questions a University of Athens study claiming e-cigarettes can cause lung damage.
Monkeys and rats were exposed continuously to high concentrations of
propylene glycol, a common component of eliquids for periods of 12 to 18 months.
Results of the research state "air containing these vapors in amounts up to the saturation point is completely harmless".
of ecigs on smoking reduction and cessation
A study showing the use of ecigarettes substantially decreased cigarette consumption without causing significant side
effects in smokers who had no intention to quit. Published in 2011 (PDF).
harm reduction as a human right
Approximately one-quarter of all lifelong smokers will die in middle age (between 35 and 69) as a result of smoking and the authors of this
2006 paper (PDF) urge tobacco harm reduction being viewed as a human right.
cigarette addiction - it's not just the nicotine
Nicotine is the major neuroactive compound of tobacco, but according to
this 2005 paper; on its own it has weak reinforcing (addictive) properties.
It appears other compounds found in tobacco smoke when combined with
nicotine produce the intense reinforcing properties of cigarette smoking that lead to addiction."
Long-term effects of inhaled
An experiment where rats breathed in a chamber with nicotine at a concentration
twice found in heavy smokers for 20 hours a day, 5 days a week over a 2
year period found no harmful effect of nicotine when given in its pure
form by inhalation. Published in 1996.
Keep checking back as I'll be adding to this page as new e-cigarette research and studies become available.