For e-cigarette use, short-term effects appear brighter than long-term impact

For those looking for a simple thumbs-up or thumbs-down view on electronic cigarettes, the newly released report from the National Academies of Sciences, Engineering, and Medicine likely will disappoint. The report concludes that on subjects such as efficacy in smoking cessation and long-term health effects, there simply isn't enough research evidence yet to draw definitive conclusions.

“It's hard to say that they are good or bad,” Maciej Goniewicz, an oncology expert at the Roswell Park Comprehensive Cancer Center in Buffalo and a member of the committee that reviewed the health effects of electronic nicotine delivery systems, tells Addiction Professional. “It depends on how they are used, and by whom.”

Absent a strong research base at this relatively early stage of e-cigarettes' history, experts must rely on population modeling to evaluate the relative risks and benefits of these devices, according to the Food and Drug Administration-sponsored report, Public Health Consequences of E-Cigarettes. By this measure, it appears that e-cigarettes generate a short-term public health benefit in helping some adults quit conventional tobacco use, which is documented to be substantially more harmful than e-cigarette use.

Over the long haul, however, the net public health benefit appears to be substantially lower, based on strong evidence that vaping among young people can often lead to conventional tobacco use by youths who never had previously smoked. “The studies that are out there all show this increased risk,” says Goniewicz, an associate professor of oncology at the cancer center's Department of Health Behavior.

Not a harmless product

The report points out that in addition to nicotine, most electronic cigarettes emit a host of potentially toxic substances. “These devices are not without any health risks,” Goniewicz says. However, exposure to toxic substances with typical use of the devices is still significantly lower than with conventional cigarettes, the evidence indicates.

Still, the research shows that e-cigarette use leads to symptoms of dependence, though again generally not at levels as severe as those commonly seen with conventional cigarettes.

Goniewicz says it will be important going forward to gain a clearer picture of the conditions under which electronic delivery systems can be most effective in helping tobacco smokers quit. “Our conclusions so far are weak,” Goniewicz says.

The report states that other strategies that will be needed to maximize e-cigarettes' potential health benefits include discouraging use among young people and increasing the devices' safety through engineering and design. Goniewicz believes reasonable government regulation designed to maximize product safety is warranted.