Health impacts of electronic cigarettes
About
Our work aims to maximise the health of Australians by providing evidence to support high-quality decision-making on e-cigarettes for the Australian context. This website outlines our program of work on the health impacts e-cigarettes, commissioned by the Australian Department of Health.
Background
E-cigarettes are a diverse group of battery-powered devices that aerosolise a liquid (often referred to as ‘e-liquid’) for inhalation. The composition of e-liquids varies widely. Standard e-liquids include water, propylene glycol and vegetable glycerine and often contain flavourings and nicotine. Nicotine is in either freebase or, more recently, in salt form. First manufactured commercially in China in 2003, e-cigarettes entered the European and United States (US) marketplaces around 2006-2007. They now include many thousands of devices and liquids.
There are currently tens of millions of e-cigarette users worldwide, with enormous variation in the prevalence of use from country to country, reflecting diverse approaches to regulation and other factors.
Australia provides a unique context for consideration of e-cigarette use, including: low smoking prevalence; a novel prescription-based e-cigarette access policy; and the national physical environment.
Approach
The program integrates multiple data sources and methods and applies them to potential public health options. Components include:
- Engagement with experts in the area and key non-industry stakeholders.
- Aboriginal and Torres Strait Islander research leadership and engagement with communities for the relevant parts of the work.
- Overviews of existing reviews and, where necessary, systematic reviews to summarise the evidence, including synthesis of qualitative data and quantitative meta-analyses, where appropriate. Other methods were used where necessary.
- Public health assessment framework development.
- Public health assessment of existing evidence and application of evidence to policy options.
The project team encompassed expertise and leadership across a wide range of disciplines, including public health, epidemiology, social science, regulation and Aboriginal and Torres Strait Islander health research.
Tobacco smoking prevalence and trends
Despite low and falling prevalence, tobacco smoking remains Australia’s deadliest habit, accounting for 9% of the total burden of illness and death. Understanding tobacco smoking prevalence and trends in Australia is important for considering likely impacts of e-cigarettes on health.
Characteristics of smoker populations as smoking prevalence declines
As smoking prevalence declines, it is important to understand the behavioural trajectory of the population of smokers. The “hardening hypothesis” proposes that as the prevalence of smoking in a population declines, a greater proportion of the remaining smokers will have less motivation to quit, be more dependent on smoking, will make fewer quit attempts and will be less likely to quit. Population “softening” reflects the converse, whereby tobacco control makes the smoker population more motivated and able to quit. This work systematically reviews the world-wide evidence on the topic.
E-cigarette prevalence and patterns of use
The introduction of e-cigarettes into the market has led to a range of patterns of population exposure to tobacco products and e-cigarettes. Tobacco control and e-cigarette policies, the local stage of the tobacco epidemic and other factors influence e-cigarette use in different populations.
Reviewing evidence on who is using e-cigarettes, patterns of e-cigarette use and the relationship of e-cigarette use to smoking behaviour provides important information when considering the impacts of e-cigarettes on public health.
E-cigarette use and smoking uptake
Given the extreme harms of smoking, understanding the likely relation of e-cigarette use to smoking uptake in youth and relapse in ex-smokers is important to quantifying their overall effects on health – the topics of these systematic reviews of the world-wide evidence.
E-cigarette use and smoking cessation
In many countries, e-cigarettes are marketed as aids to smoking cessation – explicitly or implicitly – and, among e-cigarette users, smoking cessation is a commonly reported reason for use. Reviewing evidence on the efficacy of e-cigarettes for smoking cessation is important for understanding their impacts on public health and is the subject of these reviews.
E-cigarettes and health outcomes
Ensuring appropriate evidence-based policy and practice relating to e-cigarettes requires systematic identification, review and integration of large-scale contemporary evidence on their effects on health. This report reviews the global evidence on e-cigarettes and over 20 health outcome groups, including: dependence; cardiovascular disease; cancer; respiratory disease; poisoning; burns and injuries; mental health effects; and environmental hazards relevant to health.
Public health assessment of electronic cigarettes for Australia
This public health assessment for e-cigarettes supports integration of the evidence on the health impacts of e-cigarettes and its application to policy and practice in Australia. It brings together the major elements of the program of work on e-cigarette health impacts to date, with the aim of bridging the scientific evidence and actions on the ground, as well as enabling the ongoing interpretation and application of emerging evidence to the Australian context. The framework for the assessment has been developed and the public health assessment report on e-cigarettes is expected to be released in mid-2022.
| Resources and Related Outputs | |
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Banks, E., Yazidjoglou, A., Brown, S., Nguyen, M., Martin, M., Beckwith, K., ... & Joshy, G. (2023). Electronic cigarettes and health outcomes: umbrella and systematic review of the global evidence. Medical Journal of Australia, 218(6), 267-275. |
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Banks E, Martin M, Harris M. Framework for the public health assessment of electronic cigarettes. Tobacco Control Published Online First: 06 May 2021. doi: 10.1136/tobaccocontrol-2020-056271 |
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Public Health Assessment of Electronic Cigarettes Report. Available mid-2022 |
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Wade S, Weber MF, Sarich P, Caruana M, Watts C, Vaneckova P, Ngo P, Cressman S, Scollo M, Banks E, Gartner CE, Grogan PB, Blakely T, Tammemagi MC, Canfell K. Fifty-year forecasts of daily smoking prevalence: can Australia reach 5% by 2030? Tobacco Control. 2023 May 22. http://doi.org/10.1136/tc-2022-057624 PMID: 37217260 |
Project Team
ANU Researchers
- Professor Emily Banks
- Amelia Yazidjoglou
- Sinan Brown
- Dr Cathy Day
- Dr Laura Ford
- Dr Miranda Harris
- Dr Olivia Baenziger
- Associate Professor Grace Joshy
- Dr Melonie Martin
- Sai Campbell
- Dr Katherine Thurber
- Professor Raymond Lovett
- Jennie Walker
- Dr Raglan Maddox
- Dr Alexandra Marmor
- Dr Christina Heris
- Dr Katie Beckwith
- Mai Nguyen
- Amanda Daluwatta
- Dr Tehzeeb Zulfiqa
- Dr Eva Smeets
- Emeritus Professor Robyn Lucas
Researchers working on tobacco smoking prevalence evidence
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Daffodil Centre - Marianne Weber, Pavla Vaneckova, Stephen Wade, Qingwei Luo, Dianne O’Connell, Peter Sarich, Paul Grogan, Michael Caruana, Karen Canfell
