E-cigarettes may be more harmful than beneficial, according to evidence-based research

The electronic cigarette (e-cigarette) industry is rapidly growing in the United States and the use of e-cigarettes is controversial. The controversy persists because researchers do not yet know if e-cigarette use results in more benefit than harm at the population level. New research from Dartmouth's Norris Cotton Cancer Center, in collaboration with Moores Cancer Center at UCSD, UCSF School of Nursing, and University of Pittsburgh School of Medicine, quantifies the balance of harms and benefits using the most current scientific evidence.

"Although the tobacco industry markets e-cigarettes as a tool to help adult smokers quit smoking, e-cigarette use actually only marginally increases the number of adult cigarette smokers who are able to successfully quit," says principle investigator Samir Soneji, PhD, Associate Professor at The Dartmouth Institute for Health Policy and Clinical Practice. "On the other hand, e-cigarettes may facilitate cigarette smoking initiation and confer substantial harm to adolescents and young adults once they are introduced to nicotine."

Utilizing census counts, national health and tobacco use surveys, and published literature, Soneji's team calculated the expected years of life gained or lost from the impact of e-cigarette use on smoking cessation among current smokers, and transition to long-term cigarette smoking among never-smokers. "E-cigarettes could lead to more than 1.5 million years of life lost because their use could substantially increase the number of adolescents and young adults who eventually become cigarette smokers," says Soneji. The results of their research, "Quantifying Population-Level Health Benefits and Harms of E-Cigarette Use in the United States" are newly published in PLOS ONE.

Results find that based on the existing scientific evidence related to e-cigarettes and optimistic assumptions about the relative harm of e-cigarette use compared to cigarette smoking, e-cigarette use currently represents more population-level harm than benefit. While tobacco control efforts have successfully led to a substantial reduction in youth cigarette smoking since the 1990s, e-cigarettes have the potential to slow or even reverse that trend.

Effective national, state, and local efforts are needed to reduce e-cigarette use among youth and young adults if e-cigarettes are to confer a net population-level benefit in the future. "E-cigarettes will likely cause more public health harm than public health benefit unless ways can be found to substantially decrease the number of adolescents and young adults who vape and increase the number of smokers who use e-cigarettes to successfully quit smoking," says Soneji. "We also need to close the regulatory gaps that make e-cigarettes appealing to adolescents and young adults by reducing the availability of kid-friendly flavors (e.g., fruit-flavored e-cigarettes) and issuing product standards that reduce the level of known toxins and carcinogens in e-juice."

Samir S. Soneji, PhD, is an Associate Professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College. He is also a member of the Cancer Control Program at Dartmouth's Norris Cotton Cancer Center. His research interests include the value of cancer care, tobacco regulatory control, and cancer screening, and focus on developing and applying innovative and quantitative methods to questions in tobacco control and cancer screening.