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Expert opinion

Electronic cigarettes

Final Opinion

Description

SCHEER WG on Electronic cigarettes
SCHEER members: Peter Hoet; Rodica Mariana Ion; Renate Krätke; Demosthenes Panagiotakos; Ana Proykova; Emanuela Testai; Theo Vermeire
External experts: Urmilla Nair; Reinskje Talhout; Constantine Vardavas
Contact:SANTE-C2-SCHEER@ec.europa.eu
On request from: European Commission
Adopted on: 16 April 2021

Following a request from the Commission, the Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) reviewed the most recent scientific and technical information on electronic cigarettes. The SCHEER was asked to focus only on health impacts compared to non-smoking.

The SCHEER concludes that on health effects

a) For users of electronic cigarettes

1. The overall weight of evidence is moderate for risks of local irritative damage to the respiratory tract of users of electronic cigarette due to the cumulative exposure to polyols, aldehydes and nicotine. However, the overall reported incidence is low.

2. The overall weight of evidence for risks of long-term systemic effects on the cardiovascular system is moderate.

3. The overall weight of evidence for risks of carcinogenicity of the respiratory tract due to long-term, cumulative exposure to nitrosamines and due to exposure to acetaldehyde and formaldehyde is weak to moderate. The weight of evidence for risks of adverse effects, specifically carcinogenicity, due to metals in aerosols is weak.

4. The overall weight of evidence for risks of other long-term adverse health effects, such as pulmonary disease CNS and reprotoxic effects based on the hazard identification and human evidence, is weak, and further consistent data are needed.

5. To date, there is no specific data that specific flavourings used in the EU pose health risks for electronic cigarette users following repeated exposure.

6. The overall weight of evidence for risks of poisoning and injuries due to burns and explosion, is strong. However, the incidence is low.

b) For second-hand exposed persons

1. The overall weight of evidence is moderate for risks of local irritative damage to the respiratory tract mainly due to exposure to glycols.

2. The overall weight of evidence for risks of systemic cardiovascular effects in second-hand exposed persons due to exposure to nicotine is weak to moderate.

3. The overall weight of evidence for carcinogenic risk due to cumulative exposure to nitrosamines is weak to moderate.

Electronic cigarettes are relatively new in terms of exposure to humans. More research is needed, in particular on long-term health effects.

Regarding the role of electronic cigarettes as a gateway to smoking/the initiation of smoking, particularly for young people, the SCHEER concludes that there is moderate evidence that electronic cigarettes are a gateway to smoking for young people. There is strong evidence that nicotine in e-liquids is implicated in the development of addiction and that flavours have a relevant contribution for attractiveness of use of electronic cigarette and initiation.

Regarding the role of electronic cigarettes in cessation of traditional tobacco smoking, the SCHEER concludes that there is weak evidence for the support of electronic cigarettes' effectiveness in helping smokers to quit while the evidence on smoking reduction is assessed as weak to moderate.

Keywords:

Electronic cigarettes, e-cigarettes, e-liquid, health impacts, risk assessment, initiation, gateway, cessation, scientific opinion, SCHEER

Opinion to be cited as:

SCHEER (Scientific Committee on Health, Environmental and Emerging Risks), Scientific Opinion on electronic cigarettes, 16 April 2021.

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