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Pages 1-16

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From page 1...
... The net public health effect, harm or benefit, of e-cigarettes depends on three factors: their effect on youth initiation of combustible tobacco products, their effect on adult cessation of combustible tobacco products, and their intrinsic toxicity. If e-cigarette use by adult smokers leads to long-term abstinence from combustible tobacco cigarettes, the benefit to public health could be considerable.
From page 2...
... However, because the known risks of combustible tobacco are so great, understanding the net public health effect of e-cigarettes requires understanding not only the inherent risks of e-cigarettes, but also the relationship between e-cigarette use and combustible tobacco cigarette use. Furthermore, concerns have been raised that e-cigarettes will induce youth to begin using combustible tobacco cigarettes.
From page 3...
... The committee undertook a comprehensive review of the scientific literature regarding key constituents in e-cigarettes, human health effects, initiation and cessation of combustible tobacco cigarette use, and harm reduction. The committee considered the quality of individual studies, as well as the totality of the evidence to provide structured and consistent conclusions on the strength of the evidence.
From page 4...
... •  esearch that should be a priority for federal funding. R therapy or smokeless tobacco, nicotine exposure from e-cigarette use will likely pose minimal cancer risk to users.
From page 5...
...  onclusion 4-2. There is substantial evidence that nicotine intake from C e-cigarette devices among experienced adult e-cigarette users can be compa rable to that from combustible tobacco cigarettes.
From page 6...
... There is limited evidence that the number of metals in C e-cigarette aerosol could be greater than the number of metals in combus tible tobacco cigarettes, except for cadmium, which is markedly lower in e-cigarettes compared with combustible tobacco cigarettes. Taken together, the evidence in support of these conclusions suggests that e-cigarette aerosol contains fewer numbers and lower levels of toxicants than smoke from combustible tobacco cigarettes.
From page 7...
... There is moderate evidence that risk and severity of depen C dence are lower for e-cigarettes than combustible tobacco cigarettes.  onclusion 8-3.
From page 8...
... This holds true for e-cigarette use compared with use of combustible tobacco cigarettes and e-cigarette use compared with no use of tobacco products.  onclusion 10-2.
From page 9...
... Taken together, the evidence reviewed by the committee suggests that e-cigarettes are not without physiological activity in humans, but the implications for long-term effects on morbidity and mortality are not yet clear. Use of e-cigarettes instead of combustible tobacco cigarettes by those with existing respiratory disease might be less harmful.
From page 10...
... C  onclusion 16-3. Among youth and young adult e-cigarette users who ever use combustible tobacco cigarettes, there is limited evidence that e-cigarette use increases, in the near term, the duration of subsequent combustible tobacco cigarette smoking.
From page 11...
... There is moderate evidence that secondhand exposure to C nicotine and particulates is lower from e-cigarettes compared with combus tible tobacco cigarettes. The evidence about harm reduction suggests that across a range of studies and outcomes, e-cigarettes pose less risk to an individual than combustible tobacco cigarettes.
From page 12...
... . As with other models of population health effects of tobacco use, the effects of changing cessation rates are seen earlier than effects of changing initiation rates, due to the lag time for serious chronic health effects of combustible tobacco cigarettes to manifest.
From page 13...
... Recommendation 6-2: The committee recommends that the Food and Drug Administration and other federal research sponsors and/or device manufac turers prioritize research that improves the quality of e-cigarette research to better understand the devices, constituents, and exposures. This includes protocol and methods validation and development and use of appropriate study design, including the use of the appropriate control groups.
From page 14...
... • S  tudies are needed on the association of secondhand and thirdhand ex posures with health outcomes in vulnerable populations, such as pregnant women, infants, young children, the elderly, and patients with cardiovascu lar and respiratory disease compared with secondhand tobacco smoke and the absence of secondhand exposure to both combustible tobacco smoke or to e-cigarettes. • L  ongitudinal cohort studies are needed of youth and young adults to un derstand the trajectory of dependence over time in users with little or no combustible tobacco product exposure.
From page 15...
... FINAL OBSERVATIONS Much of the research on e-cigarettes suffers from methodological flaws, and many important areas have not yet been researched. Nonetheless, the committee found sufficient literature to suggest that, while there are risks associated with e-cigarettes, compared with combustible tobacco cigarettes, e-cigarettes contain fewer toxicants; can deliver nicotine in a manner similar to combustible tobacco cigarettes; show significantly less
From page 16...
... Moreover, although infrequent, e-cigarettes can explode, leading to burns and other injuries, and consumption of or dermal exposure to e-liquids is dangerous, even fatal. More and better research on short- and long-term health effects of e-cigarettes, as well as their effects on initiation and cessation of combustible tobacco product use, will bring clarity to the question of whether e-cigarettes will prove to reduce harm or induce harm at the individual and the population levels.


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