{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T04:57:59Z","timestamp":1794373079701,"version":"4.9.0"},"reference-count":129,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,14]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The rise of electronic nicotine delivery systems (ENDS) has introduced new challenges to tobacco control and regulation, particularly among young adults, raising questions about their safety. This umbrella review aimed to synthesise existing systematic reviews with or without meta-analyses to evaluate the health impacts of ENDS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic literature search via the PICO strategy across multiple databases, focusing on e-cigarettes, ENDS and e-liquids, while excluding non-nicotine e-cigarette and nicotine replacement therapies (NRTs). Health outcomes include a range of clinical diseases and physiological changes. Quality assessment was performed via assessing the methodoligcal quality of systematic reviews 2 (AMSTAR-2), and the findings were synthesised narratively and in tables, prioritising the highest-rated reviews. The meta-analyses used R software (V.4.3) random effects models, and evidence quality was assessed via the Grading of Recommendations, Assessment, Development and Evaluation criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 5055 records, 69 systematic reviews were included. Systematic reviews have indicated increased risks of cardiovascular and respiratory diseases, mental health issues and substance abuse with ENDS use, especially among adolescents. Cardiovascular risk factors included increased heart rate (mean difference (MD) 1.41, 95%\u2009CI 0.81 to 2.01, I\n                      <jats:sup>2<\/jats:sup>\n                      =91%) from 25 studies; increased blood pressure (MD for systolic blood pressure=0.51\u2009mm Hg, 95%\u2009CI 0.26 to 0.75, I\n                      <jats:sup>2<\/jats:sup>\n                      =89%; MD for diastolic blood pressure=0.59\u2009mm Hg, 95%\u2009CI 0.35 to 0.83, I\n                      <jats:sup>2<\/jats:sup>\n                      =82%) from 23 studies; endothelial dysfunction and increased platelet activity. Respiratory risk factors included reduced lung function and a higher incidence of asthma in nine studies (OR 1.30, 95%\u2009CI 1.1 to 1.55; I\n                      <jats:sup>2<\/jats:sup>\n                      =43%) and chronic obstructive pulmonary disease. Mental health concerns, such as depression and suicidality, were also prevalent among adolescent ENDS users. Nine studies reported a negative effect of ENDS on periodontal health. Evidence of carcinogens has been found in the urinary examinations of ENDS users in some studies. The adverse events reported in seven randomised controlled trials with 2611 participants were similar between ENDS and NRT (RR 1.13, 95%\u2009CI 0.83 to 1.54, I\n                      <jats:sup>2<\/jats:sup>\n                      =12%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Exposure to ENDS is harmful to various organ systems, especially cardiovascular and respiratory systems. Comprehensive regulatory measures and public health strategies are necessary to curb the use of ENDS, particularly among young people.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-100168","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T10:50:28Z","timestamp":1760093428000},"page":"e100168","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Health impacts of electronic nicotine delivery systems: an umbrella review of systematic reviews"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9800-9203","authenticated-orcid":false,"given":"Jagdish","family":"Kaur","sequence":"first","affiliation":[{"name":"World Health Organization Regional Office for South\u2012East Asia, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5231-7083","authenticated-orcid":false,"given":"Sonu","family":"Goel","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland, Ireland"},{"name":"Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed","family":"Shabil","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy, MS Ramaiah University of Applied Sciences, Bangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3585-5346","authenticated-orcid":false,"given":"Rishabh Kumar","family":"Rana","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Shaheed Nirmal Mahto Medical College and Hospital, Dhanbad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arvind Vashishta","family":"Rinkoo","sequence":"additional","affiliation":[{"name":"World Health Organization Regional Office for South\u2012East Asia, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Department of Telemedicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1594-9337","authenticated-orcid":false,"given":"Shibaji","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Midnapore Medical College, Midnapore, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"2025120415060904000_15.10.e100168.1","unstructured":"World Health Organization . 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