{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:20:40Z","timestamp":1792174840769,"version":"4.4.0"},"reference-count":66,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T00:00:00Z","timestamp":1679270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2023,4,3]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n To review and synthesise the global evidence regarding the health effects of electronic cigarettes (e\u2010cigarettes, vapes).<\/jats:p>\n <\/jats:sec>\n \n Study design<\/jats:title>\n Umbrella review (based on major independent reviews, including the 2018 United States National Academies of Sciences, Engineering, and Medicine [NASEM] report) and top\u2010up systematic review of published, peer\u2010reviewed studies in humans examining the relationship of e\u2010cigarette use to health outcomes published since the NASEM report.<\/jats:p>\n <\/jats:sec>\n \n Data sources<\/jats:title>\n Umbrella review: eight major independent reviews published 2017\u20132021. Systematic review: PubMed, MEDLINE, Scopus, Web of Science, the Cochrane Library, and PsycINFO (articles published July 2017 \u2013 July 2020 and not included in NASEM review).<\/jats:p>\n <\/jats:sec>\n \n Data synthesis<\/jats:title>\n Four hundred eligible publications were included in our synthesis: 112 from the NASEM review, 189 from our top\u2010up review search, and 99 further publications cited by other reviews. There is conclusive evidence linking e\u2010cigarette use with poisoning, immediate inhalation toxicity (including seizures), and e\u2010cigarette or vaping product use\u2010associated lung injury (EVALI; largely but not exclusively for e\u2010liquids containing tetrahydrocannabinol and vitamin E acetate), as well as for malfunctioning devices causing injuries and burns. Environmental effects include waste, fires, and generation of indoor airborne particulate matter (substantial to conclusive evidence). There is substantial evidence that nicotine e\u2010cigarettes can cause dependence or addiction in non\u2010smokers, and strong evidence that young non\u2010smokers who use e\u2010cigarettes are more likely than non\u2010users to initiate smoking and to become regular smokers. There is limited evidence that freebase nicotine e\u2010cigarettes used with clinical support are efficacious aids for smoking cessation. Evidence regarding effects on other clinical outcomes, including cardiovascular disease, cancer, development, and mental and reproductive health, is insufficient or unavailable.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n E\u2010cigarettes can be harmful to health, particularly for non\u2010smokers and children, adolescents, and young adults. Their effects on many important health outcomes are uncertain. E\u2010cigarettes may be beneficial for smokers who use them to completely and promptly quit smoking, but they are not currently approved smoking cessation aids. Better quality evidence is needed regarding the health impact of e\u2010cigarette use, their safety and efficacy for smoking cessation, and effective regulation.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n Systematic review: PROSPERO, CRD42020200673 (prospective).<\/jats:p>\n <\/jats:sec>","DOI":"10.5694\/mja2.51890","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T09:05:01Z","timestamp":1679303101000},"page":"267-275","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":252,"title":["Electronic cigarettes and health outcomes: umbrella and systematic review of the global evidence"],"prefix":"10.5694","volume":"218","author":[{"given":"Emily","family":"Banks","sequence":"first","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4406-368X","authenticated-orcid":false,"given":"Amelia","family":"Yazidjoglou","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinan","family":"Brown","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai","family":"Nguyen","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melonie","family":"Martin","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Beckwith","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Daluwatta","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai","family":"Campbell","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Joshy","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health Australian National University Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,20]]},"reference":[{"key":"e_1_2_9_1_1","unstructured":"US Department of Health and Human Services.E\u2010cigarette use among youth and young adults: a report of the Surgeon General. 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