Vaak wordt beweerd dat er weinig of zelfs geen onderzoek bestaat ten aanzien van de veiligheid, effectiviteit of gezondheidseffecten van het gebruik van een e-sigaret.

Op deze pagina proberen we een overzicht te geven van gepubliceerde literatuurstudies, onderzoeken en papers. Regelmatig zal deze pagina worden bijgewerkt.

Regular use of e-cigarettes is extremely rare among young non-smokers (2015)
Professor Linda Bauld, Universiteit van Stirling, Cancer Research UK.
“Of the 1,205 children aged 11-16 who took part in the new UK-wide survey, 12 per cent reported that they had tried an e-cigarette. Figures for regular use were lower with two per cent reporting e-cigarette use more than monthly and one per cent more than weekly. Regular e-cigarette use was found only in children who also smoked tobacco. Experimental e-cigarette use among non-smoking children was low at three per cent. ”
Bron: Cancer Research UK

E-cigarettes versus NRT for smoking reduction or cessation in people with mental illness (2015)
Brigid O’Brien, Oliver Knight-West, Natalie Walker, Varsha Parag, Christopher Bullen
National Institute for Health Innovation, School of Population Health, Universiteit van Auckland, Nieuw Zeeland
“The use of e-cigarettes for quitting appears to be equally effective, safe, and acceptable for people with and without mental illness. For people with mental illness, e-cigarettes may be as effective and safe as patches, yet more acceptable, and associated with greater smoking reduction.
Bron: Tobacco Induced Diseases Journal

Nicotine Levels and Presence of Selected Tobacco-Derived Toxins in Tobacco Flavoured Electronic Cigarette Refill Liquids (2015)
Konstantinos E. Farsalinos, Konstantinos Poulas, Vassilis Voudris (Department of Cardiology, Onassis Cardiac Surgery Center and Department of Pharmacy, University of Patras)
“Twelve [of 21] samples had nicotine levels within 10% of the labelled value. Inconsistency ranged from −21% to 22.1%, with no difference observed between conventional and NET liquids. Tobacco-specific nitrosamines (TSNAs) were present in all samples at ng/mL levels. Nitrates were present almost exclusively in NET liquids. Acetaldehyde was present predominantly in conventional liquids while formaldehyde was detected in almost all EC liquids at trace levels. Phenols were present in trace amounts, mostly in NET liquids. Total TSNAs and nitrate, which are derived from the tobacco plant, were present at levels 200–300 times lower in 1 mL of NET liquids compared to 1 gram of tobacco products.
NET liquids contained higher levels of phenols and nitrates, but lower levels of acetaldehyde compared to conventional EC liquids. The lower levels of tobacco-derived toxins found in NET liquids compared to tobacco products indicate that the extraction process used to make these products did not transfer a significant amount of toxins to the NET. Overall, all EC liquids contained far lower (by 2–3 orders of magnitude) levels of the tobacco-derived toxins compared to tobacco products. “

Bron: International Journal of Environmental Research and Public Health

Nicotine and toxicant yield ratings of electronic cigarette brands in New Zealand (2015)
Murray Laugesen, Public Health Medicine Specialist, eigenaar van Health New Zealand Ltd, Christchurch Nieuw Zeeland.
“Electronic cigarettes (e-cigs) contain nicotine but not toxins, and so they do not kill smokers. We checked out 14 brands sold in New Zealand. We found toxic aldehydes had an average concentration of under 0.5% of that found in Marlboro cigarette smoke. Nicotine concentration was one-half to two-thirds that in a Marlboro. E-cigs are comparatively safe to switch to.
ECs labelled as high strength (16–18+ mg nicotine) contained 5–46 mg nicotine. Nicotine EC brands yielded 19–93 mcg nicotine per puff compared to 147 mcg per puff for Marlboro cigarettes, and emitted 200 times less toxic aldehydes (acetaldehyde, formaldehyde and acrolein) than Marlboro cigarette smoke. Compared with the first generation EC, study ECs emitted 73% less aldehydes. Diethylene and monoethylene glycol were not detected in vapour.”
Bron: New Zealand Medical Journal 27-03-2015, Volume 128 No. 1411

Electronic cigarette use and harm reversal: emerging evidence in the lung (2015)
Professor Dr. Riccardo Polosa, Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, Università di Catania, Catania, Italië
Er is groeiend bewijs voor omkering van rookgerelateerde longschade bij COPD en astmapatienten na (gedeeltelijke) overstap op e-sigaretten.
An improvement in symptoms of asthma and COPD after switching was reported in 65.4% and 75.7% of the respondents, respectively. Compared to dual users, improvement in symptoms of asthma and COPD were more often reported by exclusive EC users. After switching, medications were stopped in 460/2,498 (18.4%) respondents with asthma and COPD. Worsening after switching was only reported in 1.1% of the asthmatics and in 0.8% of the COPD respondents. Taken together, these findings provide emerging evidence that EC use can reverse harm from tobacco smoking”
Bron: BMC Medicine 2015, 13:54 doi:10.1186/s12916-015-0298-3

Dependence levels in users of electronic cigarettes, nicotine gums and tobacco cigarettes.
Onderzoek gepubliceerd in het “Drug and Alcohol Dependence” Journal, februari 2015.
Professor Jean-Francois Etter & Dr. Thomas Eissenberg.
Samenvatting: “Dependence ratings were slightly higher in users of nicotine-containing e-cigarettes than in users of nicotine-free e-cigarettes. In former smokers, long-term (>3 months) users of e-cigarettes were less dependent on e-cigarettes than long-term users of the nicotine gum were dependent on the gum. There were few differences in dependence ratings between short-term (≤3 months) users of gums or e-cigarettes. Dependence on e-cigarettes was generally lower in dual users than dependence on tobacco cigarettes in the two other samples of daily smokers.
Some e-cigarette users were dependent on nicotine-containing e-cigarettes, but these products were less addictive than tobacco cigarettes. E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive.
Bron: Drug and Alcohol Dependence 2015; 147:68-75.

As Vaping Rises to Record Highs, Smoking Falls to Record Lows – Use of alcohol, cigarettes, and number of illicit drugs declines among U.S. teens. (2014)
Monitoring the Future (MTF) : Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (December 16, 2014). University of Michigan
Analyse van resultaten door Jacob Sullum, Forbes/Reason.
“Far from showing that e-cigarettes are training teenagers for the real thing, the fact that vaping and smoking rates are moving in opposite directions suggests that e-cigarettes may be replacing combustible cigarettes among people who otherwise would be smoking.
The MTF data provide some additional support for that hypothesis.
Even when teenagers try e-cigarettes first, some of them might otherwise have smoked the conventional kind. The upshot in both cases would be the same: less smoking and less tobacco-related disease, something anti-smoking activists like Glantz ought to welcome.
As Tavernise notes, “most experts agree that e-cigarettes are far less harmful than traditional cigarettes.” That is why the crucial question, when it comes to assessing the public health impact of e-cigarettes, is whether they compete with tobacco cigarettes or somehow expand the market for them. The evidence so far indicates that more vaping means less smoking, not the other way around.
Bron: Forbes
Data: Monitoring the Future

Cochrane Summaries ; Electronic cigarettes for smoking cessation and reduction (2014)
Een literatuurstudie door Cochrane Collaborations.
Hayden McRobbie, Chris Bullen, Jamie Hartmann-Boyce, Peter Hajek
This study showed that people who used EC were more likely to cut down the amount they smoked by at least half than people using a patch. The other studies were of lower quality, but they supported these findings. There was no evidence that using EC at the same time as using regular cigarettes made people less likely to quit smoking. […] None of the RCTs or cohort studies reported any serious adverse events (SAEs) that were considered to be plausibly related to EC use. […] No evidence emerged that short-term EC use is associated with health risk.
Bron: Cochrane Library, 17 december 2014.
Volledige tekst: Wiley Online Library

Health Survey for England – 2013 (vrijgegeven december 2014)
Analyse door ASH“For the first time, the annual Health Survey for England published today has included questions on electronic cigarette use among both adults and children. [1] The results show that among adults 29% of current smokers and 6% of ex-smokers reported ever using e-cigarettes while just 1% of never smokers said they had used the devices. Among children the survey found only very small numbers of children aged 13-15 who had used electronic cigarettes.”
Bron: Health and Social Care Information Centre
Analyse door ASH: England-wide survey confirms e-cigarette use confined largely to smokers

Adult Smoking Habits in Great Britain, 2013
Office for National Statistics (ONS, UK), vrijgegen november 2014.
“E-cigarettes were almost exclusively used by smokers and ex-smokers. More than 1 in 10 (12%) of cigarette smokers also used e-cigarettes, compared with 1 in 20 (5%) ex-smokers and almost none of those who had never smoked (0,14%). […]
E-cigarettes were found to be used mainly as smoking cessation aids and for the perceived health benefits (compared with smoking tobacco). Over half of e-cigarette users said that their main reason for using e-cigarettes was to stop smoking, and about one in five said the main reason for their use was because they thought they were less harmful than cigarettes.”
Bron: Office for National Statistics

Effectiveness of the Electronic Cigarette (2014)
KU Leuven, Karolien Adriaens, Dinska Van Gucht, Paul Declerck, Frank Baeyens
De KU Leuven verdeelde voor een onderzoek rokers die niet van plan waren te stoppen, in twee groepen: de ene groep kreeg een e-sigaret, de andere niet. Van de deelnemers in de groep die e-sigaretten kreeg, stopte het meerendeel met roken. Later kreeg ook de controlegroep een e-sigaret . “Op het einde van de acht maanden durende studie onthield 21% van alle deelnemers zich volledig van het roken van tabak (biologisch geverifieerd, via CO-meting). Over alle groepen heen was het aantal gerookte tabakssigaretten per dag afgenomen met 60%. [..] Ter vergelijking: van alle rokers die louter op wilskracht proberen te stoppen, slaagt slechts 3 à 5% erin 6 tot 12 maanden rookvrij te blijven na een stoppoging.”
Bron: International Journal of Environmental Research and Public Health

Kennis, opvattingen en gebruik van e-sigaretten onder jongeren (2014)
Een onderzoek door het Nationaal Expertisecentrum Tabaksontmoediging, in opdracht van het Ministerie van Volksgezondheid, Welzijn en Sport, met als doel het in kaart brengen van kennis, attitudes en gebruik van e-sigaretten onder Nederlandse jongeren.
“Onder de jongeren die wel eens geëxperimenteerd hebben met e-sigaretten […] heeft 87% conventionele sigaretten gerookt. […] De huidige studie toont dat jongeren die ervaring hebben met de e-sigaret vaker dagelijkse rokers zijn dan jongeren zonder ervaring met de e-sigaret. In tegenstelling tot bevindingen van onderzoek onder volwassenen lijkt de motivatie om te stoppen met roken niet de belangrijkste reden voor jongeren om de e-sigaret te gebruiken. Voor jongeren lijkt de e-sigaret eerder een nieuw middel om mee te experimenteren dan een hulpmiddel om te stoppen met roken. […]
Jongeren staan […] vaker negatief dan positief tegenover mensen die een e-sigaret gebruiken.”

Bron: Trimbos Instituut

De Factsheet E-sigaret (2013)
Literatuurstudie door diverse dampers (gebruikers van e-sigaretten, red), in opdracht van Stichting Actiecomité voor Dampers.
In reactie op de Factsheet E-sigaretten van het RIVM heeft Acvoda een eigen factsheet opgesteld, die duiding geeft aan de door het RIVM gepresenteerde feiten.
“In zijn recent gepubliceerde factsheet heeft het RIVM het dampen van een e-sigaret ten onrechte soortgelijke gevaarlijke eigenschappen toegedicht als die van een tabakhoudende sigaret. Acvoda roept dan ook de Nederlandse overheid en eenieder die begaan is met de volksgezondheid op, zich niet te laten misleiden door het uiterlijk op elkaar lijkende dampen en roken, maar bij de regulering vooral te kijken naar de gezondheidswinst die het dampen teweeg kan brengen.”
De “Counterfactsheet” is hier te downloaden.

Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review (2014)
Konstantinos Farsalinos (Onassis Cardiac Surgery Center, Griekenland), Riccardo Polosa (Centro per la Prevenzione e Cura del Tabagismo (CPCT) en het Institute of Internal Medicine, Università di Catania, Italië)
“This systematic review appraises existing laboratory and clinical research on the potential risks from electronic cigarette use, compared with the well-established devastating effects of smoking tobacco cigarettes. Currently available evidence indicates that electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who switch from tobacco to electronic cigarettes. Research will help make electronic cigarettes more effective as smoking substitutes and will better define and further reduce residual risks from use to as low as possible, by establishing appropriate quality control and standards.”

Rapport et avis d’experts sur l’e-cigarette (2013)
OFTA (l’Office Français de prévention du Tabagisme et Autres addictions), Frankrijk, ism het Directoraat-Generaal Volksgezondheid.
“In tegenstelling tot sigaretten is er bij e-sigaretten geen uitstoot van van koolmonoxide (CO), vaste deeltjes (fijnstof), of significante hoeveelheden kankerverwekkende stoffen.
Volgens de wetenschappelijke gegevens die in mei 2013 beschikbaar zijn, zijn de irriterende effecten en / of toxische componenten van e-sigaretten veel lager het geval is bij tabaksrook.
De e-sigaret is, indien correct geproduceerd en correct gebruikt, oneindig minder schadelijk dan sigaretten, maar risico’s zijn niet geheel afwezig.”

Looks like smoking, is it smoking?: Children’s perceptions of cigarette-like nicotine delivery systems, smoking and cessation. (2013)
Centre for Tobacco Control Research, School of Population Health, University of Auckland, New Zealand
“In a context unfamiliar with electronic cigarettes or nicotine inhalers, such as New Zealand, children may misperceive use of these products as smoking. Once these products are more common and the purpose of them is known, seeing people use them should normalise quitting behaviour, something the children were very supportive of.”
Bron: Reduction Journal

Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour Extract on Cultured Myocardial Cells (2013)
Onassis Cardiac Surgery Center (Griekenland) + Abich Toxicological Laboratory (Italië) olv dr. Konstantinos Farsalinos
“De resultaten tonen wederom aan dat e-sigaret-damp aanzienlijk minder schadelijk is in vergelijking met tabaksrook.

Onze resultaten tonen duidelijk aan dat de overlevingskansen van de cellen niet geassocieerd kunnen worden met het nicotinegehalte in de vloeistof. Deze observatie bevestigt eerdere onderzoeken die aantonen dat de nicotinegehaltes die gangbaar zijn bij roken en bij het gebruik van e-sigaretten, in het geheel niet giftig zijn voor de cellen.”

Long-term effects of inhaled nicotine (1996)
Department of Medicine, University Hospital, Tronheim, Norway.
“For the first time we report the effect on the rat of long-term (two years) inhalation of nicotine. The rats breathed in a chamber with nicotine at a concentration giving twice the plasma concentration found in heavy smokers. Nicotine was given for 20 h a day, five days a week during a two-year period. We could not find any increase in mortality, in atherosclerosis or frequency of tumors in these rats compared with controls. Particularly, there was no microscopic or macroscopic lung tumors nor any increase in pulmonary neuroendocrine cells. “

Levels of selected carcinogens and toxicants in vapour from electronic cigarettes (2013)
Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, New York, USA.
Our findings are consistent with the idea that substituting tobacco cigarettes with e-cigarettes may substantially reduce exposure to selected tobacco-specific toxicants.

A fresh look at tobacco harm reduction: the case for the electronic cigarette (2013)
University Catania, Italy en University Louisville, USA.
Nicotine’s beneficial effects can be controlled, and the detrimental effects of the smoky delivery system can be attenuated, by providing the drug via less hazardous delivery systems. Although more research is needed, e-cigs appear to be effective cigarette substitutes for inveterate smokers, and the health improvements enjoyed by switchers do not differ from those enjoyed by tobacco/nicotine abstainers.

ASH UK – Briefing on Electronic Cigarettes (juni 2013)
Action on Smoking and Health, Groot-Brittannië
“one study showed that after switching from tobacco to electronic cigarettes nicotine exposure was unchanged while exposure to selected toxicants was substantially reduced.
There is little evidence of harmful effects from repeated exposure to propylene glycol, the chemical in which nicotine is suspended.12,13 One study concludes that e-cigarettes have a low toxicity profile, are well tolerated, and are associated with only mild adverse effects.

ASH UK – Briefing on Electronic Cigarettes (juni 2013)
Action on Smoking and Health, Groot-Brittannië
“As an alternative to smoking, e-cigarettes are preferable in situations where secondhand smoke poses serious health risks to others, such as in vehicles or in the home.
ASH estimates that there are 1.3 million current users of e-cigarettes in the UK. This number is almost entirely made of current and ex-smokers; with perhaps as many as 400,000 people having replaced smoking with e-cigarette use. There is little evidence to suggest that anything more than a negligible number of non-smokers regularly use the product.”

ASH UK – Briefing on Electronic Cigarettes (juni 2013)
Action on Smoking and Health, Groot-Brittannië
In the UK smokefree legislation exists to protect the public from the demonstrable harms of  secondhand smoke. ASH does not consider it appropriate for electronic cigarettes to be subject to this legislation.”

Use of e-cigarettes in Great Britain among adults and young people (mei 2013)
Action on Smoking and Health, Groot-Brittannië
“Among children regular use of e-cigarettes is extremely rare. Children who had heard of e-cigarettes were asked about their use and knowledge of them. What little use that is reported is confined almost entirely to children who currently smoke or used to smoke.”

How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century (Oktober 2013)
Faculteit Pharmacologie & Toxicologie, Karl-Franzens Universiteit Graz, Oostenrijk
“Although an LD50 of 0.8 mg/kg would implicate that the toxicity of nicotine is similar to or even higher than that of cyanide, fatal nicotine intoxications are relatively rare, and there are countless records of subjects who survived consumption of nicotine in amounts far higher than 60 mg (Larson et al. 1961). The most drastic example is probably survival of a suicide attempt with 4 g of pure nicotine (Schmidt 1931). […] These and many other literature reports on nonfatal nicotine intoxications are hardly compatible with a lethal dose of 60 mg or less. […]
Nicotine is a toxic compound that should be handled with care, but the frequent warnings of potential fatalities caused by ingestion of small amounts of tobacco products or diluted nicotine-containing solutions are unjustified and need to be revised in light of overwhelming data indicating that more than 0.5 g of oral nicotine is required to kill an adult.”

Nicotine content of electronic cigarettes, its release in vapour and its consistency across batches: regulatory implications (december 2013)
Prof. Dr. Goniewicz, prof. Peter Dr. Peter Hajek, Dr Hayden McRobbie
“Although an unsubstantiated claim is often repeated that 30–60 mg of nicotine is fatal, several suicide attempts have been recorded where people drank up to 1500 mg of nicotine in e-liquid (i.e. 50× the presumed lethal dose) without any consequence other than abdominal pain and ‘voluminous vomiting’ [13]. A recent study managed to trace the statement concerning the lethal toxicity of nicotine to dubious self-experiments in the 19th century. It has been repeated uncritically ever since. Given the low toxicity of nicotine at the doses observed and the fact that, long before any dangerous levels of nicotine concentration could be reached, an over-enthusiastic user would be warned by nausea, there is little concern that e-cigarettes can harm their users by delivering toxic nicotine levels.”