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Reviews on Environmental Health

Editor-in-Chief: Carpenter, David O. / Sly, Peter

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Electronic cigarettes: a systematic review of available studies on health risk assessment

Aziemah Zulkifli
  • Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
/ Emilia Zainal Abidin
  • Corresponding author
  • Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia, Phone: +603 89472643, Fax: +603 89472395
  • Email:
/ Najihah Zainol Abidin
  • Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
/ Amer Siddiq Amer Nordin
  • Faculty of Medicine, Department of Psychological Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
/ Sarva Mangala Praveena
  • Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
/ Sharifah Norkhadijah Syed Ismail
  • Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
/ Irniza Rasdi
  • Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
/ Karmegam Karuppiah
  • Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
/ Anita Abd Rahman
  • Faculty of Medicine and Health Sciences, Department of Community Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
Published Online: 2016-04-21 | DOI: https://doi.org/10.1515/reveh-2015-0075

Abstract

Objective: This paper primarily aimed to review articles which specifically quantified the risk of electronic cigarette’s (e-cigarette) usage via the health risk assessment (HRA) approach.

Methods: Systematic literature searches were conducted using PubMed search engine databases. Search terms such as “electronic cigarette”, “e-cigarette”, “electronic nicotine delivery systems”, “electronic cigarette liquid”, “electronic cigarette vapors”, and “health risk assessment” were used to identify the relevant articles to be included in this review. To enable comparison, hazard quotient (HQ) and lifetime cancer risk (LCR) for the chemicals measured in the selected articles were calculated for three of the articles using the formula: [1] HQ=average daily dose (ADD)/reference dose (RfD) or exposure air concentration (EC)/reference concentration (RfC); [2] LCR=lifetime average daily dose (LADD) × cancer slope factor (CSF) or exposure air concentration (EC) × inhalation unit risk (IUR).

Results: Four articles pertaining to HRA of e-cigarettes were critically reviewed, three of the papers focused on specific chemicals namely nicotine, propylene glycol (PG), glycerol and 1,2-propanediol, while one article evaluated the health risks posed by heavy metals contained in e-cigarettes. The calculated HQs for the chemicals in this review had large variations. HQs of the six chemicals, i.e. nicotine, PG, glycerol, cadmium, ethylene glycol, nickel, aluminum and titanium, were found to have the potential to contribute to non-carcinogenic health risks. None of the LCR calculated had risks exceeding the acceptable limit.

Conclusion: There are limited HRA studies and the ones that were available provided inconsistent scientific evidences on the health risk characterization arising from the usage of e-cigarettes. As such, there is a need to perform more studies on HRA of e-cigarettes by using uniformed and comprehensive steps and similar reference threshold levels of exposures.

Keywords: electronic cigarettes (e-cigarettes); e-liquid; hazard quotient; health risk assessment (HRA); margin of exposure; risk characterization

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About the article

Received: 2015-12-10

Accepted: 2016-02-09

Published Online: 2016-04-21


Citation Information: Reviews on Environmental Health, ISSN (Online) 2191-0308, ISSN (Print) 0048-7554, DOI: https://doi.org/10.1515/reveh-2015-0075.

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