E-cigarettes: The phantom menace


E-cigarettes or electronic nicotine dispensing systems (ENDS) are “devices that deliver an aerosol by heating a solution” upon user inhalation. This is an act referred to as “vaping”. E-cigarettes are also known under alternative names including “vapes”, “vape pens”, “e-cigs” and “personal vaporisers”1. These devices, as well as vaping, are most highly prevalent among young people. According to the Australian Bureau of Statistics, among those aged 18-24 years old, 21.7% have used an e-cigarette or vaping device at least once. Of those aged over 18, 8.9% currently use an e-cigarette or vaping device, and 23.8% formerly used such devices2.

The liquid solution used in e-cigarettes contains humectants and flavourings. Humectants prevent the liquid solution from drying out, and the large variety of flavourings available for e-cigarettes attracts both new smokers, and those currently using conventional cigarettes. While the liquid solution is allegedly free of harmful materials, the process of heating and aerosolising the solution can produce a range of hazardous and cancer-inducing chemicals3 including formaldehyde, acetone and acrolein1. E-cigarettes introduce fewer harmful chemicals to the user compared to conventional cigarettes4; however, the chemicals in these devices have been associated with several negative health effects on the different body systems, including the respiratory, cardiovascular, gastrointestinal, urogenital, and neurological systems5. While e-cigarettes have been suggested to have less harmful effects compared to cigarettes in the short-term, the long-term health effects of e-cigarettes have not been thoroughly investigated3.

Additionally, the levels of nicotine, an addictive component contained in e-cigarettes, can also vary between different products3. More importantly, due to the limited regulations and the high variety of e-cigarette products sold on the market, the safety of these products is difficult to assess1. In Australia, despite the purchase of nicotine-containing e-cigarettes requiring a prescription, many e-liquid cartridges were found to contain traces of nicotine6. Due to the nicotine content, e-cigarettes can be addictive. Therefore, nicotine-replacement therapy in combination with behavioural therapy is currently in practice for those who intend to quit e-cigarettes7.

E-cigarettes have also been promoted as an alternative to conventional smoking, or for the purposes of smoking cessation. However, the evidence for the efficacy of e-cigarettes in smoking cessation has been limited to date3,8, and many users engage in “dual use” of e-cigarettes and conventional cigarettes9. Furthermore, the use of e-cigarettes in young people has been found to be associated with future conventional cigarette smoking1,4, which predisposes individuals to a wide range of health issues down the track8. As such, there is a need for further refinement of the public health initiatives regarding the regulations and access to e-cigarettes and improving health literacy on the effects of vaping to reduce the uptake of e-cigarettes in young people and prevent negative health effects down the track.


  1. Australian Government Department of Health and Aged Care. About e-cigarettes. https://www.health.gov.au/topics/smoking-and-tobacco/about-smoking-and-tobacco/about-e-cigarettes
  2. Australian Bureau of Statistics. Smoking. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/smoking/latest-release
  3. Marques P, Piqueras L, Sanz MJ. An updated overview of e-cigarette impact on human health. Respir Res. 2021;22(1):151. doi:10.1186/s12931-021-01737-5
  4. Seiler-Ramadas R, Sandner I, Haider S, Grabovac I, Dorner TE. Health effects of electronic cigarette (e-cigarette) use on organ systems and its implications for public health. Wien Klin Wochenschr. Oct 2021;133(19-20):1020-1027. doi:10.1007/s00508-020-01711-z
  5. Larcombe A, Allard S, Pringle P, Mead-Hunter R, Anderson N, Mullins B. Chemical analysis of fresh and aged Australian e-cigarette liquids. Med J Aust. Jan 17 2022;216(1):27-32. doi:10.5694/mja2.51280
  6. Greenhalgh E. 18B.13 Cessation interventions for e-cigarette users. In: Greenhalgh E, Scollo M, Winstanley M, eds. Tobacco in Australia: Facts and Issues. Cancer Council Victoria. https://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes/18b13-cessation-interventions-for-e-cigarette-users
  7. Lung Foundation Victoria. E-cigarettes and vaping. https://lungfoundation.com.au/lung-health/protecting-your-lungs/e-cigarettes-and-vaping/
  8. CSIRO. E-cigarettes, smoking and health. https://www.csiro.au/en/research/health-medical/diseases/health-impacts-of-electronic-cigarettes
  9. Glantz SA, Bareham DW. E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications. Annual Review of Public Health. 2018/04/01 2018;39(1):215-235. doi:10.1146/annurev-publhealth-040617-013757

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