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The health risks of using e-cigarettes

Research output: Book/ReportCommissioned report


W. Visser, L. Geraets, W. Klerx, L. Hernandez, William Edryd Stephens, E. Croes, P. Schwillens, H. Cremers, Bos P., R. Talhout

School/Research organisations


Electronic cigarettes, or e-cigarettes, vaporise a liquid that often contains nicotine and flavourants. Although E-cigarettes are less harmful than tobacco cigarettes, the e-cigarette vapour contains several ingredients and chemical impurities such as nicotine, propylene glycol, glycerol, aldehydes, nitrosamines and metals at concentrations that can be detrimental to health. Inhalation of these can lead to irritation of and/or damage to the respiratory tract, palpitations and an increased risk of developing cancer. These health effects are, however, less severe than those associated with smoking tobacco.

The Dutch National Institute for Public Health and the Environment (RIVM) undertook a survey of e-cigarette users (vapers), performed measurements and assessed the risks. The study was performed for the ministry of Health, Welfare and Sport (VWS) because of the substantial increase in e-cigarette users, and the uncertainties surrounding the health effects of e-cigarette use. In this study, the RIVM assessed the possible health risks associated with exposure to substances in e- cigarette vapour. In 2015, the RIVM will assess the possible health effects resulting from exposure to compounds present in exhaled vapour.

Findings regarding users
The survey of Dutch e-cigarette users showed that people use e- cigarettes on the assumption that it is less harmful than smoking conventional cigarettes and will help them to stop smoking. Of the many brands and models available, refillable e-cigarettes were the most popular. Virtually all users had smoked tobacco prior to using e- cigarettes and most were dual users, continuing to smoke tobacco in addition to using e-cigarettes. There were major behavioural differences amongst 'vapers', such as large variances in the number of puffs reported per day.

E-liquid and vapour composition
Considerable differences were observed in the composition of different kinds of e-liquid available in the Dutch market and that of the resulting vapour. In some cases, the amount of nicotine in the e-liquid did not match the declared amount on the packaging. The concentration of some compounds was found to be higher in the vapour than in the liquid. Aldehydes were formed when the e-liquids are heated, and metals were released from the atomiser. Propylene glycol and glycerol function as a 'carrier liquid' for nicotine and flavourants.


Original languageEnglish
PublisherRijksinstituut voor Volksgezondheid en Milieu (RIVM, Netherlands National Institute for Public Health and the Environment))
Number of pages50
Publication statusPublished - 2015

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