The health effects of vaping and e-cigarettes: consensus recommendations

OBJECTIVE: To develop evidence-informed recommendations on the health effects of e-cigarettes to guide healthcare practitioners and the public to balance individual and population harm reduction. METHODS: Systematic and umbrella reviews investigating the health effects of e-cigarette use were conducted (September 2017 - January 2024). An international panel of subject matter experts (n = 23) and people in Canada with lived experience (n = 7) participated in a two-day, hybrid meeting, and used a consensus-based approach to develop recommendations. A guidance resource and four accompanying knowledge products were tested for usability with end users. RESULTS: Consensus was reached on 14 recommendations spanning four health effects: carcinogen exposure, cardiovascular health, respiratory health, and nicotine dependence. Quality of evidence was voted as ranging from high/moderate to moderate/low, and strength of most recommendations was voted as strong. CONCLUSIONS: Guidance has been informed by best available evidence and expertise, providing direction to support decision-making. The use of established methods to evaluate divergent published literature combined with consensus-building methods among a range of stakeholders on vaping is possible. As higher quality evidence continues to emerge, recommendations will require iterative refinement.