ArticleAnnals of internal medicine2017
Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study.
Article in Annals of internal medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 286 papers, 12 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Switching to a Non-tobacco-based Oral Nicotine Product Among Adult Cigarette Smokers: Exploring the Roles of Product Characteristics and User History
Complicanze Post-operatorie e Abitudine Tabagica in Chirurgia Colorettale (Studio PASSAGE). Uno Studio Multicentrico Osservazionale Prospettico e Retrospettivo in Italia
Who cites it
286 citing papers in PubMed, 12 syntheses or guidelines pooled it, 531 citations in OpenAlex.
- Electronic cigarettes and cardiovascular outcomes: a systematic review and meta-analysis of Major Adverse Cardiovascular Events (MACE).BMC public health · 2026Pooled it
- Inflammatory and Carcinogenic Biomarker Signatures in E-Cigarette Users: A Comprehensive Meta-Analysis of ∼24,000 Adults.International journal of public health · 2025Pooled it
- Smoking cessation and harm reduction: a systematic overview of ongoing, randomized controlled trials.BMC psychiatry · 2024Pooled it
- Vaping during pregnancy: a systematic review of health outcomes.BMC pregnancy and childbirth · 2024Pooled it
- Exposure to Tobacco-Specific Nitrosamines Among People Who Vape, Smoke, or do Neither: A Systematic Review and Meta-Analysis.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2024Pooled it
- The genitourinary impacts of electronic cigarette use: a systematic review of the literature.World journal of urology · 2023Pooled it
- The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- Urgent Need for Novel Investigations of Treatments to Quit E-cigarettes: Findings from a Systematic Review.Cancer prevention research (Philadelphia, Pa.) · 2022Pooled it
- Heated tobacco products for smoking cessation and reducing smoking prevalence.The Cochrane database of systematic reviews · 2022Pooled it
- Cardiovascular autonomic effects of electronic cigarette use: a systematic review.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2020Pooled it
- How effective are electronic cigarettes for reducing respiratory and cardiovascular risk in smokers? A systematic review.Harm reduction journal · 2020Pooled it
- Factors influencing the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke: a qualitative evidence synthesis.The Cochrane database of systematic reviews · 2020Pooled it
- Adverse symptoms attributed to e-cigarettes over 6 months among participants of a randomized controlled trial testing nicotine free-base e-cigarettes for smoking cessation: secondary analysis of the ESTxENDS trial.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026Trial
- Carcinogen reduction in a randomized controlled study comparing e-cigarette provision to assessment only among people with serious mental illness who smoke.Drug and alcohol dependence · 2025Trial
- Evaluation of Dual Use: Real Time Reductions in Combustible Cigarette Smoking During Co-Occurring Use of E-Cigarettes.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2025Trial
- Atherogenic Effects of Acute Electronic Cigarette Compared With Tobacco Cigarette Smoking in People Living With HIV: A Randomized Crossover Trial.Journal of the American Heart Association · 2025Trial
- Arrhythmogenic effects of acute electronic cigarette compared to tobacco cigarette smoking in people living with HIV.Physiological reports · 2024Trial
- Examining acute psychopharmacological effects of nicotine vaping versus heated tobacco products in a randomised crossover study of product naïve adult smokers.Scientific reports · 2023Trial
- Abuse liability of two electronic nicotine delivery systems compared with combustible cigarettes and nicotine gum from an open-label randomized crossover study.Scientific reports · 2023Trial
- Assessing the impact of protonating acid combinations in e-cigarette liquids: a randomised, crossover study on nicotine pharmacokinetics.Scientific reports · 2023Trial
226 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
9 authors at 1 institution in 2 countries.
Funding
Abstract
backgroundGiven the rapid increase in the popularity of e-cigarettes and the paucity of associated longitudinal health-related data, the need to assess the potential risks of long-term use is essential.
objectiveTo compare exposure to nicotine, tobacco-related carcinogens, and toxins among smokers of combustible cigarettes only, former smokers with long-term e-cigarette use only, former smokers with long-term nicotine replacement therapy (NRT) use only, long-term dual users of both combustible cigarettes and e-cigarettes, and long-term users of both combustible cigarettes and NRT.
designCross-sectional study.
settingUnited Kingdom.
participantsThe following 5 groups were purposively recruited: combustible cigarette-only users, former smokers with long-term (≥6 months) e-cigarette-only or NRT-only use, and long-term dual combustible cigarette-e-cigarette or combustible cigarette-NRT users (n = 36 to 37 per group; total n = 181). MEASUREMENTS: Sociodemographic and smoking characteristics were assessed. Participants provided urine and saliva samples and were analyzed for biomarkers of nicotine, tobacco-specific N-nitrosamines (TSNAs), and volatile organic compounds (VOCs).
resultsAfter confounders were controlled for, no clear between-group differences in salivary or urinary biomarkers of nicotine intake were found. The e-cigarette-only and NRT-only users had significantly lower metabolite levels for TSNAs (including the carcinogenic metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol [NNAL]) and VOCs (including metabolites of the toxins acrolein; acrylamide; acrylonitrile; 1,3-butadiene; and ethylene oxide) than combustible cigarette-only, dual combustible cigarette-e-cigarette, or dual combustible cigarette-NRT users. The e-cigarette-only users had significantly lower NNAL levels than all other groups. Combustible cigarette-only, dual combustible cigarette-NRT, and dual combustible cigarette-e-cigarette users had largely similar levels of TSNA and VOC metabolites. LIMITATION: Cross-sectional design with self-selected sample.
conclusionFormer smokers with long-term e-cigarette-only or NRT-only use may obtain roughly similar levels of nicotine compared with smokers of combustible cigarettes only, but results varied. Long-term NRT-only and e-cigarette-only use, but not dual use of NRTs or e-cigarettes with combustible cigarettes, is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes. PRIMARY FUNDING SOURCE: Cancer Research UK.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.