Health Hazards of E-Cigarettes and Heated Tobacco Products: a Comprehensive Analysis of Hazardous Substances and Regulatory Gaps

Clinical Snapshot

Key Findings

• P Value: Not applicable - descriptive analysis

• Effect Size: 134 out of 1740 substances (7.7%) classified as Category 1 highest hazard

• Primary Outcome: Classification of hazardous substances in EC and HTP products

• Nnt Or Sensitivity: 134 high-priority substances identified for regulatory action and further research

• Confidence Interval: Not reported

Clinical Application

High - provides practical framework for substance prioritisation and regulatory decision-making Highly relevant for TGA regulation of vaping products, supports evidence-based approach to therapeutic goods scheduling and import controls under current prescription-only framework Healthcare providers counselling patients on tobacco harm reduction, public health professionals developing vaping policies

Abstract

INTRODUCTION: Ingredients and products of electronic cigarettes (ECs) and heated tobacco products (HTPs) formed during heating are aerosolized and inhaled. Hazard information on ingredients and emissions is often unavailable. Our objective was to identify and classify substances in the ingredients and emissions of ECs and HTPs based on scientific hazard classifications. METHODS: Ingredient data were collected from the European Union (EU) Common Entry Gate, a mandatory notification system for tobacco and related products. Substances in ECs and HTPs emissions were identified with a systematic literature review and classified into three categories based on existing health hazard classifications. Category 1 substances (i.e., highest potential health hazard) were regarded as high-priority substances for research and quantification. Categories 2 and 3 included potentially harmful substances and substances lacking sufficient toxicological data respectively. RESULTS: A total of 134 of the 1740 identified substances were classified in Category 1. Several substances possess Carcinogenic, Mutagenic, or Reprotoxic properties, prohibited as tobacco additives. Most substances lacked sufficient toxicity data and were classified in Category 3. CONCLUSION: Our classification can be used for monitoring and enforcement, ensuring proactive management of potential risks. Therefore, we recommend strengthening the enforcement of existing bans. Implications: This study identifies and classifies 1740 substances found in the ingredients and emissions of ECs and HTPs, including 134 hazardous chemicals, among which are carcinogens, mutagens, and reproduction toxicants. This indicates regulatory gaps and the need for stricter enforcement of existing bans. The findings provide a valuable tool for policymakers and public health professionals for monitoring and mitigating risks.

References

1. 1.El Bouz, M., Neto, C., Mansuy, T., Becher, R., Valen, H., Mariussen, E., Blanco-Escauriaza, D. A., González-Marrón, A., Zervas, E., Havermans, A., Talhout, R., & Staal, Y. C. M. (2026). Health hazards of e-cigarettes and heated tobacco products: A comprehensive analysis of hazardous substances and regulatory gaps. Nicotine & Tobacco Research. https://doi.org/10.1093/ntr/ntaf246