E-cigarette devices expose users to toxic metals, UTS study finds

University of Technology Sydney

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Vaping is largely believed to be a safer alternative to cigarettes, but new research shows that vaping devices can deliver toxic metals directly into lung tissue.

A study published in Analytical and Bioanalytical Chemistry by University of Technology Sydney (UTS) researchers showed that even short‑term vaping at exposure levels below typical daily human use resulted in measurable accumulation of toxic metals in lung tissue – including lead, copper and nickel.

Lead researcher Dr Dayanne Bordin, a lecturer in analytical chemistry, said the pre-clinical study provides the first evidence that e-cigarette aerosols include metal-containing (organometallic) species, including those associated with tin and mercury – forms that are often more bioavailable and biologically reactive than inorganic metals.

“From a risk perspective, the findings reveal under‑recognised hazards associated with vaping,” she said.  “Metal emissions and their biological effects are rarely incorporated into current safety assessments or public understanding. Unlike cigarettes, which are a relatively consistent products, e-cigarettes and devices are often manufactured with poor quality control involving materials and components with unknown toxicological relevance.

“The metal profiles observed are consistent with emissions from heating coils and electrical components, identifying the device itself as a critical source of exposure and highlighting important gaps in how vaping risks are evaluated.”

Dr Bordin explains this is important because many people believe vaping carries less risk than conventional cigarettes. This perceived reduction in harm, along with misleading marketing campaigns, has contributed to the rapid uptake of e-cigarettes globally, particularly among younger demographics. In Australia, for example, e-cigarette use among young adults increased from 5.3% in 2019 to over 21% in 2023, with a similar rise in adolescents.

“Our findings challenge the assumption that e-cigarettes are safer and shows how critical it is to review current vaping regulations, which should be expanded to include device-derived emissions, not just e-liquid composition,” she said.

“Vaping can deliver toxic metals directly into the lungs, even after short-term use. This information is important for anyone considering vaping, especially young people, because these metal exposures are largely invisible and rarely discussed.

“Specifically, there is a need for standards and routine testing of metal and organometallic emissions from e-cigarettes, particularly from heating coils and internal components,” said Dr Bordin.

“The results also support updating risk assessment frameworks and public health guidance to incorporate metal exposure and bioaccumulation and improving consumer awareness around these previously unrecognised risks.”

 

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Journal

Analytical and Bioanalytical Chemistry

DOI

10.1007/s00216-026-06487-1 

Method of Research

Observational study

Subject of Research

Animals

Article Title

Analytical investigation of metal distribution from e-cigarette aerosols to lung deposition using multi-platform mass spectrometry

Article Publication Date

16-Apr-2026

More Teens Used Cannabis After Adult Recreational Use Was Legalized In California

April 19, 2026 
By Eurasia Review

Teen cannabis use in Northern California increased following the legalization of adult recreational cannabis and later declined during the COVID-19 pandemic, according to new research from Kaiser Permanente published in JAMA Network Open.

“We saw adolescent cannabis use begin to rise after legalization was passed and before retail sales began,” said lead author Kelly Young-Wolff, a research scientist with the Kaiser Permanente Division of Research. “This suggests that changes in social norms and perceptions may play an important role in shaping teen behavior.”

The study analyzed 1.3 million well-child pediatric visits among Kaiser Permanente patients aged 13 to 17 between 2011 and 2024. At each well-child visit, adolescents completed a confidential screening questionnaire that included questions about substance use.

Cannabis use among teens had been steadily declining for years prior to legalization, from 10.4% reporting past-year use in 2011 to 6.8% in 2016, the year California voters approved recreational cannabis. After legalization, rates began increasing, reaching 8.1% in 2017 and 9.5% in 2018, and continued to rise as retail sales were implemented.

The authors suggested the increase may reflect shifting perceptions and greater access. Adolescents may have viewed cannabis as more socially acceptable and less risky, alongside increased availability, lower prices, and the rise of vaping products, including flavored options.

Additional studies are needed to better understand how local cannabis policies, including retail access and advertising, affect adolescent cannabis use following state legalization, the researchers said.

The findings are consistent with national data showing declines in adolescent substance use during the pandemic. Possible contributing factors include reduced social interaction, increased parental supervision, and decreased access to substances.

Cigarette Smoking Almost Twice As Likely For People Living With Chronic Pain

April 14, 2026

By Eurasia Review

New research from the University of Kansas shows people who experience chronic pain tend to consume cigarettes and e-cigarettes at higher rates than others. The findings, based on analysis of the National Health Interview Survey from 2014-2023, should inform therapies for both chronic pain and smoking cessation.

The study appears in the American Journal of Preventive Medicine.

“People get caught in this really vicious cycle where pain is driving smoking, smoking makes the pain worse, which makes it really hard to quit,” said co-author Jessica Powers, assistant professor of psychology at KU. “We know pain drives tobacco use. Tobacco has short-term pain-relieving properties, so a lot of people find it helpful in the moment, but it actually causes negative effects in the long term. Tobacco smoking can actually make pain worse and make you more likely to develop a chronic pain condition.”

Powers, who also serves as assistant scientist with the KU Life Span Institute’s Cofrin Logan Center for Addition Research & Treatment, said there’s a growing understanding that chronic pain relates to substance-use disorders and addiction.

“In our case, we’re seeing a lot of data showing that those with chronic pain are much more likely to use tobacco — cigarettes, e-cigarettes and other types of nicotine or tobacco products,” she said.


Powers and her colleagues analyzed responses from more than 195,600 Americans surveyed over 10 years. The key finding: Chronic pain is tied to smoking and vaping at higher rates.

“Smoking tends to make everything worse,” Powers said. “We see impacts on mental health. As a pain psychologist, when I work directly with patients, we talk about smoking as a way to cope with the lower mood that comes with living with chronic pain, not being able to get out of the house or do things that are important to them. That coping strategy tends to make everything worse. We talk about it as a cycle involving pain, addiction, mood and functioning.”

While fewer Americans are smoking overall, the reduction is declining more slowly in people with chronic pain, the study shows.

“We know that cigarette smoking rates overall are going down, which is good,” Powers said. “But what these results show is that the decline isn’t happening as fast for people with chronic pain. People with chronic pain are about twice as likely to smoke cigarettes and to use other types of tobacco products, including e-cigarettes, and to use multiple products together.”

Furthermore, the KU researcher said people with chronic pain are more likely to vape e-cigarettes.

“There’s a lot of complexity with e-cigarettes,” she said. “On the one hand, an e-cigarette is going to be a less harmful product than a combustible product. You’re not getting all the carcinogens from smoking. But we also have reason to believe that nicotine and the way it works on our pain system might also make pain worse. In folks with pain, we’re not quite sure yet what level of harm we may be seeing from e-cigarettes.”

The data also revealed more frequent or disabling pain was tied to a higher likelihood of tobacco smoking.

“You can think about this in two ways,” Powers said. “Smoking may be making pain worse and increasing the likelihood of high-impact chronic pain. At the same time, people with greater pain impact are more likely to turn to cigarettes as a way to cope. When pain interferes with seeing grandchildren or doing meaningful activities, negative mood increases. All of those things may drive further smoking as a coping mechanism.”

Powers said the takeaway from her research for clinicians and policymakers is people with chronic pain are being left behind


“We know that cigarette smoking rates overall are going down, which is good,” she said. “But what these results show is that the decline isn’t happening as fast for people with chronic pain.”

Powers’ collaborators were Julianna Lazzari and Dana Rubenstein of the Duke University School of Medicine, joined by F. Joseph McClernon and Maggie Sweitzer, also of the Duke University School of Medicine in Durham, North Carolina. Additional co-authors included Lauren Pacek of Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.

Moving forward, Powers thinks the results should inform clinical interventions for those living with chronic pain and looking to quit tobacco.

“I’m a licensed clinical psychologist and worked in addiction and pain settings,” she said. “When I was doing intensive outpatient treatment groups for people early in withdrawal, pain came up frequently in clinical work. The goal of my research is to develop smoking cessation interventions that incorporate pain management for people with chronic pain. We have great pain treatments and great smoking cessation treatments, but we need to put them together.”

 

UC San Diego study links flavored tobacco bans to lower youth vaping in California

Analysis of more than 2.8 million students across California finds reductions in youth vaping use emerging several years after local flavor bans took effect, with no evidence that bans increased cigarette smoking

University of California - San Diego

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Researchers from the University of California San Diego have found that local sales bans on flavored tobacco in California are associated with reduced youth vaping over time without increasing cigarette smoking. The findings, based on an analysis of more than 2.8 million middle and high school students, were published April 10, 2026 in JAMA Health Forum.

“Our findings suggest that local flavored tobacco bans can be an effective strategy for reducing youth e-cigarette use,” said Eric Leas, PhD, MPH, assistant professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science and senior author of the study. “Importantly, we did not find evidence that these policies led young people to switch to cigarettes, which has been a major concern raised in policy debates.”

Electronic nicotine delivery systems (ENDS), commonly known as e-cigarettes or vaping products, have been widely used by adolescents in the U.S. National data show that youth vaping peaked in 2019 when more than a quarter of high school students reported using e-cigarettes, though prevalence has since declined. Despite this decrease, frequent use remains common among current users, raising concerns about nicotine dependence and long-term health risks.

One approach policymakers have used to reduce youth vaping is restricting the sale of flavored tobacco products, which often include fruit, candy or mint flavors that appeal to young users. Prior research has shown that flavored products are a major driver of youth e-cigarette use. 

To better understand the impact of these policies, the research team analyzed responses from 2,805,708 students who participated in the California Healthy Kids Survey between 2017 and 2022. The survey includes students in grades 7, 9 and 11 and asks about past-month use of tobacco products.

The researchers compared tobacco use among students attending schools in jurisdictions with flavored tobacco bans to those in areas without such policies. The study used a dynamic difference-in-differences design to account for variations in when different cities adopted the bans and to track how outcomes changed over time. The dynamic difference-in-differences design method allowed researchers to see whether youth vaping changed after flavored tobacco bans were adopted in different cities — and whether those changes grew over several years, rather than just looking at a simple before-and-after comparison.

Youth vaping rates were lower in areas with flavored tobacco bans. In jurisdictions with a ban, 6.2% of students reported current e-cigarette use, compared with 7.7% in areas without one. Over time, the study found these policies were associated with sustained declines in youth vaping. 

By contrast, the study found no meaningful association between flavored tobacco bans and cigarette smoking among youth. Cigarette use remained roughly the same in jurisdictions with and without the policies.

The delayed reductions in vaping may reflect how policies evolve and are enforced over time. Many local jurisdictions gradually strengthened their rules after initial adoption, for example by expanding definitions of flavored products or adding enforcement provisions. Resources and support for enforcing these laws also grew over time, particularly after California’s statewide ban took effect, helping local communities better implement the restrictions.

California voters approved a statewide flavored tobacco sales ban in 2022, which took effect in 2023. Because many cities had implemented their own restrictions years earlier — some as early as 2011 — the researchers say these local policies provide an opportunity to study longer-term impacts of flavor bans.

The authors note that the study focused on California, a state with historically strong tobacco control policies and relatively low youth smoking rates compared with other states. As a result, the magnitude and timing of the effects may differ in places with different policy environments.

Future research will be needed to understand the long-term impact of statewide bans and how similar policies affect youth tobacco use across different regions and communities.

“Local policies gave us a valuable window into how flavored tobacco restrictions may influence youth behavior over time,” said Giovanni Appolon, MPH, first author of the study who conducted this research as part of experiential learning as doctoral candidate in the UC San Diego - San Diego State University Joint Doctoral Program in Public Health. “As more jurisdictions adopt these policies, continued monitoring will help determine how enforcement, policy design and community context shape their public health impact.”

Link to full study: https://doi.org/10.1001/jamahealthforum.2026.0631

Additional co-authors on the study include: David Strong, PhD, Dennis R. Trinidad, PhD, from UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science. Heather A. Pines, PhD, S. Wilton Choi, PhD, and Eyal Oren, PhD, from San Diego State University. 

The study was funded by the Tobacco-Related Disease Research Program (Grant # T34DT8325).

Authors disclose no competing interests.

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Journal

JAMA Health Forum

DOI

10.1001/jamahealthforum.2026.0631 

 

Vaping likely to cause cancer: New findings

University of New South Wales

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Nicotine-based vapes, or e-cigarettes, are likely to cause cancers of the lung and oral cavity, according to a new study led by UNSW Sydney and published today in Carcinogenesis.

The study analyses a wide body of global research and was led by UNSW cancer researcher Adjunct Professor Bernard Stewart AM, with investigators from The University of Queensland, Flinders University, The University of Sydney, as well as Royal North Shore, The Prince Charles and Sunshine Coast University hospitals.

The team brought together experts from multiple disciplines, including pharmacists, epidemiologists, thoracic surgeons and public health researchers. Together, they examined the evidence from different scientific perspectives.

 “To our knowledge, this review is the most definitive determination that those who vape are at increased risk of cancer compared to those who don’t,” Prof. Stewart says.

This assessment of carcinogenicity – or, cancer causation – review argues that while researchers have long focused on vaping as a gateway to smoking, less attention has been paid to whether the devices might cause cancer on their own.

It is one of the most detailed attempts yet to determine whether vaping itself may cause cancer, independent of tobacco smoking. The analysis draws together clinical studies, animal experiments and laboratory research examining the chemicals produced by e-cigarettes.

“Considering all the findings – from clinical monitoring, animal studies and mechanistic data – e-cigarettes are likely to cause lung cancer and oral cancer,” Prof. Stewart says.

He says though the consistency of findings across those disciplines was striking, the exact number of attributable cancer cases remains unclear.

“Our assessment is qualitative and does not involve a numerical estimate of cancer risk or burden. We’ll only be able to determine the precise risk once longer-term studies are available.”

Growing public health concerns

E-cigarettes were first sold in the early 2000s and became available in Australia around 2008. Early marketing framed them as a ‘safer’ alternative to tobacco cigarettes, as well as a possible aid for quitting smoking.

But the colourful, flavoured devices of today have spread quickly and widely, particularly among young people. Vaping is now a common sight outside schools, bars and train stations across Australia, despite the Australian Government introducing new laws to regulate vapes in 2023. Disposable vapes and non-therapeutic vapes are banned, while therapeutic vapes can only be sold in pharmacies, and only to help people quit smoking.

“E-cigarettes are known to be a gateway to smoking and hence cancer,” says co-author UNSW Associate Professor Freddy Sitas.

“But the extent to which they may cause cancer in their own right has not received as much attention in research,” he says.

“The evidence was remarkably consistent across fields,” he says. “It dictated an unequivocal finding now, though human studies that estimate the risk will take decades to accumulate.”

A clear outcome

Smoking has been studied for more than a century. Though e-cigarettes are relatively new, inhaling nicotine-laced aerosols is already linked to addiction, poisoning, inhalation injuries and burns.

While researchers wait for long-term population studies showing whether people who vape are more likely to develop cancer, they must rely on multiple other forms of evidence.

The team identified numerous carcinogenic compounds in e-cigarette aerosols, including volatile organic chemicals and metals released from heating coils.

They examined several types of evidence: biomarkers in people showing DNA damage, oxidative stress and tissue inflammation; experiments in mice that caused lung tumours; and laboratory studies showing cellular damage and disrupted biological pathways linked to cancer.

Taken together, the researchers say the evidence points strongly in one direction.

A compounding problem

There is also growing evidence that many smokers who switch to vaping don’t quit cigarettes.

“Most of those who use e-cigarettes to quit smoking end up in ‘dual-use-limbo’, unable to shake off either habit,” says A/Prof. Sitas.

“What we do know from recent epidemiological evidence from the USA is that those who both vape and smoke are at an additional four-fold increased risk of developing lung cancer.”

This was described in commentary also published today by A/Prof. Sitas and Prof. Stewart in Cancer Epidemiology.

History repeating

A/Prof. Sitas and Prof. Stewart traced parallels between the early scientific evidence linking smoking to disease and emerging concerns about vaping.

It took nearly a century of scientific investigation – from the mid-1800s to the landmark US Surgeon General’s report in 1964 – before smoking was officially recognised as a cause of lung cancer.

During that time, early warning signs were often dismissed or overlooked.

“Early reports linked smoking to infectious diseases such as tuberculosis, followed by cardiovascular disease, stroke and lung cancer,” A/Prof Sitas says.

He says the same pattern may now be unfolding with vaping – and that researchers should not repeat the delay that occurred with cigarettes.

“E-cigarettes were introduced about 20 years ago. We should not wait another 80 years to decide what to do.”

MULTIMEDIA

• Embeddable video short: https://youtu.be/ITBmOZTxcwU
• Hi-res media reel available on request via the media contact listed.

 

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Journal

Carcinogenesis

DOI

10.1093/carcin/bgag015 

Method of Research

Systematic review

Article Title

The carcinogenicity of e-cigarettes: a qualitative risk assessment

Article Publication Date

30-Mar-2026

 

E-cigarettes rated most effective smoking cessation method by new evidence review

Society for the Study of Addiction

A new overview of the best available evidence worldwide for smoking cessation has found that nicotine‑containing e‑cigarettes appear to be more effective for smoking cessation than other interventions such as nicotine replacement therapy (nicotine patches, gum, lozenges, etc.) e-cigarettes with no nicotine, and behavioural support. 

This ‘overview’ of systematic reviews summarises existing evidence from several systematic reviews and makes the findings more accessible.  The overview pooled the evidence from fourteen systematic reviews of smoking cessation interventions from 2014 to 2023.

Findings from higher-quality reviews consistently showed greater smoking cessation with nicotine-containing e‑cigarettes than other interventions. Lower-quality reviews produced more variable and imprecise estimates. When restricted to higher-quality evidence, results consistently favoured nicotine e‑cigarettes over nicotine replacement therapy, non-nicotine e-cigarettes, and other comparators.

The overview also created an ‘Evidence and Gap Map’ (EGM) to identify gaps in the current evidence that urgently need to be filled.  There are currently no high-quality systematic reviews directly comparing nicotine e-cigarettes with cytisine, bupropion, or nicotine pouches.  Also, direct evidence comparing nicotine e-cigarettes with varenicline is extremely limited, with only a single small trial at high risk of bias.

The EGM also showed that current evidence of serious adverse events associated with e-cigarettes is inconclusive, and that most of the studies collected data from high-income countries.  Future primary research on e-cigarettes for smoking cessation should continue to collect data on serious adverse events and expand its data collection to include low-and middle-income countries.

Lead author DrAngela Difeng Wu, Senior Researcher and Lecturer at the Nuffield Department of Primary Care Health Sciences, University of Oxford, says “We hope this overview and Evidence and Gap Map can lay to rest some claims that evidence is ‘mixed’ regarding the impacts of nicotine e-cigarettes on smoking abstinence.  In fact, the evidence is clear and consistent across all of the meta-analyses we consulted:  e-cigarettes are effective at helping people stop smoking.”

-- Ends –

For editors:

This Open Access paper is available on the Wiley Online Library from the embargo date (https://onlinelibrary.wiley.com/doi/10.1111/add.70388) or you may request an early copy from Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org.

To speak with lead author Dr Angela Difeng Wu, please contact her at the Nuffield Department of Primary Care Health Sciences, University of Oxford by email (angela.wu@phc.ox.ac.uk).

Full citation for article: Wu AD, Conde M, Butler AR, Knight E, Lindson N, Livingstone-Banks J, Hajek P, McRobbie H, Begh R, Theodoulou A, Notley C, Turner T, Zhitnik E, and Hartmann-Boyce J. Electronic Cigarettes for Smoking Cessation: An Overview of Systematic Reviews and Evidence and Gap Map.  Addiction. 2026. DOI: 10.1111/add.70388.

Primary funding:  This research work was funded by Cancer Research UK, Grant Number PRCPJT‐Nov22/100012.

Declaration of interests: Dr Hartmann-Boyce is paid for research consultancy from the Truth Initiative. Dr Lindson is an associate editor for Addiction. Dr. Notley has received an honorarium from Vox Media for filming a 'nicotine explainer' on the role of nicotine in addiction.  All other authors report no known conflicts of interest.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, gambling, editorials, and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.

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Journal

Addiction

DOI

10.1111/add.70388 

Method of Research

Systematic review

Subject of Research

People

Article Title

Electronic Cigarettes for Smoking Cessation: An Overview of Systematic Reviews and Evidence and Gap Map

Article Publication Date

27-Mar-2026

COI Statement

Dr Hartmann-Boyce is paid for research consultancy from the Truth Initiative. Dr Lindson is an associate editor for Addiction. Dr. Notley has received an honorarium from Vox Media for filming a 'nicotine explainer' on the role of nicotine in addiction. All other authors report no known conflicts of interest.

Nicotine E-cigarettes more successful in helping smokers quit

Analysis of 14 systematic reviews co-led by UMass Amherst public health researcher finds higher long-term quit rates than patches or gum

University of Massachusetts Amherst

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A new analysis of existing studies co-led by a University of Massachusetts Amherst public health researcher finds that nicotine e-cigarettes consistently help adults quit smoking, a conclusion that emerges with striking agreement across nearly a decade of studies.

The “review of reviews,” published today in Addiction, examined 14 systematic reviews covering 109 primary studies conducted between 2014 and 2023. Across 21 separate meta-analyses, every pooled estimate pointed in the same direction: Smokers using nicotine e-cigarettes were more likely to quit than those using most other methods.

The review found that nicotine e-cigarettes are associated with quit rates approximately 20% to 40% higher than traditional nicotine replacement therapies, such as patches or gum, for smoking cessation lasting at least six months. Compared with non-nicotine e-cigarettes or placebo devices, nicotine e-cigarettes performed even better, with quit rates at least 46% higher.

“We set out to determine if scientists agree on whether nicotine e-cigarettes help people quit smoking,” says senior author Jamie Hartmann-Boyce, assistant professor of health policy and management in the School of Public Health and Health Sciences at UMass Amherst. “Based on the consistency of the findings here, it’s clear that they do.”

However, she cautions that this doesn’t necessarily mean e-cigarettes are the best option to quit smoking, or that they will work for everyone. Vaping also comes with health risks, but those risks pale in comparison to the dangers of smoking.

“It’s not just the person who smokes who is affected by their smoking,” Hartmann-Boyce notes. “It’s the people around them who are affected by secondhand smoke, and secondhand vaping is nowhere near as harmful as secondhand smoking either.”

The effectiveness of e-cigarettes may stem from more than just nicotine delivery.

“If you look at neuro-imaging studies, the addiction often isn’t just to the nicotine,” she explains. “There are the sensory cues around it that really feed into those addiction pathways. Vaping fulfills some of those cues in a way that a patch doesn’t”—including the throat hit, the hand-to-mouth motion and the visible exhale.

Many of those same features, Hartmann-Boyce points out, are why youth uptake remains a serious concern.

“The primary concern about e-cigarettes is their use among people who don’t smoke and wouldn’t have otherwise smoked,” she says. “That doesn’t mean these devices don’t help people quit smoking.”

While e-cigarettes with nicotine may prove more effective than traditional nicotine replacement therapies, it remains unclear if they are as effective a class of drugs known as nicotine receptor partial agonists, which are available only via prescription. Varenicline, marketed as Chantix in the U.S., can lessen smoking satisfaction and reduce withdrawal cravings.

“We don’t have enough studies to compare these drugs to nicotine e-cigarettes to say whether one is better than the other for helping people quit smoking,” Hartmann-Boyce says.

She hopes the new analysis will provide some clarity about vaping. While the evidence that nicotine e-cigarettes can help quit smoking has never been stronger, public perception of vaping has soured, amid lung injuries associated with a certain additive in some THC-vaping products and marketing campaigns targeting young people.

When half of all lifelong daily smokers die from the habit, Hartmann-Boyce insists that evidence matters.

“We know e-cigarettes are not risk free, but they are so much less harmful than smoking,” she says.

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Journal

Addiction

DOI

10.1111/add.70388 

Method of Research

Systematic review

Subject of Research

People

Article Title

Electronic cigarettes for smoking cessation: An overview of systematic reviews and evidence and gap map

Article Publication Date

27-Mar-2026

COI Statement

Dr. Hartmann-Boyce is paid for research consultancy from the Truth Initiative. Dr. Lindson is an associate editor for Addiction. Dr. Notley has received an honorarium from Vox Media for filming a 'nicotine explainer' on the role of nicotine in addiction. All other authors report no known conflicts of interest.