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In summary, 22 out of 37 included studies received low risk of bias note [12, 20, 21, 23, 27,28,29, 31, 34,35,36, 38,39,40,41, 44, 46,47,48,49, 54, 55], 11 out of 37 were identified as moderate risk of bias [22, 24,25,26, 32, 33, 37, 43, 45, 51, 52] and 4 studies received high risk of bias note [30, 42, 50, 53]

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Though vaping exposes the us er to fewer toxic substances than smoking, it is not harmless: the aerosol inhaled and exhaled during vaping may contain nicotine, heavy metals, and carcinogens.Encouragingly the levels of carcinogens and toxins in e-cigarettes are much lower than in cigarettes, and short-term studies suggest that smokers who switch to vaping do experience reduced exposure to carcinogens