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Health risks of alternative tobacco products

Over the last few years products have regularly been launched on the market as alternatives to cigarettes and tobacco. E-cigarettes are becoming increasingly popular and shisha pens are also increasing in popularity. RIVM is carrying out research into the health risks of alternative tobacco products.

E-cigarettes are battery-driven devices that administer nicotine. They were designed to be used in a similar way to traditional cigarettes. They are intended to quickly provide users with nicotine without exposing them to the many harmful chemicals that are found in traditional cigarettes. A shisha pen is an electronic atomiser that is similar to an e-cigarette. This product cannot be distinguished from e-cigarettes, as they are available with or without nicotine and they are used in virtually the same way.

Shisha pens

In 2013 there was social unease about shisha pens, as a lot of young children were thought to be using the pen to practise smoking, which could lower the threshold for smoking tobacco products. RIVM was commissioned by the Ministry of Health, Welfare and Sport to look into whether shisha pens could be harmful to health. This study showed that for most people just one drag on a shisha pen causes a dry throat and coughing. The effects of long-term use could not be estimated using the data available. For this to be done first of all there needs to be research into how exactly consumers use shisha pens.

Woman smokes electronic cigarette


In 2013 RIVM also published a fact sheet about e-cigarettes. The conclusion was that there is insufficient research available to state that e-cigarettes are safe. The packaging of e-cigarettes does not contain important information about the amount of nicotine, the correct usage and the dangers of e-cigarettes. In large quantities, nicotine can be fatal for adults and children. There are a lot of misleading or unproven claims about the health effects of e-cigarettes. For example, that the health benefits of e-cigarettes are as great as those of giving up smoking. Or that people who smoke e-cigarettes do not develop smoker’s cough and that e-cigarettes are not carcinogenic and moreover are safe for pregnant women. E-cigarette manufacturers are focusing in particular on young people by adding flavours, such as cherry, cola and Pina Colada, and opting for product designs that appeal to young people.


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