The New England Journal of Medicine has published a report by Chitra Dinakar, M.D., University of Missouri-Kansas City School of Medicine professor of pediatrics, that examines the health effects of electronic cigarettes.

Dinakar’s journal article was also highlighted in a health article on the Consumer Reports website, in which she states, “There are many unexplored potential toxic effects that need further study.”

In the New England Journal of Medicine article published on Oct. 6, Dinakar and co-author George O’Connor, M.D., of the Boston University School of Medicine, say that while e-cigarettes might be safer than smoking conventional cigarettes according to some studies, it is impossible to reach a consensus on their overall safety.

More study is necessary, their report says, to better understand the effectiveness of e-cigarettes as a tool for smoking cessation, identify their health risks and to make them as safe as possible.

Dinakar, a specialist in allergy and immunology, and O’Connor conclude that using e-cigarettes does have biologic effects and that there are also possible health-related effects for users who do not smoke conventional tobacco products. Epidemiologic data, they say, indicate e-cigarettes may promote nicotine addiction in minors and young adults who otherwise would be nonsmokers.

A significant public health concern is the increased use among middle- and high-school students who have never smoked conventional cigarettes. As cigarette smoking reportedly decreased and leveled off among youths in 2014 and 2015, 16 percent of high-school students reported using e-cigarettes in 2015.

The use of e-cigarettes among adults showed a dramatic rise from 1.8 percent to 13 percent between 2010 and 2013. Reports of overall use of cigarettes jumped from 0.3 to 6.8 percent during the same time period.