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E-Cigarettes & Vaping: An Update

September 11, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

Earlier this year, the Risky Business column presented information about the growing use of electronic cigarettes (e-cigarettes) and the practice of vaping. The use of these products continues to be controversial. Advocates cite the health-related benefits and safety compared to smoking tobacco. Naysayers point to marketing of e-cigarettes to teenagers and young adults, who are in danger of becoming hooked on nicotine and converting to conventional cigarettes.

New Study: E-Cigarette Users Turning to Regular Cigarettes

In a medical study published in JAMA (the Journal of the American Medical Association) last month, researchers followed 2530 9th grade students who did not smoke tobacco cigarettes; 222 of these kids used e-cigarettes. By the end of the 10th grade, more than 25% of the e-cigarette users ended up using tobacco products such as conventional cigarettes and cigars, compared to just 9.3% of the kids who had not used e-cigarettes.

Although this data does not prove that e-cigarettes causes later tobacco use in teens and is only suggestive, one of the study’s researchers from Harvard Medical School noted that the results are “the strongest evidence to date that e-cigarettes might pose a health hazard by encouraging adolescents to start smoking conventional tobacco products.”

The possible relationship between e-cigarette use and tobacco use is underscored by recent information from the CDC (Centers for Disease Control and Prevention) about teen smoking behavior in the U.S. According to the CDC, e-cigarette use has tripled among middle and high school students, while tobacco use has dropped from 16% in 2011 to 9% in 2014. For the first time, more teens are vaping instead of smoking. Although the significant drop in tobacco use among teens is welcome news, there is concern that the increase in vaping will lead to a reversal in the tobacco use rates.

Contentious Debate Over Safety of Vaping

For the most part, the debate is between public health critics who are concerned that e-cigarette use will lead to a revival of smoking and industry supporters of e-cigarettes who see the products as a way to help cigarette smokers quit.

Critics concerns include:

  • e-cigarettes deliver nicotine, a highly addictive drug
  • e-cigarettes deliver several toxins that may be harmful over time
  • some research studies show that e-cigarettes do not help people quit tobacco
  • e-cigarettes may open the door to later tobacco use
  • large tobacco companies are moving into the e-cigarette industry

On the other hand, supporters of vaping say:

  • critics concern about safety are overblown
  • some research studies show that e-cigarettes are as helpful as nicotine patches or gum to help people quit smoking
  • e-cigarettes have significantly less cancer-causing toxins that regular cigarettes

Supporters of vaping also point to a recent report from the U.K. that maintains that e-cigarettes are 95% less harmful than conventional cigarettes. The British authors of the report even recommend that physicians suggest e-cigarettes to patients who want to quit smoking.

New FDA Regulations Coming

According to the FDA, “In today’s rapidly evolving tobacco marketplace, the surge in youth use of novel products like e-cigarettes forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened.” 

Cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco are currently subject to the authority of the Food and Drug Administration (FDA), which is currently finalizing regulations for e-cigarettes. The new rules may go into effect later this year or in early 2016.

In 2014, the FDA proposed to extend its tobacco regulating authority to e-cigarettes, which would restrict sales to minors younger than 18, require health warnings on packaging, prohibit vending machine sales, and prohibit marketing the products as healthy or safe. 

Most likely, the new proposed regulations will be more stringent and may treat each vaping flavor (of which there are more than a thousand) as a new drug, which would require clinical studies showing that they do not impact the health of users. These studies could cost at least $300,000 each. According to the vaping industry, these restrictions could force many small vaping businesses to close.

The American Academy of Pediatrics, expecting that the market for e-cigarettes will continue to explode and the FDA will assert jurisdiction, is promoting the following position:

  • Sales of e-cigarettes to minors younger than 18 years old should be prohibited.
  • Candy and fruit-flavored e-cigarettes, which encourage youth smoking initiation, should be banned.
  • Federal, sate, and local government should enact and enforce laws that mandate the provision of smoke-free environments, including e-cigarette vapor, in all public places and require employers to provide smoke-free/e-cigarette vapor-free work environments for their employees.
  • To prevent poisoning, all e-liquids should be required to be sold in childproof packaging.

And, according to the Campaign for Tobacco Free Kids, “Responsibly marketed and properly regulated, it is possible that e-cigarettes could benefit public health if they help significantly reduce the number of people who use conventional cigarettes and die of tobacco- related disease. But in the absence of FDA oversight, the easy availability of nicotine in uncontrolled quantities, packaging and flavors and marketing that appeals to youth raises serious concerns.”

Resources

The following resources offer an array of viewpoints:

American Vaping Association, a nonprofit organization that advocates for small- and medium-sized businesses in vaping and electronic cigarette industry. 

Electronic Cigarettes: Vulnerability of Youth, recently published in the medical journal Pediatric Allergy, Immunology, and Pulmonology is an excellent review of scientific studies that look at various health-related claims about e-cigarettes.

Electronic Nicotine Delivery Systems, an excellent review of the basics of e-cigarettes from the American Academy of Pediatrics.

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