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Electronic Cigarettes: What You Don’t Know Can Hurt You

On May 14, 2015, the AACR in cooperation with Representative Jackie Speier (D-Calif.) and Senator Richard Blumenthal (D-Conn.) sponsored a briefing entitled, “Electronic Cigarettes: What You Don’t Know Can Hurt You.”

While the merits of electronic cigarettes and other electronic nicotine delivery systems (ENDS) as smoking cessation tools remain the subject of intense research and discussion, the AACR and other organizations have become concerned with the rising popularity of these devices, particularly among underage youth, in the absence of hard data demonstrating their safety. In January, the AACR in conjunction with the American Society of Clinical Oncology (ASCO) released a policy statement that detailed 14 policy recommendations regarding the use, marketing, and sale of ENDS.

Both Rep. Speier and Sen. Blumenthal provided remarks at the briefing. Rep. Speier voiced her support of ENDS regulation and discussed her bill called the SMOKE Act (“Stop Selling and Marketing to Our Kids E-Cigarettes Act”, H.R. 5010), which seeks to fill the gaps in the proposed FDA regulatory rules on ENDS, including restrictions on marketing to children, introduction of safety standards such as childproof caps, and a ban on flavors that are “clearly being targeted” at youth. Sen. Blumenthal made the point that Big Tobacco views ENDS as a means to addict youth to nicotine and thus as a gateway to combustible tobacco products. This is evidenced by the proliferation of the use of advertising for ENDS using means that have been banned for combustible tobacco for more than 40 years.​

In addition to Rep. Speier and Sen. Blumenthal, the following participants provided remarks (click on each name to read/download a PDF of their presentation):

  • Roy S. Herbst, MD, PhD, chief of medical oncology, Yale Comprehensive Cancer Center, New Haven, Connecticut
  • Maciej Goniewicz, PhD, PharmD, assistant professor of oncology, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
  • Brian Kin​g, PhD, MPH, deputy director for research translation (acting), Office on Smoking and Health, CDC, Atlanta, Georgia

A brief history of ENDS was discussed, including the evolution of products from small “cigalikes” to newer, more sophisticated devices that offer the user more customization in terms of vapor flavor and nicotine concentration. The variability of these products makes their evaluation difficult, yet there does appear to be consensus that they are less harmful than combustible tobacco products. However, we don’t yet understand the risks and potential harm of their use by nonsmokers, particularly because of ethical concerns around testing their effects on naïve users.

Also discussed in this briefing were recent studies by the Centers for Disease Control and Prevention (CDC) beginning with the HealthStyles survey in 2009 and including ongoing efforts. While studies are ongoing and state-level data is expected to be available later this year, some of the major takeaways from the data currently available include the following:

  • 77 percent of ENDS users still smoke cigarettes (i.e., are “dual users”), and this number has been increasing, while the percentage of former smokers using ENDS has remained stable. These data suggest that ENDS use might be promoting dual use vs. cessation.
  • Use of ENDS among high school students has tripled in the past year and has increased nine-fold over the past three years (2011-2014). Based on self-reported data, more than 2.5 million high school students have used an ENDS product in the previous 30 days.
  • More than 250,000 people who had never smoked combustible tobacco used ENDS in 2013, and studies show that the intent to smoke cigarettes is greater in users of ENDS vs. those who don’t use ENDS.

Download the briefing fl​yer.

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