January 24, 2018

E-cigarettes might help adults quit—but help young people start, landmark report finds

Daily Briefing

    Electronic cigarettes (e-cigarettes) are less harmful than traditional cigarettes, but evidence suggests the products encourage young people to begin smoking—even as they might help adults quit, according to a comprehensive report released Tuesday by a National Academies of Sciences, Engineering, and Medicine (NASEMEM) panel.

    How to get the word out about lung cancer screening

    About e-cigarettes

    E-cigarettes have been sold in the United States for at least a decade, according to the Associated Press. After years of industry resistance, FDA gained regulatory authority over e-cigarettes in 2016. FDA at the time commissioned the NASEM report to review existing science and identify gaps in research on e-cigarettes, according to Mitch Zeller, head of FDA's tobacco division.

    Report findings

    For the report, a NASEM panel reviewed more than 800 studies on e-cigarettes—though the authors noted that much of the existing research contains flawed methodology or is funded by industry.

    NASEM said there was sufficient evidence to suggest e-cigarettes are less harmful than traditional cigarettes—though, according to Vox, that's a low baseline: Traditional cigarettes are among the riskiest consumer products available, accounting for nearly one in five deaths in the United States each year, according to CDC data.

    The researchers said that e-cigarettes contain numerous potentially toxic chemicals, but they contain fewer toxic chemicals than conventional cigarettes, and the chemicals are present in lower levels. This, according to Vox, is partly due to how the two products operate: E-cigarettes heat liquid nicotine to produce a vapor, but they do so at lower temperatures than traditional cigarettes. Experts say the higher heat produces more toxic chemicals in tobacco smoke.

    The researchers said replacing conventional cigarette use with e-cigarette use could significantly reduce exposure to cancer-causing chemicals, but that a user would need to use e-cigarettes exclusively to see those benefits.

    The authors said there was "insufficient evidence" to determine whether e-cigarettes could help adult tobacco users quit smoking. They noted that several observational studies—which the authors considered to be less robust than randomized controlled trials—showed "moderate evidence ... that more frequent use of e-cigarettes is associated with increased likelihood of cessation."

    Meanwhile, the researchers found "substantial" evidence that e-cigarette use among young users correlates with traditional tobacco use later in life, based on 10 high-quality studies into the connection between youth e-cigarette use and conventional tobacco use.

    Implications for public health

    The researchers wrote, "Under the assumption that using e-cigarettes increases the net cessation rate of combustible tobacco cigarettes among adults, the modeling projects that in the short run, use of these products will generate a net public health benefit, despite the increased use of combustible tobacco products by young people."

    However, the researchers continued, "Yet in the long term (for instance, 50 years out), the public health benefit is substantially less and is even negative under some scenarios. If the products do not increase combustible tobacco cessation in adults, then with the range of assumptions the committee used, the model projects that there would be net public health harm in the short and long term."

    The report says further research into the health implications of e-cigarettes is needed.

    Discussion

    David Eaton, who led the analysis and serves as dean and vice provost of the University of Washington's graduate school, said, "E-cigarettes cannot be simply categorized as either beneficial or harmful."

    According to the Times, the vaping industry was "cautiously optimistic about the report." Gregory Conley, president of the American Vaping Association, said, "In the wake of this report, it is more apparent than ever that true leadership is needed in public health to ensure that adult smokers have access to truthful information about the benefits of switching to smoke-free products."

    Meanwhile, public health advocates said the report does not ease existing concerns.

    Matthew Myers, president of Campaign for Tobacco-Free Kids, said, "What the report demonstrates is that despite the popularity of e-cigarettes, little is known about their overall health effects, and there is wide variability from product to product." He added, "That makes the case even stronger for F.D.A. regulation."

    FDA Commissioner Scott Gottlieb said the report would be key in the agency's efforts to regulate e-cigarettes. "We need to put novel products like e-cigarettes through an appropriate series of regulatory gates to fully evaluate their risks and maximize their potential benefits," Gottlieb said (Perrone, AP/Sacramento Bee, 1/23; Kaplan, New York Times, 1/23; Belluz, Vox, 1/23; Neighmond, "Shots," NPR, 1/23; Anapol, The Hill, 1/23).

    How to get the word out about lung cancer screening

    Ten million individuals nationwide are eligible for lung screening every year—but the average program only screens about 25. Given its potential to increase survival and volumes, lung cancer screening is one of the best opportunities to achieve program cost, quality, and growth goals.

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