The recent and growing epidemic of serious lung injury apparently related to electronic nicotine delivery devices, AKA electronic cigarettes or e-cigarettes, has caused us to rethink a lot of our assumptions in the tobacco control community.
For example, we assumed e-cigarettes were considerably safer than the standard combustible tobacco cigarettes. This assumption was based on reasonable science. Public Health England made the assertion in 2017 that e-cigarettes were “95% safer” compared with tobacco cigarettes. (1) This statement was based on the fact that the level of many toxic chemicals that are known to be disease causing and found in tobacco smoke were orders of magnitude lower in concentration in the e-cigarette aerosols tested. What we did not know at that time with how rapidly e-cigarette technology would advance and how widely e-cigarettes would diffuse in the population, particularly among youth. New devices and new electronic cigarette solutions used in those devices have come on the market in great numbers with uptake of these devices among our teenagers and young adults in astounding numbers.
We also assumed that e-cigarettes would provide a means for adult tobacco cigarette users to quit smoking tobacco in a way that was much more acceptable than the pharmacological treatments that are available. In fact, some early data suggests this might be possible. (3) But in this largely unregulated industry we have also seen products marketed to youth using attractive flavors and advertisements to entice young people to use them. The four-fold rise in the prevalence of current e-cigarette use among high school students in the United States from 2017 to 2018 (4), coupled with the report from the National Academy of Science, Engineering and Medicine showing that young people who use e-cigarettes are more likely to use tobacco cigarettes (5), has made us wonder whether we can “thread the needle” -- make e-cigarettes widely available to adults as an aid to smoking cessation, while keeping them out of the hands of teenagers.
I have abandoned most of my assumptions about e-cigarettes and the role they may play in ending the scourge of tobacco caused death and disease. My hope is that the current news grabbing had lines about the dangers of e-cigarettes will spur execution on effective regulation and awaken healthcare community to the role they should play in advising their patients about the dangers of e-cigarettes and in helping them to quit.
- McNeill A, Brose LS, Calder R, Bauld L & Robson D (2018). Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England.
- Centers for Disease Control and Prevention. Outbreak of severe pulmonary disease associated with using e-cigarette products: investigation notice. August 30, 2019 (link).
- Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med 2019; 380:629-637. DOI: 10.1056/NEJMoa1808779.
- Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018. MMWR November 16, 2018 / 67(45);1276–1277.
- National Academies of Sciences, Engineering, and Medicine. 2018. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press. DOI: Public Health Consequences of E-Cigarettes | The National Academies Press .
- AMERICAN ACADEMY OF PEDIATRICS, et al. v. FOOD AND DRUG ADMINISTRATION, et al. Case 8:18-cv-00883-PWG Document 73 Filed 05/15/19 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND. [PDF] Accessed 11SEP2019.