Debate, Research on E-Cigarettes Continue

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December 11, 2014 by NCI Staff

A photo of two electronic cigarettes

Electronic cigarettes, also known as e-cigarettes, are battery-operated products designed to deliver nicotine, flavor and other chemicals.

Since they first began to be sold in North America in the mid-2000s, electronic cigarettes have been the subject of intense debate.

With more than 400 brands and many different looks and styles currently available, e-cigarettes are clearly a market that is “rapidly evolving,” said Dr. Michele Bloch, chief of NCI’s Tobacco Control Research Branch.

Dr. Bloch provided an update on some of the issues surrounding e-cigarettes at the December 2 joint meeting of NCI’s National Cancer Advisory Board and Board of Scientific Advisors.

Although cigarette is in the name, e-cigarettes are different in composition and design than traditional cigarette products. E-cigarettes come in many shapes and sizes, but are typically comprised of a battery, a heating element, and a reservoir for the liquid solution that usually contains nicotine (often called e-liquid).  

And although the use of e-cigarettes is often referred to as “vaping,” the term is a misnomer, Dr. Bloch noted, because the products emit an aerosol—“a dense fog of liquid droplets”—and not a vapor. As Dr. Bloch explained, very small particles in the aerosol “can penetrate deep into the lungs,” making the presence of toxic chemicals in the aerosol potentially hazardous.

As a result, emissions from e-cigarettes also have implications for smoke-free laws. The question, Dr. Bloch continued, isn’t whether e-cigarettes produce less toxicants than traditional cigarettes. “The standard should be clean air,” she said. “There are undoubtedly toxicants that these [products] release and bystanders are exposed to them.”

Proponents argue that e-cigarettes are far less harmful than traditional tobacco products and can help people to quit smoking. However, many tobacco control experts argue that there are a host of unknowns about these products that make such a conclusion premature.

For example, although there are some data on who uses e-cigarettes, it is less clear how they are using the products and what impact that will have on cigarette smoking and other tobacco product use (e.g., adults trying to quit smoking traditional cigarettes, teens who have already experimented with or are regularly using traditional tobacco products).  

There are also concerns that the e-liquid flavors—more than 7,000 have been catalogued, ranging from bacon to peanut butter chocolate—are particularly attractive to adolescents and teens, making the products a potential gateway to traditional tobacco products. There are data that suggest this is a real possibility. A recent CDC study found that never-smoking youth who have used e-cigarettes are twice as likely to say they intend to smoke conventional cigarettes than never-smoking youth who have not used e-cigarettes.

And at a time when cigarette smoking rates have hit their lowest levels since they started being widely tracked in the mid-1960s, some in tobacco control are worried that widespread e-cigarette use could serve to “renormalize smoking,” said Dr. Bloch.

As for e-cigarettes’ role in cessation, the available evidence is limited, including little data on short- and long-term safety of these products.

The bottom line, Dr. Bloch said, is that quitting cigarettes entirely as quickly as possible is key, “because continued smoking, even at reduced levels, continues to impose health risks.”

Researchers, including many funded by NCI and other NIH institutes, are studying e-cigarettes, Dr. Bloch told advisory board members. That research includes projects supported by the Food and Drug Administration’s Center for Tobacco Products to assess issues like e-cigarette aerosol toxicity and the impact of marketing on e-cigarette use, among others, to inform the agency’s development of an appropriate regulatory framework.

Dr. Bloch’s entire presentation is available on NIH videocast.

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