Behavioral scientists at The University of Texas MD Anderson Cancer Center in Houston note that the third and largest of the U.S. tobacco companies are planning to launch e-cigarette products this fall, opening what they characterize as the next frontier for “Big Tobacco” in renewing its presence in a declining marketplace. These smoking cessation experts warn the e-cigarettes constitute a potential gateway to new smokers taking up the habit, particularly among teens and in emerging/foreign markets.
E-cigarettes are battery-powered devices that provide inhaled doses of nicotine vapors and flavorings. According to an MD Anderson Center release, the Centers for Disease Control and Prevention estimates that approximately six percent of adults have tried e-cigarettes, a metric that has nearly doubled since 2010. Being absent of tobacco, e-cigarettes have been promoted as a possible aid in getting people to stop smoking and thereby reducing their lung cancer risk.
However, MD Anderson cancer prevention experts Paul Cinciripini, Ph.D., director of the Tobacco Treatment Program, and Alexander Prokhorov, M.D., Ph.D., head of the MD Anderson Center Tobacco Outreach Education Program, and professor in the M.D. Anderson Department of Behavioral Science, caution that more research is needed to understand the potential role of e-cigarettes in smoking cessation.
“Independent studies must rigorously investigate e-cigarettes, as there’s considerable potential benefit in these products if they’re regulated and their safety is ensured,” says Dr. Cinciripini in a release. “But promoting the e-cigarettes already on the shelves as ‘safe’ is misleading and, if looked at as a harmless alternative to cigarettes, could potentially lead to a new generation of smokers more likely to become tobacco dependent.”
With the impending introduction to the marketplace of another e-cigarette, Drs. Prokhorov and Cinciripini urge consumers to make themselves aware the following information:
— E-cigarettes are unregulated and there’s little research on their safety or efficacy as smoking cessation tools. “These products are not approved by the Food and Drug Administration and this is concerning because it’s impossible to know what you’re really getting or if it’s safe. In one analysis nicotine levels have been shown to vary widely among e-cigarette products,” says Dr. Prokhorov. For now, he recommends that those looking to quit stick with approved devices, such as nicotine inhalers.
— Switching from tobacco to e-cigarettes could help smokers avoid approximately 6,000 chemicals, some of which are human carcinogens. “Reduced exposure to harmful chemicals warrants research of these products as a smoking cessation vehicle,” says Dr. Cinciripini. “Unbiased studies, free from the ethical and legal challenges of ‘Big Tobacco’-sponsored trials, are needed.”
— Branded as “safer,” available in a variety of colors and flavors and promoted by celebrities, e-cigarettes could be a hook for future smokers. “E-cigarettes are a novel way to introduce tobacco smoking to young people, and their potential ‘gateway’ role should be a concern for parents and health officials alike,” adds Dr. Prokhorov.
“Once a young person gets acquainted with nicotine, it’s more likely that they’ll try other tobacco products. E-cigarettes are a promising growth area for the tobacco companies, allowing them to diversify their addictive and lethal products with a so-called “safe cigarette,” Dr. Prokhorov observes. “Unfortunately, there’s no proof that e-cigarettes are risk-free.”
Dr. Cinciripini has more than 30 years’ experience conducting basic and clinical research in smoking cessation and nicotine psychopharmacology. Dr. Prokhorov is the principal architect of MD Anderson’s ASPIRE program, a teen-focused website and, Tobacco Free Teens, a smartphone app designed to discourage teens from taking up smoking and/or encourage them to quit if they’ve started. The app is available for free on the Apple iTunes Store.
Speaking of technological aids to smoking cessation, an app developed by Dr. Prokhorov to help persuade teens from taking up smoking and to encourage them to quit if they’ve started is now just a few taps away and available free on the Apple iTunes Store.
“Our app combines education and entertainment with comics and interactive games,” says Dr. Prokhorov. “It motivates teens to stay away from tobacco and teaches behavioral skills to help them resist pro-tobacco pressures. Such an approach is much more appealing to youth than text-based instructional tools.”
Dr. Prokhorov, is also director of MD Anderson’s Tobacco Outreach Education Program, led the development of theTobacco-Free Teens app from content largely drawn from MD Anderson’s ASPIRE (A Smoking Prevention Interactive Experience) program, a bilingual, online tobacco prevention and cessation curriculum targeting middle and high school students around the world.
Equipped with animated teen characters and contemporary tunes, the app – available for the iOS platform – addresses those who have never smoked, those wanting to quit, those having trouble quitting and those not interested in quitting. The app includes gaming activities that reinforce smoking-cessation tips tailored for the teenage audience. In one game the user’s task is to tap away various temptations to smoke – depicted as objects – that rapidly move around the smartphone screen.
Another game challenges teens to match two pairs of cards that contain memorable images of smoking consequences including yellow teeth, bad breath and stained fingers. “Every module of the app was carefully designed with teens in mind,” says Dr. Prokhorov. “Most teens are very particular about their appearance and don’t realize that smoking can affect their appearance well before they develop cancer.”
Dr. Prokhorov has been on the edge of prevention and smoking-cessation technology innovations for teens for many years now, and is co-director of MD Anderson’s e-Health Technology Program, which is funded by the Duncan Family Institute for Cancer Prevention and Risk Assessment. He is confident the app will serve as a handy tool to help dissuade teens from smoking, educate and encourage teen smokers to quit, and prevent relapse among recent quitters.
“The Tobacco-Free Teens app is a perfect tool complimenting the many smoking-cessation efforts that are underway at MD Anderson,” says Dr. Prokhorov. “We’re proud to be among the pioneers of tobacco prevention and cessation apps.”
Tobacco-Free Teens was funded by the Tobacco Outreach Education Program (TOEP). It has been downloaded more than 1,000 times since its launch June 27 on the Apple iTunes App store.
During his tenure at MD Anderson, Dr. Prokhorov has established a strong record of obtaining state and federally funded research grants and has authored numerous peer-reviewed publications and book chapters. His work primarily focuses on creating and testing innovative tobacco prevention and cessation programs for high-risk teens and young adults. His interactive multimedia Web site ASPIRE (A Smoking Prevention Interactive Experience) has reached thousands of young users in Texas, across the nation and the world. He also develops programs aimed at increasing awareness of the tobacco risks among the general public and enhancing smoking cessation counseling skills among health care providers in Texas and beyond. Dr. Prokhorov also has projects with low income adults as a Principal Investigator for “Enhancing Cancer Outreach for Low-Income Adults with Innovative Smoking Cessation.” This study uses an existing network of community sites to deliver smoking cessation treatment to a multiethnic population of uninsured and underinsured adults living in the greater Houston, Texas metropolitan area.
Dr. Cinciripini serves as Professor and Deputy Chair for the Department of Behavioral Science, and is the Director of the Tobacco Treatment Program at MD Anderson Cancer Center. He has over 30 years experience conducting basic and clinical research in the area of smoking cessation and nicotine psychopharmacology. His major research interests include studies developing novel behavioral and pharmacological treatments for nicotine dependence, and those that study individual differences associated with treatment outcome. In particular Dr. Cinciripini’s work in this area has focused on psychological (negative affect, coping self-efficacy ), psychophysiological (emotional reactivity), neural (EEG/fMRI) and genetic predictors of treatment outcome (pharmacogenetics). In addition to community based samples my work has also involved populations with psychiatric and medical co-morbidities including depression, pregnancy and cancer. Dr. Cinciripini has authored over 120 articles and book chapters, conducted over 18 NIH and other sponsored randomized clinical trials examining behavioral and pharmacological interventions for smoking cessation, served as a senior co-investigator on over 20 NIH sponsored trials, and mentored 18 junior scientists.