Over the six months that I’ve been a contributing editor to BioNews Texas, no item I’ve filed has drawn a more voluminous and passionate response than a report published on August 13 entitled “UTSA and UNTHSC Scholars To Study Health Effects Of Electronic Cigarettes.” In the article I noted that electronic cigarettes or “e-cigarettes” are being marketed by their manufacturers as a “healthier way to smoke” and as an aid to help users quit smoking, leading to debate over their safety and their effectiveness as a smoking cessation method, with some critics claiming that e-cigarettes may be as harmful, or even more harmful than tobacco cigarettes. Evidently, more than a few readers inferred that in writing the report I was taking an anti e-cigarette advocacy stance, which was not my intent. A former smoker myself, I am convinced that to say it’s better not to smoke is an understatement, and I know firsthand how difficult it is to quit, so if e-cigarettes can be demonstrated scientifically to be less harmful to users than smoking conventional tobacco cigarettes, then I’m a qualified supporter of the lesser evil. In general, any personal element of bias brought to the discussion in my reportage of this topic is oriented toward scientific proof, not promotion of any ideology. So, that established, once more into the breach.
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, e-cigarettes not marketed for therapeutic purposes are currently unregulated by the Food and Drug Administration. The FDA Center for Tobacco Products has announced that it intends to expand its jurisdiction over tobacco products to include e-cigarettes, but has not yet issued regulatory rules. The CDC maintains that while e-cigarettes appear to have far fewer of the toxins found in smoke compared to traditional cigarettes, their on long-term health must be studied, with research needed to assess how e-cigarette marketing could impact initiation and use of traditional cigarettes, particularly among young people. “If large numbers of adult smokers become users of both traditional cigarettes and e-cigarettes — rather than using e-cigarettes to quit cigarettes completely — the net public health effect could be quite negative,” says Tim McAfee, M.D., M.P.H., director of the CDC Office on Smoking and Health, commenting on a study released back in February of this year that found about six percent of all adults have tried e-cigarettes, estimates nearly doubling from 2010. Houston MD Anderson Cancer Center prevention experts Paul Cinciripini, Ph.D., director of the Tobacco Treatment Program, and Alexander Prokhorov, M.D., Ph.D., head of the M.D. 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,” notes Dr. Cinciripini who has more than 30 years’ experience conducting basic and clinical research in smoking cessation and nicotine psychopharmacology, 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.”
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Dr. Cinciripini’s concern in that regard is underscored in data published by the Centers for Disease Control and Prevention in a Morbidity and Mortality Weekly Report September 5 indicating that more than 75 percent of youth users of e-cigarettes smoke conventional cigarettes too, and that the percentage of U.S. middle and high school students who use electronic cigarettes, or e-cigarettes more than doubled from 2011 to 2012. The findings from the National Youth Tobacco Survey show that the percentage of high school students who reported ever using an e-cigarette rose from 4.7 percent in 2011 to 10.0 percent in 2012. During the same time period, the proportion of high school students using e-cigarettes within the past 30 days rose from 1.5 percent to 2.8 percent, and use also doubled among middle school students. Altogether, the report estimates that in 2012, more than 1.78 million middle and high school students nationwide had tried e-cigarettes. “The increased use of e-cigarettes by teens is deeply troubling,” says CDC Director Tom Frieden, M.D., M.P.H. in a release. “Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.” The study found that 76.3 percent of middle and high school students who used e-cigarettes within the past 30 days also smoked conventional cigarettes in the same period. In addition, one in five middle school students who reported ever using e-cigarettes say they have never tried conventional cigarettes. This raises concern that there may be young people for whom e-cigarettes could be an entry point or “gateway” to use of conventional tobacco products, including cigarettes.
“About 90 percent of all smokers begin smoking as teenagers,” says the CDC’s Tim McAfee. “We must keep our youth from experimenting or using any tobacco product. These dramatic increases suggest that developing strategies to prevent marketing, sales, and use of e-cigarettes among youth is critical.” Because e-cigarettes are largely unregulated, the agency does not have good information about them, such as the amounts and types of components and potentially harmful constituents. “These data show a dramatic rise in usage of e-cigarettes by youth, and this is cause for great concern as we don’t yet understand the long-term effects of these novel tobacco products,” says Mitch Zeller, director of FDA’s Center for Tobacco Products in the CDC release. “These findings reinforce why the FDA intends to expand its authority over all tobacco products and establish a comprehensive and appropriate regulatory framework to reduce disease and death from tobacco use.” Although some e-cigarettes have been marketed as smoking cessation aids, the CDC says there is no conclusive scientific evidence that e-cigarettes promote successful long-term quitting. However, there are proven cessation strategies and treatments, including counseling and FDA-approved cessation medications.
The CDC notes that cigarette smoking remains the leading preventable cause of disease, disability, and death in the United States, and is responsible for an estimated 443,000 deaths each year, and that for every one death, there are 20 people living with a smoking-related disease. To quit smoking, free help is available at 1-800-QUIT NOW or http://www.cdc.gov/tips. The National Youth Tobacco Survey was designed to provide national data on long-term, intermediate, and short-term indicators key to the design, implementation, and evaluation of comprehensive tobacco prevention and control programs. The NYTS also serves as a baseline for comparing progress toward meeting selected Healthy People 2020 goals for reducing tobacco use among youth: Under the Affordable Care Act, more Americans than ever will qualify to get health care coverage that fits their needs and budget, including important preventive services such as services to quit smoking that are covered with no additional costs. More information is available at Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more. Open enrollment in the Marketplace begins October 1 for coverage starting as early as January 1, 2014. More information is available in PDF format here: http://www.cdc.gov/tobacco/data_statistics/surveys/yts/pdfs/yts_brochure.pdf