E-Cig Science Remains Hazy—and Is Still Emerging

Posted by on June 30, 2015

The science related to e-cigarettes (or e-cigs) remains hazy at best, primarily because e-cigs are relatively new to the marketplace. Nonetheless, scientists are diligently working to collect data on the use of e-cigs and their potential health effects. A simple PubMed search for published articles with the term “e-cigarette” in the title reveals about 50 publications in 2015 alone; this is just scratching the surface. Innovative Science Solutions (ISS) has been closely tracking the latest scientific developments related to e-cigs (see here for a post on tracking the science), as well as the US Food & Drug Administration’s (FDA’s) activities on this front—including its recent three-part workshop on e-cigs. In this post, we provide an update on some of the latest science that has emerged with regard to the safety and efficacy of e-cigs as smoking-cessation tools.

In case you missed it in recent news, for the first time, US government anti-smoking advertisements have targeted e-cigs. While some experts support the use of e-cigs as an effective tobacco smoking-cessation tool, others suggest that e-cigs may actually act as a gateway to tobacco use. Because the science related to the safety and efficacy of e-cigs is still in its infancy, it is crucial for all interested parties, including e-cig manufacturers, consumers, and attorneys, to stay informed.

Below, we highlight three recent e-cig studies; two are perception studies and one is a safety and efficacy study. The data drawn from these studies will likely help inform the FDA’s e-cig regulatory efforts.

Reasons for Electronic Cigarette Experimentation and Discontinuation among Adolescents and Young Adults

In this study, investigators examined whether e-cig experimentation and/or discontinuation by adolescents and young adults differed by school level or cigarette-smoking status. The researchers conducted focus groups and surveys among middle school, high school and college students to better understand why young people initiate and discontinue e-cig use. According to the authors, the primary reasons for experimentation were curiosity, appealing flavors, and peer influence, while the primary reasons for discontinuation included disinterest, perceiving e-cigs as “uncool,” and health concerns. The authors suggest that these data could inform prevention efforts that target youth e-cig use.

Electronic Cigarettes Efficacy and Safety at 12 Months: A Cohort Study

To evaluate the safety and efficacy of e-cigs as a smoking-cessation tool, investigators conducted a prospective cohort study that compared e-cigs users, tobacco smokers, and dual users (i.e., those of both tobacco and e-cigs).

Although researchers plan to present their final results in 2019, this interim study reported the results of the 12-month follow-up. After one year, researchers measured participants’ sustained smoking abstinence from tobacco and their reduction in the number of tobacco cigarettes smoked daily. According to the authors, the data suggest that the addition of e-cigs to tobacco smoking did not promote smoking cessation or reduction. However, the use of e-cigs alone may help ex-tobacco smokers remain abstinent from tobacco.

Smokers’ and Ex-smokers’ Understanding of Electronic Cigarettes: A Qualitative Study

Researchers conducted a qualitative study to evaluate how nicotine-containing products, specifically e-cigs, are perceived and experienced by smokers and ex-smokers.

The results of this study highlight the fact that there is an absence of concrete data related to the safety of e-cigs. The study findings suggest a general apprehension surrounding e-cig safety. The authors conclude that “the ambiguity around e-cigarettes in public health debates and medical practice is reflected in the positions and concerns of smokers. There is a need for both clear, up-to-date trustworthy information about their benefits and risks….”

Overall, as the FDA continues to scrutinize the scientific evidence related to e-cigs in their efforts to regulate these products, anyone with an interest in e-cigs should stay abreast of the regulatory happenings and science, so that they can be prepared to defend their company or client accordingly.

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On another note, earlier this month, the FDA hosted the third and final workshop on electronic cigarettes and public health. Scientists and medical experts, as well as public health officials, government agencies, and members of the tobacco industry, convened in Hyattsville, Maryland to report new scientific information and discuss e-cigs. Over the course of the two-day event, presentations and panelists addressed the following topics:

  • Prevalence and patterns of use
  • Reasons for use, and flavor and product appeal
  • Marketing
  • Knowledge, attitudes, and beliefs
  • Exhaled e-cig aerosols: evaluation of constituents and exposure
  • Health effects of secondary and tertiary e-cig exposure

While it is unclear how the FDA will use the information discussed and gathered during the three workshops, it is important to follow new developments, as they will be key in informing potential regulations.

Interestingly, when asked about his approach in the production of new government anti-smoking ads, Dr. Tom Frieden, director of the Centers for Disease Control and Prevention (CDC), said, “There’s still a lot we don’t know about e-cigarettes, and we have to remember they are tobacco products…. There are things we don’t know about their toxicity.”

Although the question of the safety and efficacy of e-cigs remains unresolved, new science continues to emerge at a fast pace. Given the potential liability issues that may unfold, it is critical for anyone in the e-cig industry to follow key scientific and regulatory developments.

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