Christine Cheng, Smoking Cessation Leadership Center at UCSF

Why E-cigarettes Have Some People All Choked Up

If you follow the news at all, you’ve probably noticed a lot of talk about whether e-cigarettes are safe. Do they help people quit smoking traditional cigarettes? Can they lead people, especially young people, to other substances? So let’s explore why these newbies to the nicotine world have some folks all choked up.

E-cigarettes (also known as ENDS, Electronic Nicotine Delivery Systems) are devices that operate electronically by “vaporizing” (more accurate term is aerosolizing) a liquid solution that contains nicotine.  The aerosol or vapor is then inhaled by the user.  Some of the recent models are based on a 2003 invention by a Chinese pharmacist after seeing his father die from lung cancer caused by smoking.

While these devices are growing in popularity, unlike traditional tobacco products, e-cigarettes are not currently regulated by the FDA. The agency has issued a proposed rule that would extend its tobacco authority to cover additional products such as e-cigarettes but final ruling has yet to occur and most likely may take years. This concerns many in the public health field because e-cigarettes are rapidly evolving devices with an increasing number and variety of models available for purchase online and in mall kiosks, from ciga-likes or minis (looks just like a traditional combustible cigarette) to mid-sized ones, to “tanks” or modified systems.

Cost savings claims are being made by the e-cigarettes makers (many of the brands are owned by tobacco companies) and celebrity (film, music, and sports stars) endorsement of e-cigarettes are pervasive.  Earlier this year, the CDC reported a rise in calls to poison centers related to fluids in the e-cigarettes and well as the alarming increase of youth use of e-cigarettes, tripling from 2011 to 2012. In fact, just last month, a CDC study found that more than a quarter-million youth who had never smoked a cigarette used e-cigarettes in 2013.

As with any novel products, debates about the e-cigarettes abound.  Some providers are advocating using them as part of “harm reduction” and others have argued that they are a potential gateway to combustible cigarettes and other illicit drugs such as marijuana and cocaine for young adults.  While it is true that e-cigarettes are safer than combustibles, more data and research are needed before they can be deemed “safe”.

While supporters of e-cigarettes claim that they can help traditional smokers quit, the potential clinical and health risks and benefits of e-cigarette use as part of cessation treatment have yet to be determined. 

More and more public health experts are urging that e-cigarettes be regulated swiftly – especially to prevent youth consumption. In fact, on Monday, Aug. 24, 2014, a WHO report recommended ending e-cigarette use indoors and other regulations.  The report explains that while further research is needed on many areas of e-cigarette use, regulations are required now to address health concerns, in particular for:

  • Advertising: An appropriate government body must restrict e-cigarette advertising, promotion and sponsorship, to ensure that it does not target youth and non-smokers or people who do not currently use nicotine.
  • Indoor use: legal steps should be taken to end use of e-cigarettes indoors in public and work places. Evidence suggests that exhaled e-cigarette aerosol increases the background air level of some toxicants, nicotine, and particles.

Many thanks to CADCA for the opportunity to present on e-cigarettes with the other panelists at the2014 Mid-Year Training Institute on the session titled, “New Trends Got You All Choked Up? A Dialogue with Leading Tobacco Control Organizations”.

Christine Cheng is the Partner Relations Director at the Smoking Cessation Leadership Center at UCSF, a national program office of the Robert Wood Johnson Foundation.  SCLC also receives significant funding from the Legacy Foundation.