A new paper co-authored by a majority of recognized tobacco control experts in the United Sates endorses the harm reduction benefits of vaping for adult smokers trying to quit combustible cigarettes. The group of experts state that the public image of vaping products must be improved and electronic nicotine-delivery systems (ENDS) should be promoted as a safer alternative to combustible cigarettes.
“Opponents focus on e-cigarettes’ risks for young people, while supporters emphasize the potential for e-cigarettes to assist smokers in quitting smoking. Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths,” the report states. “Because of their messaging, much of the public—including most smokers—now consider e-cigarette use as dangerous as or more dangerous than smoking. By contrast, the National Academies of Science, Engineering, and Medicine concluded that e-cigarette use is likely far less hazardous than smoking. Policies intended to reduce adolescent vaping may also reduce adult smokers’ use of e-cigarettes in quit attempts.”
The paper, published August 19 in The American Journal of Public Health, was led by Kenneth Warner, a professor emeritus of health management and policy at the University of Michigan and a distinguished tobacco control expert. Fifteen former presidents of the Society for Research on Nicotine and Tobacco (SRNT), the leading scientific professional society focused on nicotine and tobacco, co-authored the paper.
The authors present four categories of evidence supporting vaping as a quit aid for combustible tobacco use: the results of randomized trials, which show e-cigarettes outperform other cessation methods like nicotine patches; population studies, the findings of which “are consistent with a near doubling of quit attempt success”; cigarette sales, which decrease rapidly as vaping sales increase; and the unintended consequences of policies restricting vaping, such as bans that unintentionally shot up cigarette smoking.
“The major elements of the public health community that are concerned with tobacco have been singularly focused on the risk to kids,” Warner told Alex Norcia of Filter. “They seem to truly have no interest whatsoever in adult smokers. The other piece is that you’re seeing lots of allegedly scientific papers that are raising health concerns that are unwarranted.” One such paper, which claimed that vaping increased the likelihood of having a heart attack, was later retracted.
The paper also presents “a sensible mix of policies” to boost ENDS use, including taxing traditional cigarettes higher than e-cigarettes to encourage adult smokers to switch, allowing flavored vaping products available only at vape shops, restricting advertising to limit youth initiation and reducing the nicotine levels in cigarettes while ensuring the availability of “consumer-acceptable” reduced-risk nicotine products.
“Because evidence indicates that e-cigarette use can increase the odds of quitting smoking, many scientists, including this essay’s authors, encourage the health community, media, and policymakers to more carefully weigh vaping’s potential to reduce adult smoking-attributable mortality,” the paper states.
A research initiative on the potential harmful effects of electronic nicotine delivery systems (ENDS) by Chemical Insights, an institute of Underwriters Laboratories and Georgia State University’s School of Public Health are now underway. The collaboration will characterize airborne particulate aerosols and volatile organic chemicals released during e-cigarette use and determine human exposure levels and toxicity for users and bystanders, according to a press release.
Essentra Scientific Services’ new laboratory is dedicated to testing electronic cigarettes.
“With a focus on public health and safety benefits, our research findings will identify specific particles and chemicals that infiltrate the lungs of a user so that steps can be taken to reduce human health risks,” said Marilyn Black, vice president and senior technical advisor with Chemical Insights.
The release states that one contributing factor to youth use of ENDS is the perception that ENDS are a safer alternative to cigarettes and other traditional tobacco products. “However, a series of studies have proven pulmonary toxicity in e-cigarettes and a link to negative impacts on adolescents’ respiratory health,” the release states. “ENDS lags in product safety testing for numerous proprietary liquids and aerosol delivery methods available in the expanding marketplace.”
The study will reportedly provide scientifically sound data to inform policy makers, healthcare providers, manufacturers and consumers of potential health risks and approaches for product usage and label warnings to educate consumers of potential respiratory hazards, according to Roby Greenwald, assistant professor in the School of Public Health and co-principal investigator of the study. “We’re looking at multiple liquids and aerosol delivery methods that are readily available to better understand toxicity and their impact on human health.”
The U.S. Food and Drug Administration is currently evaluating the harm-reduction potential of vapor products through its premarket tobacco product application (PMTA) process. The regulatory agency has stated that ENDS are safer than combustible tobacco products, but do not come without risk.
Research findings will begin to be released in fall 2021.
If vapor product sales were restricted to tobacco flavors, one-third of U.S. vapers between the ages of 18 and 34 would switch to smoking combustible cigarettes, according to a new study in Nicotine & Tobacco Research.
The study analyzed data from February to May 2020 and looked at 2,159 young adults in Atlanta, Boston, Minneapolis, Oklahoma City, San Diego and Seattle, examining support for e-cigarette sales restrictions and the perceived impact of flavor and vaping bans.
This study precedes the FDA’s impending Sept. 9 deadline for premarket tobacco product application (PMTA) decisions, which could potentially take most vapor products off the market.
The FDA’s deadline will be “like watching an unstoppable object hit an immovable wall,” said Charles Gardner, executive director of INNCO, a global nonprofit supporting the rights of adults using safer nicotine products. “The FDA must know flavor bans will increase teen, young adult and older adult smoking.”
“In general, the FDA does not comment on specific studies but evaluates them as part of the body of evidence to further our understanding about a particular issue and assist in our mission to protect public health,” an FDA spokesperson said.
Two other recent studies showed similar results. A study in JAMA Pediatrics showed that following San Francisco’s flavor ban, teens were more likely to smoke than those in other school districts. A different study in Nicotine & Tobacco Research shows that teens who vape would be smoking cigarettes if vapes hadn’t become available.
“All hell will break loose if [the FDA] authorize[s] flavors as ‘appropriate for the protection of public health,’” said Gardner. “The Truth Initiative and the Bloomberg-funded Campaign for Tobacco-Free Kids have staked their reputations on the public health benefits of flavor bans. And many key leaders in the U.S. Congress believe them.”
Large companies may soon dominate the U.S. vapor market while e-cigarettes produced by smaller companies may disappear, according to new research by ECigIntelligence.
Analysis of FDA premarket tobacco product applications (PMTAs) shows that more applications for simpler disposables and cigalike devices were submitted than applications for open systems. According to ECigIntelligence, the simpler products usually come from large companies while the open systems usually come from smaller businesses.
Only about 30 open system brands have filed PMTAs, implying that 85 percent of open system brands will be removed from the market, even if all 30 filed PMTAs are approved.
“This may indicate the discouragement nontobacco companies face when applying for PMTA approval,” said ECigIntelligence Managing Director Tim Phillips. “The PMTA process can be a grueling one for nontobacco companies without sufficient financial means or knowhow. And if smaller brands are to become less prevalent in this category, consumers may soon only have the option of a few models provided by a handful of big companies.”
A study led by the University of California – Los Angeles (UCLA) has found that women who use electronic cigarettes during pregnancy are 33 percent more likely than those who don’t to give birth to low-birthweight infants, according to a press release. Low-birthweight babies — those weighing less than 5.5 pounds — often require specialized medical care and are at greater risk of early-life complications and long-lasting health issues, said Annette Regan, the study’s corresponding author and an adjunct assistant professor of epidemiology at the UCLA Fielding School of Public Health.
Credit: Duster 112
Findings from the study, which also involved researchers from the University of San Francisco, Texas A&M University and the U.S. Centers for Disease Control and Prevention, are published online in the journal Obstetrics & Gynecology.
The researchers analyzed data on approximately 80,000 mothers from the 2016–18 Pregnancy Risk Assessment Monitoring System, or PRAMS, a CDC-coordinated project that collects information nationwide on maternal experiences before, during and shortly after pregnancy. Among that cohort, 1.1 percent (800) reported having used e-cigarettes during the final three months of their pregnancy, and nearly two-thirds (533) of those e-cigarette users said they had also combustible cigarettes during that period.
“Although only a small percentage of people used e-cigarettes, we were surprised with how many used both e-cigarettes and combustible cigarettes during pregnancy,” said Regan, who also teaches at the University of San Francisco’s nursing school. “We found increased rates of low birthweight for e-cigarette users, and this occurred even for those who didn’t also smoke cigarettes.”
Juul Labs paid $51,000 to buy out an entire issue of the American Journal of Health Behavior (AJHB) and make it publicly available, the New York Times reported.
The AJHB’s May/June issue published 11 company-funded studies that promote the health benefits of Juul devices in helping smokers quit traditional tobacco products.
“Electronic nicotine delivery systems (ENDS) represent a significant opportunity to realize tobacco harm reduction at the population level around the world,” the authors write in an introduction to the journal.
Juul Lab’s five-figure buyout of the journal issue is part of a public influence campaign that the Center for Responsive Politics tallied at more than $3.9 million in 2020 alone.
Juul Labs recently reached a legal settlement with the state of North Carolina in which it will pay $40 million to avoid a jury trial over the question of whether it illegally marketed nicotine products to teens.
A large study conducted by the TPA shows e-cigarettes control youth smoking.
By Maria Verven
An extensive, state-by-state analysis conducted by the Taxpayers Protection Alliance (TPA) proves e-cigarettes are more effective in controlling youth smoking than tobacco control programs started after the Master Settlement Agreement (MSA).
“Tobacco & Vaping 101: 50 State Analysis,” authored by Lindsey Stroud, uses data from the Centers for Disease Control and Prevention (CDC) to argue the benefits of vaping, especially when it comes to teen usage. Ironically, this same data had been used to create public hysteria over vaping rates, especially among youth.
“As lawmakers across the country seek to reduce youth tobacco and vapor product use, many have introduced and passed legislation that regulates, taxes and in some cases prohibits the sale of products that actually help reduce tobacco use,” Stroud said.
Stroud said she’s been using the findings in state legislative testimony this year. “I’ve received positive feedback from pro-vaping and tobacco groups but have not heard much back from the anti-groups,” she said. “They may be surprised to see that I used the same data they do to argue the benefits of vaping,” she said, adding that she’s determined to make this information publicly available and accessible.
Stroud said she hopes other researchers and industry followers will use the report’s state-by-state information on adult and youth use of tobacco and vapor products in future articles and reports.
Of particular interest is the effectiveness—or lack thereof—of tobacco settlement payments, taxes and vapor products on reducing combustible cigarette use.
While all 50 states and Washington, D.C. saw a decrease in the percent of smokers, some states actually saw an increase in the number of smokers, due to an overall increase in the state’s population. Stroud’s analysis took into account both the percent difference and population change in examining adult and youth vapor and tobacco rates.
The analysis of cigarette tax revenues between 2000 and 2019 found that while cigarette tax hikes helped increase revenues in the short-term, these increases didn’t contribute to the decline in smoking rates.
It also shows that most states drastically underfunded programs for tobacco cessation services, education and prevention after collecting cigarette tax revenue and tobacco settlement monies over the past 19 years.
Vapor products tied to decrease in youth smoking
Of greatest importance is the analysis on the reduction in youth use of combustible cigarettes—which is at an all-time low. The report also examines youth vapor rates, specifying whether they ever tried an e-cigarette or are truly current or daily users.
Here’s where the data got really interesting. Stroud compared the smoking rates among 18-year-olds to 24-year-olds in the 10 years after the MSA with the smoking rates in the 10 years after e-cigarettes appeared on the market.
Credit: Vaksmanv
Lo and behold, there were greater decreases in smoking rates in the 10 years after the emergence of e-cigarettes when compared to the 10 years after tobacco settlement lawsuits.
And in the four states where smoking rates actually increased after e-cigarettes came on the market, policymakers had increased scrutiny and restrictions on e-cigarettes due to the perceived youth vaping “epidemic.” Coincidence? Stroud doesn’t think so.
“Addressing youth use of any age-restricted product is laudable, but it should not come at the expense of adult users of such products,” Stroud wrote in Politics, adding that bans, arduous regulations and/or unfair taxation threaten adult access to e-cigarettes and other tobacco harm reduction products.
“Completely disregarding that youth smoking rates are at all-time lows, officials often propose ‘solutions’ that fail to address the real reason why youth use e-cigarettes,” Stroud said.
States with higher rates of youth smoking have higher rates of youth vaping. Stroud said that the data clearly indicate that youth use e-cigarettes because friends and family members use them.
When asked about the “primary reason” for using e-cigarette products (among current users, only 10 percent of respondents from many states answered it was due to “flavors” while 17 percent cited “friends and family” and 51 percent cited “other.”
Vapor Voice caught up with Lindsey Stroud to learn more about this groundbreaking report and how this plethora of tobacco and vaping data can be used to inform future policymaking.
Vapor Voice: How was all this data collected? How long did it take?
Stroud: The idea was to provide policymakers with a plethora of tobacco-related data in a simplified manner.
We compiled the data manually by inputting data from the Centers for Disease Control and Prevention’s Behavior Risk Factor Surveillance System (BRFSS) between 1995 and 2019.
While state-specific BRFSS data included detailed demographic information such as age, gender, race, education level, income and smoking status, it wasn’t easy finding that data for the U.S. as a whole. So I started going through individual state data and putting together state-specific spreadsheets on cigarette use.
In addition, I examined annual state cigarette tax receipts, annual state tobacco control funding, cigarette tax increases and youth tobacco and vapor product use, which came from the CDC’s Youth Risk Behavior Survey.
It’s important to note that the Campaign for Tobacco-Free Kids also uses this same BRFSS data. However, while Tobacco-Free Kids only shows smoking rates and the cost of smoking in each state, we pulled various data items to tell a more complete, insightful picture.
What surprised you the most about this project?
I was amazed that my hypothesis—that e-cigarettes were more effective than the MSA in reducing smoking rates among young adults—actually held true. It was really eye-opening.
It’s still pretty amazing that 45 states and D.C. saw greater decreases in smoking rates among 18[-year-old] to 24-year-old adults in the 10 years after e-cigarettes emerged on the market than in the 10 years after the tobacco companies started shelling out millions that states were supposed to use on smoking cessation programs.
In the outlier states, smoking rates were at their lowest levels ever until 2018—the same year the surgeon general declared a “youth vaping epidemic.” Tragically, that’s when smoking rates began to increase.
Why did you feel this data was needed?
I really wanted to show policymakers data that compared youth vaping to youth smoking rates, which were way higher in the 1990s, especially compared to today’s youth vaping rates.
In all states, cigarette tax increases led to immediate increases in revenue in the short term, but these have all fallen as less adults smoke cigarettes.
I also wanted to call attention to the lack of state funding for tobacco control programs, despite the fact that states receive millions if not billions of dollars annually from tobacco monies such as excise taxes and tobacco settlement payments.
As far as I know, this is one if not the first analysis of the BRFSS data to include graphs—which clearly show the reduction in smoking rates among young adults as well as how little funding is spent on tobacco control.
Finally, I wanted to prove my hypothesis that vaping can take much of the credit for the reduction in both adult and youth smoking rates.
Policies that restrict the sale of flavored e-cigarettes, e-liquids and other tobacco products including menthol cigarettes impact health disparities among vulnerable populations is the subject for a new study to be conducted by the University of Kentucky College of Medicine. The five-year, $2.8 million grant from the National Cancer Institute (NCI) will support the study on how local policies impact at-risk groups — including communities of color, low-income populations and youth — that are more likely to use flavored tobacco products.
Credit: Wolterke
The results could help lawmakers create policies that are more equitable, says the study’s principal investigator Shyanika Rose, Ph.D., a faculty member of the Center for Health Equity Transformation (CHET), assistant professor in the Department of Behavioral Science and member of the Markey Cancer Center Cancer Prevention and Control Program. “We already know that stopping the sale of these products can reduce their availability and use in these communities,” said Rose. “But understanding the impact of policies across race and socioeconomic status will give guidance about what kinds of policies work and have the most equitable benefits.”
Rose says flavored tobacco (including vaporizers and e-cigarettes) products, which are more appealing, easier to use and more addictive, have a long history of being disproportionately marketed toward vulnerable communities, particularly African Americans. Currently, federal laws only prohibit the sale of certain flavored tobacco products.
The sale of menthol cigarettes and all flavors of smokeless tobacco, cigars and hookah is still permitted. While the Food and Drug Administration recently announced new steps to implement a ban on the sale of menthol cigarettes and flavored cigars, the proposal will not eliminate all flavored tobacco products from the market, specifically flavored e-cigarettes and e-liquids.
“While the FDA is moving federal policy in the right direction, comprehensive policies that restrict the sale of all flavored tobacco products may be more likely to protect the health of the most vulnerable populations and this is something this project will investigate,” Rose said.
A comprehensive review of the scientific evidence for vaping products, their potential health effects and their role in tobacco harm reduction by BAT as World Vape Day sets to be celebrated on May 30.
Credit: Coloures Pic
This review shows that, over the past decade, the number of people who incorrectly believe vaping is as harmful or more harmful than smoking conventional cigarettes has risen in the UK, Europe, and the U.S., according to a press note. This is despite several scientific reviews published in the same period showing that vaping products manufactured in accordance with quality standards present less risk to health than combustible cigarettes.
According to population modelling studies cited in the review, a significant reduction in premature deaths could be achieved if current smokers switched exclusively to vaping rather than continuing to smoke. These modelling studies use population data and simulations to project the health-related outcomes associated with the long-term risks of smoking versus vapour use over time.
David O’Reilly, Director of Scientific Research at BAT, said the paper is a comprehensive summary of more than 300 peer-reviewed scientific papers and other evidence published by an estimated 50 institutions over the past decade.
“The scientific evidence is clear – but consumer misperceptions remain. In England and the United States, only one in three adults is aware that there is scientific evidence available, including from leading public health authorities, that supports the conclusion that vaping is less harmful than smoking,” O’Reilly said. “The reality is that many leading public health authorities have reported that vaping is less harmful than smoking, and that this harm reduction potential can be maximized if those smokers who would otherwise continue to smoke switch exclusively to using vapor products.”
The review highlights that vaping products can effectively compete with combustible cigarettes by providing nicotine and the sensorial enjoyment sought by smokers, according to the press note.
In 2018, San Francisco voters overwhelmingly approved a ballot measure banning the sale of flavored vaping products. Public health advocates celebrated the law that supporters say was justified because flavors attract youth to vaping. A new study suggests that law may have backfired and driven more kids to try combustible cigarettes.
Credit: YSPH
According to a new study from the Yale School of Public Health (YSPH), researchers say that after the ban’s implementation, high school students’ odds of smoking conventional cigarettes doubled in San Francisco’s school district relative to trends in districts without the ban, even when adjusting for individual demographics and other tobacco policies, according to press release.
The study, published in JAMA Pediatrics on May 24, is believed to be the first to assess how complete flavor bans affect youth smoking habits. “These findings suggest a need for caution,” said Abigail Friedman, the study’s author and an assistant professor of health policy at YSPH. “While neither smoking cigarettes nor vaping nicotine are safe per se, the bulk of current evidence indicates substantially greater harms from smoking, which is responsible for nearly one in five adult deaths annually. Even if it is well-intentioned, a law that increases youth smoking could pose a threat to public health.”
Friedman used data on high school students under 18 years of age from the Youth Risk Behavior Surveillance System’s 2011-2019 school district surveys. Prior to the ban’s implementation, past-30-day smoking rates in San Francisco and the comparison school districts were similar and declining. Yet once the flavor ban was fully implemented in 2019, San Francisco’s smoking rates diverged from trends observed elsewhere, increasing as the comparison districts’ rates continued to fall.
To explain these results, Friedman noted that electronic nicotine-delivery systems (ENDS) have been the most popular tobacco product among U.S. youth since at least 2014, with flavored options largely preferred. “Think about youth preferences: some kids who vape choose e-cigarettes over combustible tobacco products because of the flavors,” she said. “For these individuals as well as would-be vapers with similar preferences, banning flavors may remove their primary motivation for choosing vaping over smoking, pushing some of them back toward conventional cigarettes.”
The San Francisco study does have limitations. Because there has been only a short time since the ban was implemented, the trend may differ in coming years. San Francisco is also just one of several localities and states that have implemented restrictions on flavored tobacco sales, with extensive differences between these laws. Thus, effects may differ in other places, Friedman wrote.
Still, as similar restrictions continue to appear across the country, the findings suggest that policymakers should be careful not to indirectly push minors toward cigarettes in their quest to reduce vaping, she said.
