Panelists at GW discuss challenges regulating and measuring long-term impacts of tobacco alternatives.
“Vape pipes,” “hookah pens,” “e-hookahs”—depending on your location, age and preferred brand, any of these names might apply to the battery-powered electronic cigarettes that are quickly growing in popularity among young people.
But do e-cigarettes, by any other name, harm as much as traditional tobacco products?
That’s the question troubling public health experts who say that, with the wide variety of brands and new names on the market, measuring the use of e-cigarettes and their health effects is becoming an increasingly difficult task.
“E-cigarettes are the topic du jour in tobacco control. There are well over 450 brands, and that’s a low-ball estimate,” said Brian King, a deputy director for research translation at the Centers for Disease Control, at the George Washington University Wednesday. “This is important to keep under consideration when we’re assessing surveillance.”
Dr. King joined a panel of experts who addressed these challenges during a forum held at the Milken Institute School of Public Health. The event was the second in a series of research forums hosted by GW’s Office of Industry and Corporate Research within the Office of the Vice President for Research and ICF International.
E-cigarette use among high school students tripled from 4.5 percent in 2013 to 13.4 percent in 2014, according to CDC findings from the National Youth Tobacco Survey. The CDC data shows that traditional cigarette use fell for high school students and remained the same for middle school students in the same time period.
Since e-cigarettes don’t contain tobacco, e-cigarette companies have argued that their products are not as toxic as regular cigarettes. Some health professionals also have said that e-cigarettes could actually be helpful tools for smokers who are trying to quit.
“On the other side of that, the e-juices or e-liquids contain a variety of harmful constituents, which includes nicotine, a poisonous and addictive substance,” said Kimberly Horn, the associate dean of research at Milken SPH. Dr. Horn also directs the new D.C. Metro Tobacco Research and Instruction Consortium (MeTRIC), a partnership of DC-based experts in tobacco control.
She pointed out that the rapid rise in e-cigarette use concerns public health officials who also worry that the products could act as a gateway to tobacco products or drugs.
Jennifer Pearson, M.P.H., ’07—GW alum and research investigator at the Schroder Institute for Tobacco Research—discusses how to better conduct e-cigarette research.
But Ray Niaura, associate director of the Schroder Institute for Tobacco Research and Policy Studies, warned against ringing any alarm bells too soon.
“Beware of strong opinions disguised as scientific fact.” Dr. Niaura said. “That’s not to say that there aren’t important issues on both sides, but we know far less than we’d like to at this point.”
On the issue of addiction, he noted that there is a fundamental difference between smoking e-cigarettes and smoking tobacco products.
“When people are smoking a cigarette, they are pretty much compelled to smoke the whole thing—especially with the price of what they are these days,” he said. “With the e-products, if you work at it you can do that. But is that how people really use them? You can take a puff, put it in your pocket, and take a couple of other puffs here and there. We have no idea what that means in producing liability for long-term addiction.”
To address this gap in information, there needs to be more longitudinal, evidence-based research, Dr. Niaura said.
The CDC’s Dr. King and Schroeder Institute Research Investigator Jennifer Pearson, M.P.H., ’07, knows this is easier said than done.
“Measuring e-cigarette use is really difficult,” Dr. Pearson said. “There is no one term for the class of products or any one way to assess frequency of use.”
Researchers are now beginning to modify their surveys by including new terminology for e-products, as well as asking participants about reasons and frequency of use, in order to more accurately monitor the e-cigarette landscape.
Since the long-term health impacts of e-cigarettes remain unclear, the U.S. Food and Drug Administration does not regulate the products. Recently, the FDA proposed a “deeming” rule that would include e-products. If the proposal becomes a rule, then the agency would prohibit the sale of e-cigarettes to children under the age of 18.
The role of the FDA’s Center for Tobacco Products—the agency that has the authority to regulate tobacco products—is to look for ways to reduce the harm of the product to the population, said Carolyn Dresler, associate director for Medical and Health Sciences at the FDA. But the agency needs the science to guide its regulatory actions.
“Since I was in my teens, I have been working on tobacco-related issues. So I think that I know a lot about tobacco. And what so amazes me, what is so interesting, is that even decades later, there is so much that we don’t know,” she said. “There is still a lot of information we need to know in order to have an evidence base to regulate the product.”