The public health consequences of e‐cigarettes: a review by the National Academies of Sciences. A call for more research, a need for regulatory action

Abstract

Electronic nicotine delivery systems (ENDS) are less harmful than combustible cigarettes but lack demonstrated safety. They may help some smokers to quit, while enticing future generations to smoke. The US regulatory environment has restricted research on ENDS for tobacco cessation yet extended the time for open market sales. Calls for further research ought not to stall regulatory action.Electronic nicotine delivery systems (ENDS; e.g. ecigarettes) have gained world-wide attention. Gaps in the evidence on ENDS have contributed to varied opinions, many passionately at odds. The National Academies of Sciences' (NAS) review of more than 800 research papers on ENDS was congressionally mandated and sponsored by the US Food and Drug Administration (FDA) to summarize the state of the science and identify research needs [1]. The NAS report provides a useful summary for policymakers, practitioners and researchers internationally and sheds light on the nuances in the risk/benefit equation for ENDS.Of the nearly 50 conclusions in the NAS report, the strongest evidence (deemed as substantial or conclusive) is listed in Box 1. Are ENDS harm-reducing or harm-creating? The answer is probably both. That is, ENDS may be harm-reducing for smokers seeking to quit (i.e. when the comparator is combustible tobacco), while harm-creating for former or never smokers, particularly among youth, for whom ENDS use appears to increase the risk of future use of combustible tobacco.Being less harmful than combustible cigarettes, which contribute to the deaths of two in three long-term users [2,3], does not mean ENDS are safe. ENDS aerosol contains nicotine, which is addictive; ultrafine particles, that can be inhaled deeply into the lungs; flavorings such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds; cancer-causing chemicals; and heavy metals such as nickel, tin and lead, although all at lower levels than in combusted tobacco smoke [4]. This list is limited by the chemicals assayed to date. Other toxicants, yet to be determined, may be created by repeated heating of the plastic and metal devices.The NAS findings were incorporated into a dynamic population model, and the conclusion was a net public health benefit with reduced loss of life when modeled out to 2050. These gains, however, were lost when extended

Comprehensive overview of common e-liquid ingredients and how they can be used to predict an e-liquid’s flavour category

“…Flavours increase product attractiveness among all types of (potential) users, that is, among youth and adults8 and among current smokers, dual users, exclusive vapers, as well as never-users 9. For smokers, switching to e-cigarettes may be beneficial, as e-cigarette use (ie, vaping) is considered less harmful than regular cigarette smoking 10–14. In line with this, the use and marketing of e-liquid flavours that are appealing to smokers may contribute to public health benefits.…”

“…However, flavours may also stimulate vaping among non-users, in particular young people 15–17. This is concerning, as e-cigarettes are not safe10 18 19 That is, chemicals in e-cigarette emissions (eg, tobacco-specific nitrosamines, metals, aldehydes and other flavourings) can be toxic and thus harmful to consumers’ health 20–22. In addition, e-cigarettes may facilitate smoking initiation among never-smokers 23.…”

Lethal news: The dexterous infiltration of news media by the tobacco industry agenda

“…Third, Altria recently bought 35% of Juul, the manufacturers of highly addictive nicotine vaping that has caused an epidemic of nicotine addiction among American youth. The National Academies of Sciences, Engineering and Medicine concluded that e‐cigarettes may be harm‐reducing for smokers seeking to quit combustible tobacco, while harm‐creating for former or never smokers. Simulations to 2070 suggest that e‐cigarette use will not diminish the overall burden of disease.…”

Vaping Perpetuates Cardiac Electrical Instability

“…Alarmingly, from 2017 to 2018 alone, there was a 75% increase in ENDS use by high school students 1 . The popularity of flavored ENDS likely fueled the proliferation of manufacturers, and the surge in sales of these products 2 . In 2014, it was estimated that there were more than 7600 different flavored ENDS products from 466 brands 3 , and as of this date, these numbers have only increased.…”