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Two New Studies Reiterate The Urgent Need For Science And Regulation Of E-cigarettes

Statement From Legacy®, A National Public Health Group Dedicated to Reducing Tobacco Use

WASHINGTON, Sept. 7, 2013 /PRNewswire-USNewswire/ -- Two new studies this week reinforce the need for continued study of "e-cigarettes," an emerging product that allows users to inhale vaporized nicotine in a cigarette-like fashion. Legacy has long held the position that e-cigarettes need to be approached with caution, and that the U.S. Food and Drug Administration's Center for Tobacco Products should regulate the devices.


On Thursday, September 5, the U.S. Centers for Disease Control and Prevention released a study showing increasing e-cigarette initiation use among young people. Findings from the National Youth Tobacco Survey, detailed in CDC's Morbidity and Mortality Weekly Report, found that the percentage of U.S. middle and high school students who have ever used e-cigarettes more than doubled from 2011 to 2012. Other findings indicated:
  • 20.3% of middle school students and 7.2% of high school students who had ever used e-cigarettes had never used conventional cigarettes
  • Among middle school current e-cigarette users, 61.1% reported current conventional cigarette smoking
  • Among high school current e-cigarette users, 80.5% reported current conventional cigarette smoking

These findings raise troubling questions. With 20 percent of middle school students having tried e-cigarettes, but having never experimented with tobacco, do e-cigarettes have the potential to serve as a gateway product for experimentation with other conventional tobacco products? With stats also finding the majority of current e-cigarette users also are using traditional cigarettes, will dual usage become a norm?  

A second study, released on Saturday, September 7 in The Lancet, found that e-cigarettes and nicotine patches offer comparable success in quitting.  Researchers say the study is the first clinical trial to compare the two products and the "first ever trial to assess whether e-cigarettes are more or less effective than an established smoking cessation aid, nicotine patches, in helping smokers to quit." In the trial, smokers in New Zealand were given a 13-week course of patches, nicotine e-cigarettes, or placebo e-cigarettes, which contained no nicotine. Findings indicated roughly that abstinence rates were similar – regardless of which of the three methods was used.    

The study also measured the safety of e-cigarettes and their appeal to smokers trying to quit. In a group of 300+ people over the 13-week period, the study found no statistically significant difference in adverse health effects between e-cigarettes and nicotine patches. And on the question of appeal, the study found participants in the e-cigarette groups (nicotine and no nicotine) were much more likely to recommend e-cigarettes to family or friends as a quit smoking aid than those in the nicotine patch group were likely to recommend nicotine patches. Despite these data reflecting the appeal of e-cigarettes, study authors raised a cautionary note. The leader of the research team, Associate Professor Chris Bullen, Director of the National Institute for Health Innovation at The University of Auckland in New Zealand: 

" Our study establishes a critical benchmark for e-cigarette performance compared to nicotine patches and placebo e-cigarettes, but there is still so much that is unknown about the effectiveness and long-term effects of e-cigarettes.  Given the increasing popularity of these devices in many countries, and the accompanying regulatory uncertainty and inconsistency, larger, longer-term trials are urgently needed to establish whether these devices might be able to fulfill their potential as effective and popular smoking cessation aids."

The Lancet study does not address e-cigarettes' popularity. Anecdotally, e-cigarette usage is seen more and more in daily life across the U.S. With the unregulated status of e-cigarettes, the tobacco and e-cigarette industries are free to advertise these products as an alternative to smoking -- and they have, with ads becoming increasingly ubiquitous on TV, radio, and in magazines. Celebrities such as actor Stephen Dorff and talk show host Jenny McCarthy have signed on as spokespeople.

Legacy maintains that more science around the devices is needed and regulation is essential.  There are serious questions about the quality control of these devices, long-term health effects, efficacy as a quit smoking aid, and their appeal as a potential gateway device to traditional tobacco use. The two studies demonstrate that action and science are needed now – before more and more young people and smokers strive to take up use of these devices.

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