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FDA decision brings University e-cigarette simulation to attention

Electronic cigarettes are more likely to encourage traditional cigarette smokers to quit than cause non-smokers to begin, according to a recent University of Michigan study.

E-cigarettes — considered an alternative to traditional cigarettes since their introduction to the market in 2003 — are battery-powered products which vaporize a flavored liquid, which is inhaled by the user. Ecigarettes are sometimes used as tools to quit smoking.

According to a 2014 survey by the Centers for Disease Control and Prevention, nearly 22 percent of adults ages 18 to 24 had tried an e-cigarette, and about four percent of adults used e-cigarettes every day or some days.

T he rising popularity of e-cigarettes has raised concern as to how e-cigarettes would be regulated and marketed, and whether they would be treated the same as traditional cigarettes with regard to public policy — despite minimal research conducted on the health effects of e-cigarettes.

For example, despite popular belief, e-cigarettes contain many of the ingredients traditional cigarettes do, such as nicotine, unknown chemicals, flavorings and colorings.

A previous University study indicated that both teenage ecigarette users and their parents wish to see e-cigarette regulation in public places, another concern that accompanies the product.

Last T hursday, the Food and Drug Administration announced that it will regulate e-cigarettes and other products — such as cigars and hookahs — in the same way it regulates traditional cigarettes and tobacco.

According to the announcement made T hursday by Secretary of Health and Human Services Sylvia Burwell and FDA commissioner Robert Califf, restrictions will be placed on the sale and distribution of e-cigarettes and other tobacco products, including age restrictions and advertising and promotion restrictions for public health purposes.

Sarah Cherng, a Rackham student and lead author of the University study, agreed that there is a large debate surrounding the potential harms and benefits of e-cigarettes.

“We’re seeing a very large increase in high schoolers and adolescents using electronic cigarettes,” Cherng said. “On one hand, there are people who are very concerned that electronic cigarettes are going to act as a gateway to traditional smoking initiation. Whereas, on the other hand, there is the harm reduction type research … (which believes) e-cigarettes can actually help with smoking cessation — help current smokers stop smoking.”

T he researchers used data from resources such as the National Health Interview and the CDC showing previous and current national rates of smoking, as well as statistics on the growth rate of e-cigarette usage, to come up with a simulation model.

Cherng said the researchers wanted to perform a quantitative analysis to see whether e-cigarettes act as a gateway to smoking initiation or as an aid for current smokers who need to quit.

T here has so far been few studies looking into the health differences of using a traditional cigarette and an e-cigarette, as well as little research on the long-term effects of using ecigarettes as a cessation device.

According to the University study, a 20 percent increase in the rate of smoking cessation would correlate to a six percent reduction in overall smoking popluation by the year 2060. On the contrary, for smoking rates to increase by six percent in 2060, smoking initiation would have to increase by 200 percent — an unlikely occurrence, according to the researchers.

“Based on the patterning of e-cigarette use among adults right now … their use is primarily concentrated among current smokers,” Cherng said. “Any potential effects that e-cigarettes have on smoking initiation or the overall smoking prevalence in the United States is going to have a much smaller effect than if e-cigarettes have an effect on smoking cessation or an increased smoking cessation because we have so many more current smokers using e-cigarettes.”

Consistent with the team’s finding, statistics from the American Lung Association show that 76.8 percent of people who recently used e-cigarettes in 2013 also were traditional cigarette smokers.

Cherng said further research is imperative for future debates and policymaking about e-cigarettes.

“Because the evidence is so scant right now about whether or not they actually do increase smoking initiation among neversmokers versus their effect on cessation, in terms of the policy implications, it’s important to contextualize that in e-cigarette regulation,” Cherng said, adding: “if we can start focusing people towards the potential benefits of e-cigarettes and also enact legislation that helps prevent young kids from using them, then what we expect is that there is a potential of a huge benefit
resulting from e-cigarette use if they increase cessation.”

Paula Lantz, associate dean for research and policy engagement, echoed Cherng’s statements and said in an email interview that there is merit to the argument that too much regulation for ecigarettes could be detrimental.

“(Many) are concerned that the FDA might “over-regulate” ecigarettes, in that it will make it harder for e-cigarettes to be used as a harm reduction approach or smoking cessation tool for current smokers,” Lantz said. “While much more research is needed…the Cherng simulation model forecasts demonstrate quite clearly that, under any reasonable set of assumptions, the harm reduction and smoking cessation gains will significantly outweigh any increase in youth smoking due to e-cigarettes.

T his supports the concerns that over-regulating e-cigarettes will be bad for public health.”

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