National Jewish Health Welcomes First Steps at Regulation of E-Cigarettes

More Stringent Regulation in the Future Urged

National Jewish Health welcomes the U.S. Food and Drug Administration’s (FDA) initial efforts to protect the health of Americans, especially young people, by regulating e-cigarettes as well as other tobacco products. The FDA’s proposed rules appear to be a good first step at asserting authority over e-cigarettes’ production, sales and marketing, but more stringent regulation will be needed in the future.

National Jewish Health is the leading respiratory hospital in the nation. Founded 115 years ago as a nonprofit hospital, National Jewish Health today is the only facility in the world dedicated exclusively to groundbreaking medical research and treatment of patients with respiratory, cardiac, immune and related disorders. Every day physicians at National Jewish Health see the harmful effects of tobacco, which kills 430,000 Americans every year and is the leading cause of preventable death in the United States. National Jewish Health also operates tobacco-cessation quitlines for 12 states.

National Jewish Health supports proposed regulations that will:

• Limit sale of e-cigarettes to youth.
• Require registration of e-cigarettes and reporting of their ingredients. This is an important first step toward knowing what products are available and assuring that the products are uniformly and safely manufactured.
• Prohibit unsubstantiated health claims that e-cigarette manufacturers make about their products, including the removal of TV ads that imply e-cigarettes are healthy and a good way to quit tobacco. There is currently little evidence supporting e-cigarettes as a tool to quit smoking. In fact, there is some evidence to support that e-cigarettes are a bridge into smoking.
• Include health warnings on e-cigarette packaging about nicotine. Nicotine is an addictive drug, with direct, negative effects on the brains of developing fetuses and adolescents.

National Jewish Health looks forward to:

• Limitation or elimination of e-cigarette advertising on television and other marketing campaigns aimed at youth. Current advertisements glamorize e-cigarettes and appeal to youth.
• Prohibition of flavored e-cigarettes, which also appeal primarily to youth.
• Regulation of nicotine content in e-cigarettes. Currently some e-cigarettes deliver very high doses of nicotine in each puff.
• Additional research into the health hazards and benefits of e-cigarettes.

Previous Statement on E-cigarettes:

David Tinkelman, MD, and Amy Lukowski, PsyD, the medical and clinical directors of Health Initiatives at National Jewish Health, previously outlined their current view of e-cigarettes and desires for regulation. Health Initiatives at National Jewish Health operates tobacco-cessation quitlines for 12 states.

At this time, not much is known about the inhalation of concentrated nicotine combined with propylene glycol. It may take years to fully understand the potentially harmful and/or positive effects. What we do know is that nicotine is an addictive drug, with direct, negative effects on the brains of developing fetuses and adolescents.

Lacking significant scientific evidence, the best way to view e-cigarette use is to look at its relative risk compared to tobacco cigarettes. E-cigarette vapor contains far fewer toxic chemicals and carcinogens than does tobacco smoke. Therefore, if e-cigarettes are used to wean individuals off tobacco or to significantly reduce the amount smoked per day, this is a good result. However, if e-cigarettes used by non-smokers produce nicotine addiction and smoking habits that lead to new tobacco use, e-cigarettes are causing harm. Preliminary research and anecdotal evidence suggest that both of these effects may occur.

No matter what, the growing popularity of e-cigarettes must be viewed as a public health threat to children. Of special concern is the marketing of these products, which clearly has been developed to glamorize vaping and attract young people. This cannot be tolerated by society.

At National Jewish Health, we firmly believe that the U.S. Food and Drug Administration needs to develop a comprehensive regulatory approach for all nicotine-containing products similar to its oversight of tobacco. At a minimum, this approach should cover deciding the legal age at which minors can purchase e-cigarettes; regulating the marketing of these products, with particular focus on limiting the appeal to youth; and establishing standards of dosing and additives used in the products. Last, we highly recommend that the FDA promote, through the CDC, further scientific research into both the positive and negative aspects of these products. – David Tinkelman, MD, and Amy Lukowski, PsyD.