Despite great successes in reducing tobacco use over the past five decades, smoking leads to more than 480,000 deaths in the United States annually and remains the number-one preventable cause of sickness and mortality. Unfortunately, a new generation of young Americans is being introduced to tobacco via flavored tobacco products (small cigars, hookahs) and e-cigarettes, which until now have been subject to none of the federal oversight that apply to cigarettes. Given the many unknowns about these products’ safety and the fact that the flavorings and advertising make them especially appealing to young people, there has been a growing awareness of the need for the Food and Drug Administration (FDA) to step in and exercise its regulatory authority over these products.
Today, after more than two years of examining the evidence and getting feedback from scientists, public health leaders, industry stakeholders, and the public, the FDA announced that flavored tobacco products as well as e-cigarettes will now be legally considered (or “deemed”) tobacco products for purposes of regulation. Devices introduced after 2007—which includes most devices currently on the market—will need to undergo the same level of FDA review for safety, will need to carry warning labels, and will be subject to other restrictions that apply to cigarettes. It will now be illegal to sell any of these products to people under 18.
The harms of hookahs and cigars, which are merely different forms of smoked tobacco, are well understood. The tar and other chemicals from burning tobacco are no less harmful to the lungs when inhaled through water, as in a hookah, or when flavored. E-cigarettes, on the other hand, remain unknown quantities in the current tobacco and drug landscape. Because they deliver flavored vapor in place of tar-filled smoke, we expect e-cigarettes will pose a lower risk of cancer than traditional cigarettes.
However, some studies have found other possibly harmful chemicals in e-cigarette vapor, and some research suggests nicotine itself could be unsafe for young people. The adolescent brain is still developing, and nicotine exposure during this period may make other drug use and even addiction more likely. Research already indicates that among teens, e-cigarettes are being used as a new drug experience, not a substitute for an old one; thus there is concern that they could actually open the door to cigarette use among some kids.
Evidence thus far is mixed on whether e-cigarettes actually help wean smokers off traditional cigarettes. A recent National Cancer Institute–funded review and meta-analysis in The Lancet found that smokers who used e-cigarettes were 28 percent less likely to quit than smokers who didn’t. On the other hand, an FDA- and NIDA-funded framework for evaluating the public health impacts of vaping products just published in Addiction suggests that adults and teens most likely to use e-cigarettes are those most likely to use or continue using cigarettes anyway and that any possible gateway effects may not outweigh their potential benefits as a smoking-cessation aid. Clearly more scientific research is needed to address this important question.
Whether or not e-cigarettes will prove useful as quit aids, the increasing safety protections for the consumer that the FDA regulations will provide are badly needed. People have a right to know what they are getting, including how much nicotine they are consuming and what other toxicants might be in the vapor. Most importantly, taking steps to prevent youth from initiating use of tobacco products beyond traditional cigarettes is a long-needed step in the interest of public health. We must not allow the public health gains made against smoking over the last five decades to erode because of new products that are uniquely appealing to a new generation of potential users.