Regulating e-cigarettes will help both adolescents and adults

Fruit Medley. Watermelon Rush Ice. Sour Worms. What sound like flavors of candy are instead flavors of e-juice – a liquid containing nicotine, propylene glycol, vegetable glycerin, and flavorants used in e-cigarettes (a.k.a vapes). Flavored e-juices and e-cigarette devices are available in gas stations and corner stores, from online retailers, and in vape shops across the United States.

Flavored e-juice is at the root of a growing e-cigarette epidemic among young people. In 2018, 3.6 million middle and high school students in the US reported using e-cigarettes in the past 30 days, and 28% of high school users reported frequent use, according to the Centers for Disease Control and Prevention. At the University of Iowa, use of e-cigarettes among students increased 362% between 2016 and 2019.  

Cigarette smoking prematurely kills half of smokers who do not quit. By offering an alternative to cigarettes, many have hoped e-cigarettes would be an innovative and life-saving cessation strategy. Some e-cigarette advocates cite a recent clinical trial in the United Kingdom that found that e-cigarette use was more effective for cigarette cessation than available nicotine replacement products when study participants received rigorous behavioral therapy.

Much of the conversation around e-cigarettes includes a simple narrative that offers two options: either we help youth (by regulating e-cigarettes) or we help adults (by not regulating them). That narrative implies we cannot do both, but that narrative is deceptive for several reasons.

In the past several months, vaping (with nicotine or cannabis) has been implicated in seven deaths and hundreds of cases of lung illness. While the cause of these illnesses remains unidentified, this tragic news demonstrates that e-cigarettes introduce distinct harms that are not caused by cigarette smoking and that some of those harms can occur far quicker than cigarette-related illness. This means that, even if e-cigarettes helped smokers quit, they are not a silver-bullet solution. Choosing not to regulate e-cigarettes puts adult smokers at risk.

The public health impact of e-cigarettes will reach far beyond these surprising lung illnesses. A mountain of evidence finds that e-cigarette use leads to future smoking among young people. Choosing not to regulate e-cigarettes means that this new generation of nicotine users will experience both the unique harms of e-cigarettes and the long-term dangers of cigarette smoking.

The Food and Drug Administration can act now to prevent youth initiation and still investigate whether e-cigarettes are safe and effective for cessation. Well-designed clinical trials like the one described above can build a body of scientific evidence over time. If rigorous research demonstrates e-cigarettes to be an effective and safe cessation device, the FDA can make them available in a way that maximizes their benefits to current smokers and eliminates their appeal and availability to youth. By leaving e-cigarettes on the market, the FDA has abdicated its role to review the scientific evidence carefully and protect the public health.

No evidence from clinical trials can justify leaving e-cigarettes available in gas stations and online retailers where young people can gain access. Young people have been put at great risk because of a hope that e-cigarettes will help adults quit smoking and their bodies are demonstrating the effects of e-cigarettes on nicotine addiction and on health. It is as if this generation of young people are unknowing subjects in an ill-formed research study.

To defend flavored e-juice, and perhaps even e-cigarettes altogether, puts both youth and adults at risk. 

If you are interested in learning more about e-cigarettes and how they affect us in eastern Iowa, the University of Iowa College of Public Health invites you to attend a series of free community events. The first session, “What are E-cigs and What Do They Do?,” is Monday, September 23rd from 6:30-8pm at the Englert Theatre, 221 E. Washington Street, Iowa City. Learn more and register at: https://events.uiowa.edu/30097.   

Shannon Lea Watkins is an assistant professor of community and behavioral health in the University of Iowa College of Public Health.