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AHA releases policy statement on e-cigarettes
The American Heart Association has issued policy recommendations for the regulation and oversight of electronic cigarettes.
The association recommends a federal ban on e-cigarettes for minors, citing concerns about e-cigarettes’ potential to lead to nicotine addiction among youth, according to a press release.
“In the years since the FDA first announced it would assert its authority over e-cigarettes, the market for these products has grown dramatically,” Nancy Brown, CEO of the AHA, said in the press release. “We fear that any additional delay of these new regulations will have real, continuing public health consequences. Hence, we urge the agency to release the tobacco deeming rule by the end of this year.”
In their policy statement, published in Circulation, the AHA wrote that it supports:
- The inclusion of e-cigarettes in smoke-free air laws.
- Prohibiting the sale of e-cigarettes to minors via both state and federal law.
- Restricted marketing and advertising of e-cigarettes to minors.
- Taxing e-cigarettes at a rate high enough to discourage use by youth, as well as increasing taxes on combustibles and using the revenue to support tobacco cessation and prevention programs.
- FDA regulation that addresses marketing, access for minors, labeling, quality control over manufacturing, free sampling and standards for contaminants. However, “regulation should allow for quality-controlled products for adults who want to transition from conventional cigarettes to e-cigarettes or to quit or reduce smoking.”
- Warning labels and child-proof packaging on refill cartridges.
- Tobacco screening at clinical visits and work/community health screenings should include questions about e-cigarettes. Additionally, clinicians should be knowledgeable about e-cigarettes and counsel patients on tobacco cessation plans.
- Improved surveillance of e-cigarette use throughout the US, as well as additional research to determine the impact of e-cigarettes on public health.
- Defining e-cigarettes as tobacco products under state laws, rather than creating a separate definition for the product.
The authors also recommended numerous potential topics for further research, including health effects and toxicity, economic issues, psychological effects and use patterns, among others.
“E-cigarettes have caused a major shift in the tobacco-control landscape,” study author Aruni Bhatnagar, PhD, FAHA, chair of cardiovascular medicine at the University of Louisville, said in the press release. “It's critical that we rigorously examine the long-term impact of this new technology on public health, [CVD] and stroke, and pay careful attention to the effect of e-cigarettes on adolescents.”
The authors expressed concern over e-cigarettes’ potential to promote nicotine addiction or lead to the use of other drugs or dangerous substances. Additionally, their acceptance could “renormalize” smoking habits, particularly among children.
“Over the last 50 years, 20 million Americans died because of tobacco,” Brown said in the release. “We are fiercely committed to preventing the tobacco industry from addicting another generation of smokers. Recent studies raise concerns that e-cigarettes may be a gateway to traditional tobacco products for the nation’s youth, and could renormalize smoking in our society. These disturbing developments have helped convince the association that e-cigarettes need to be strongly regulated, thoroughly researched and closely monitored.”
For more information:
Bhatnagar A. Circulation. 2014;doi:10.1161/CIR.0000000000000107.
Disclosures: See the full statement for a list of relevant financial disclosures.
Perspective
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I don’t have any disagreements with the AHA’s statement. I would like to emphasize that I believe we need to enable the FDA to regulate these products. We need to recognize that they do contain nicotine, and potentially toxic substances of which we know nothing. We cannot relax any of our legislative efforts to create smoke-free environments. We cannot relax efforts to hold advertising account executives to task for lining up a series of celebrities making e-cigarettes look attractive, especially without any information to the effect that e-cigarettes are helpful as a smoking cessation tool.
I’m very supportive of additional research so that we can understand these devices. If it does turn out that e-cigarettes might help some patients quit smoking, then perhaps they can be prescribed, much like we prescribe other nicotine products like the patch or gum. I think this would be a much safer way to make these devices available to the public, but only after more research is done.
All of us, as adults and as parents, would worry about the availability of flavored devices that create an aura that it is not only normal but enjoyable to smoke. The impression that this would leave on vulnerable youngsters could perhaps start them on a pathway to nicotine addiction.
The exposure to middle school and high school kids to these devices has simply skyrocketed. They’re easily available, and I would be very suspicious of a flavoring approach that would only increase their attractiveness to vulnerable people.