New Study Finds Dual Users of E-Cigarettes and Cigarettes Do Not Reduce Exposure to Toxic Substances – and May Increase Exposure to Some

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
December 14, 2018

WASHINGTON, D.C. – A study published today by the journal JAMA Network Open, based on 2013-14 data, finds that exclusive users of e-cigarettes were exposed to lower levels of tobacco-related toxic substances compared to smokers, but dual users of e-cigarettes and cigarettes – who make up the large majority of e-cigarette users – had toxicant exposures that were similar to or even higher than for those who only used cigarettes.

It is important to note that this study is based on 2013-14 data from the FDA’s Population Assessment of Tobacco and Health (PATH) Study, so many of the products involved are no longer available and the e-cigarette market has been completely transformed. Juul, a product introduced in 2015, now has about 76 percent of the e-cigarette market in stores. As a result, the relevance of this study’s findings to today’s e-cigarette market is at best uncertain.

This study underscores that e-cigarettes will have a potential public health benefit if and only if specific products are shown to be effective at helping smokers stop using cigarettes completely and if they are responsibly marketed and sold so they do not attract young people. As the study’s lead author stated, “Our data suggest that potential harm reduction can only be achieved if smokers switch completely to e-cigarettes and discontinue use of deadly combustible tobacco products.” However, to date there is only “limited evidence that e-cigarettes may be effective aids to promote smoking cessation,” according to a comprehensive January 2018 report by the National Academies of Sciences, Engineering, and Medicine. The new study does not tell us anything about whether e-cigarettes are effective at helping smokers quit.

Given that the large majority of e-cigarette users are dual users of cigarettes and e-cigarettes, the finding that dual use of e-cigarettes and cigarettes does not reduce – and in some cases, may increase – exposure to toxic substances is especially troubling. Nearly 60 percent of adult e-cigarette users in the U.S. are also current cigarette smokers, according to the CDC.

While there is limited evidence that e-cigarettes can help smokers give up cigarettes, there is no longer any doubt that both that e-cigarette use among kids has skyrocketed to epidemic levels and that an ever greater percentage of these kids are becoming addicted. Results of the 2018 National Youth Tobacco Survey, released last month, showed that current (past 30 day) e-cigarette use increased by 78 percent among high school students this year (to 20.8 percent). More than 3.6 million middle and high school students now use e-cigarettes – a shocking increase of 1.5 million in just one year. In 2018, nearly 28 percent of current high school e-cigarette users reported use on at least 20 of the past 30 days, demonstrating that many kids aren’t just experimenting with e-cigarettes, but using them regularly and becoming addicted. The National Academies report found there is “substantial evidence” that e-cigarette use increases risk of ever use of regular cigarettes among youth and young adults.

The recent youth epidemic has been driven by the popularity of Juul, which is sleek, small and easy to hide, comes in sweet flavors including mango and mint, and delivers a potent dose of nicotine.

Effective FDA regulation is critical to prevent youth use of e-cigarettes and determine whether e-cigarettes can benefit public health by helping smokers quit. The FDA should strengthen its efforts to address the youth e-cigarette epidemic by banning all flavored e-cigarettes that have not been subject to public health review by the agency and enforcing rules prohibiting the introduction of new products without prior FDA review. Through the pre-market review process, the FDA must also require manufacturers to demonstrate whether their products are effective at helping smokers switch completely and ensure smokers have accurate information.

Finally, the fact that the data in this study is several years out of date points out a serious problem that needs to be addressed. The PATH research team and the FDA need to take steps to ensure that data from the PATH study is released much more quickly so it is an effective tool in informing regulations to protect public health. Science and regulation must keep up with a rapidly changing tobacco market, especially with regard to e-cigarettes.