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Surgeon General’s Report Finds Effective Treatments Exist to Help Smokers Quit, but the Evidence is Inadequate to Conclude E-Cigarettes Increase Smoking Cessation

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
January 23, 2020

WASHINGTON, DC – Today the U.S. Surgeon General issued the first comprehensive review of the scientific evidence about what is effective in helping smokers quit in 30 years, including the most up-to-date review about the efficacy of e-cigarettes in smoking cessation.

This report reaffirms that we have proven strategies that can help more smokers quit and win the fight against tobacco use – the nation’s number one cause of preventable death. But the report highlights that too few people are getting access to effective treatments, particularly those who are disproportionately impacted by tobacco.

Equally important and contrary to the claims of the e-cigarette industry, the Surgeon General concludes, “There is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation.” The Surgeon General also cautions that because e-cigarettes are not a single product, but “a continually changing and heterogeneous group of products” that “are used in a variety of ways,” it is difficult to make broad generalizations about the efficacy of e-cigarettes for smoking cessation based upon any one study or any one product.

This conclusion has important implications for public policy on e-cigarettes. First, it shows that e-cigarette interests distort the evidence when they cite the purported smoking cessation benefits of e-cigarettes in fighting policies needed to reverse the current youth epidemic, especially bans on flavored e-cigarettes. There is limited evidence that e-cigarettes in general help adult smokers quit and no credible evidence that flavored e-cigarettes do so. In contrast, there is clear evidence that flavored e-cigarettes attract kids. From Congress to states and cities, policymakers must quickly prohibit the flavored products that have lured more than 5.3 million U.S. kids to use e-cigarettes.

Second, this conclusion demonstrates that the FDA’s failure to require e-cigarette manufacturers to provide scientific evidence about their products has hurt smokers by eliminating the need for manufacturers to conduct valid scientific studies about the impact of their products on smoking cessation and by denying smokers accurate information about which, if any, e-cigarette products are effective for cessation.

This report further demonstrates why the FDA must rigorously enforce the May 12, 2020, deadline for e-cigarette manufacturers to apply to the FDA and demonstrate a public health benefit in order to keep their products on the market. The FDA must only allow e-cigarette products on the market if manufacturers demonstrate that the products will help adult smokers quit and will not result in youth use.

In addition to its conclusions about e-cigarettes, the Surgeon General’s report reaffirms that FDA-approved cessation medications and behavioral counseling, especially when used in combination, are effective in helping smokers quit. However, it also underscores the importance of requiring private and public health plans, including Medicaid, to provide barrier-free coverage for these treatments. As the report concludes, “Insurance coverage for smoking cessation treatment that is comprehensive, barrier-free and widely promoted increases the use of these treatment services, leads to higher rates of successful quitting, and is cost-effective.” Comprehensive Medicaid coverage is essential as Medicaid recipients smoke at more than double the rate as those with private health insurance (23.9% to 10.5%).

The report further confirms that smoking cessation can be increased by implementing proven tobacco control strategies, including cigarette price increases, comprehensive smoke-free policies, mass media campaigns, pictorial health warnings (the FDA faces a court-ordered deadline of March 15 to issue a final rule requiring such warnings in the U.S.), and sustained, statewide tobacco control programs.

This report is a timely reminder that effective and overdue FDA regulation of e-cigarettes is critical in order to prevent e-cigarettes from addicting a new generation of kids and to assist smokers by determining which, if any, e-cigarette products are effective at helping smokers quit.