Public Health Consequences of E-Cigarettes (2018) / Chapter Skim
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1 Introduction
1 Introduction
Pages 23-42
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From page 23... ...
For example, whether e-cigarette use confers lower risk of addiction compared with combustible tobacco cigarettes is one point of controversy. Likewise, there are uncertainties about the harm of e-cigarettes themselves, because of the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals, such as youth and young adults, who have never used tobacco products.
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From page 24... ...
(See Box 1-1 for the complete Statement of Task and Appendix A for a list of questions CTP provided for the committee to consider in addition to the Statement of Task.) The Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems includes experts in toxicology, nicotine pharmacology, adolescent and adult tobacco use patterns, epidemiology, public health, inhalation toxicology/pulmonology, cardiology, 1 As of March 2016, the Health and Medicine Division continues the consensus studies and convening activities previously undertaken by the Institute of Medicine (IOM)
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From page 25... ...
. Throughout this report the committee uses the terms "electronic cigarettes" and "e-cigarettes" interchangeably to refer to any device with a heating element that produces an aerosol from a liquid that users can inhale.
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This section summarizes rates of electronic cigarette use as reported in these sources, including rates among subpopulations. Of note, although e-cigarettes entered the U.S.
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11.3 (9.9–12.9) Middle School 0.6 (0.4–0.9)
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Electronic cigarette use varies substantially across demographic subgroups, including age, gender, and race and ethnicity. In terms of age, e-cigarette use tends to increase with age among youth across all measures of use.
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reported currently using e-cigarettes compared with the next three products -- combustible tobacco cigarettes, cigars, and smokeless tobacco (each at 2.2 percent) , which were followed by hookah (2.0 percent)
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From page 30... ...
Additionally, 39.2 percent of current e-cigarette users reported current use of other combustible tobacco products (filtered cigars, cigarillos, traditional cigars, hookahs, and pipes) and 8.9 percent reported current use of non-combustible tobacco products (smokeless tobacco [snus pouches, loose snus, moist snuff, dip, spit, or chewing tobacco]
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From page 31... ...
According to 2016 MTF data, 26 percent of college students and young adults reported ever using electronic cigarettes, and 5.8 percent reported past 30-day use (Schulenberg et al., 2017)
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From page 32... ...
of infrequent e-cigarette users reported using a refillable device and 58.6 percent reported using a rechargeable device; among those using rechargeable devices, 71.0 percent reported using cartridges. With respect to what substance adults are vaping, most adults reported vaping e-cigarettes that contain nicotine -- 91.2 percent of daily users, 88.2 percent of non-daily users, and 89.5 percent of both daily and non-daily users overall (Coleman et al., 2017)
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From page 33... ...
Therefore, understanding the net public health effect of e-cigarettes requires understanding not only the inherent risks of e-cigarettes, but also the relationship between e-cigarette use and combustible tobacco cigarette use. A central issue addressed in this report is the use of e-cigarettes as a harm-reduction tool, with a thorough evaluation of the evidence base for the hypothesis that electronic cigarettes are substantially less harmful and are a less toxic alternative to combustible tobacco cigarettes, because combustion, which produces substantial toxic substances, does not occur.
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From page 34... ...
Rather, the law stated that any other tobacco products that the Secretary of Health and Human Services deems as relevant to the law may be included under FDA's regulatory jurisdiction. Importantly, the Tobacco Control Act considers any product a "tobacco product" if it includes any constituent "made or derived from tobacco," but is not otherwise regulated as a "drug," "device," or "combination product."2 To regulate electronic cigarettes as tobacco products, FDA was required to undertake the rulemaking process.
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From page 35... ...
For instance, under the deeming rule, anyone who "makes, modifies, mixes, manufactures, fabricates, assembles, processes, labels, repacks, relabels, or imports" any electronic cigarette product qualifies as a tobacco product "manufacturer," and is therefore subject to the existing rules governing tobacco products (CTP, 2017c)
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Terry, Surgeon General, releases first report of the Surgeon General's Advisory Committee on Smoking and Health.a 1965 Herbert A Gilbert's patent request for an early approximation of an e-cigarette is approved on August 17.b 1992 Passage of the Synar Amendment to Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act on July 10 requires states to restrict sale and distribution of tobacco products to minors.c Prescription nicotine patches are introduced to the U.S.
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Electronic cigarettes have been officially introduced to the United States.h 2009 In April, FDA denies import of e-cigarettes and accessories, as products appear to be unapproved drug-delivery devices.i In June, President Barack Obama signs the Family Smoking Prevention and Tobacco Control Act into law, giving FDA the authority to regulate tobacco products to protect public health. CTP is established; FDA announces a ban on combustible tobacco cigarettes with fruit, candy, or clove flavorings.j 2010 U.S.
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From page 38... ...
Unlike FDA regulation of pharmaceuticals under the standard of "safe and effective," FDA regulates tobacco products based on a public health standard that considers the risks and benefits of the tobacco product on the population as a whole.3 Functionally, this means that FDA considers the effect of a tobacco product not only on those who use the product (e.g., smokers) , but also on those who do not (e.g., people who have quit smoking combustible tobacco cigarettes but might relapse due to the presence on the market of a newly introduced product, or people who might begin to use tobacco who would not have otherwise)
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From page 39... ...
A chapter using population dynamic modeling presents the results of a range of scenarios of the possible effects of e-cigarettes on a population measure of mortality (years of life lost) and reflects the range of conclusions relevant to the public health standard FDA is statutorily obligated to use in its regulatory decision making about tobacco products.
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2016a. Deeming tobacco products to be subject to the federal Food, Drug, and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Control Act; restrictions on the sale and distribution of tobacco products and required warning statements for tobacco products.
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2016. Char acteristics of electronic cigarette use among middle and high school students -- United States, 2015.
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