As Teen Use of E-Cigarettes Climbs, Societies Call for More Regulation

The American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO) have collaborated on an outline that would help policymakers regulate electronic cigarettes and other electronic nicotine devices (ENDS) without undermining their potential as a smoking cessation tool, the two cancer organizations announced.

The two organizations’ recommendations, which were published in the AACR’s Clinical Cancer Research and ASCO’s Journal of Clinical Oncology, are a guide for policymakers to help regulate the devices to help deter children from using ENDS while conducting research to better understand the impact that ENDS have on their users and to see if the devices are a suitable smoking cessation tool.

The AACR and ASCO statement delineates steps that can be taken now in the interest of public health and includes recommendations such as childproofing the caps of all e-liquid containers, prohibiting all youth-oriented ENDS advertising and marketing, and requiring ENDS manufacturers to register with the FDA and report all product and ingredient listings, as well as the nicotine concentration in the ENDS solution.

“As a physician-scientist who treats patients with cancer, I am concerned about the delayed time course that’s needed to assess the adverse impacts of ENDS use,” Carlos L. Arteaga, MD, AACR president, and professor of medicine and cancer biology and director of the Center for Cancer Targeted Therapies and the Breast Cancer Program at the Vanderbilt-Ingram Cancer Center, said in a statement.

“Therefore, although we call for additional research to determine with certainty the potential negative public health consequences of these products, particularly in youth, we cannot afford to wait to take prudent steps to stop those under 18 from using e-cigarettes. This is especially important since e-cigarette use is growing fast among this age group, as reported in the most recent National Youth Tobacco Survey.”

Unlike combustible cigarettes and many other tobacco products, the FDA does not currently regulate e-cigarettes and other ENDS. Some state and local governments have enacted e-cigarette regulations, including imposing restrictions on the sale of e-cigarettes to minors and prohibiting use of e-cigarettes in public places.

Federal regulations have yet to be adopted, and manufacturing standards and quality controls on e-cigarettes are also absent. The statement calls on federal policymakers to immediately implement these recommendations, most specifically the ones that are aimed at restricting the sale, distribution, marketing, and advertising of ENDS to youth.

The University of Michigan’s 2014 “Monitoring the Future” study found that e-cigarette use has surpassed tobacco cigarette use among teens. Vaping is now the “cool and hip thing to do,” despite the fact that the safety of e-cigarettes has not been fully studied and the health effects on the individual—as well as the environment—are not known.

“We are concerned that e-cigarettes may encourage nonsmokers, particularly children, to start smoking and develop nicotine addiction. While e-cigarettes may reduce smoking rates and attendant adverse health risks, we will not know for sure until these products are researched and regulated,” said Peter Paul Yu, MD, FACP, FASCO, ASCO president. “The FDA has signaled its willingness to regulate e-cigarettes and other electronic nicotine delivery systems, and we urge the agency to follow through on this intention.”

Although tobacco use constitutes the largest preventable cause of death and is responsible for 30% of all cancer deaths and is associated with increased risk for at least 18 types of cancer, e-cigarettes and other ENDS are capable of delivering a nicotine solution in aerosolized form, which has been promoted as a potential tobacco cessation tool that is a “safer” alternative to combustible cigarettes.

Lisa Schulmeister, RN, MN, APRN-BC, OCN, FAAN, an oncology nursing consultant and adjunct assistant professor of nursing at Louisiana State Health Sciences, says patients who smoke are asking about e-cigarettes because “they believe e-cigarettes are safer and will assist in quitting smoking. However, we don’t have sufficient evidence to support the safety of e-cigarettes and their role in smoking cessation.”

“Further research and regulation are needed to determine if e-cigarettes can help people stop smoking combustible cigarettes,” said Roy S. Herbst, MD, PhD, Ensign professor of medicine, professor of pharmacology, and chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital, who served as chair of the joint AACR/ASCO committee that developed the statement.

“In the meantime, oncologists should encourage patients to use FDA-approved cessation medications, refer them for smoking cessation counseling, and provide education about the potential risks and lack of known benefits of long-term e-cigarette use.”