ACP: Tighter Regulations, More Research Needed on E-Cigarettes and Their Consequences

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ACP joins other organizations in issuing principles for addressing the epidemic of e-cigarette use among youth and young adults

Nov. 15, 2019 (ACP) – As the government explores ways to stem the epidemic of electronic nicotine delivery system (ENDS) use among young people, the American College of Physicians (ACP), in tandem with other major medical organizations, is calling for tighter regulations on e-cigarettes and other ENDS, as well as more research into the short- and long-term health consequences of vaping, especially among teens and adolescents.

ACP President-Elect Dr. Jacqueline Fincher, along with Dr. Patrice Harris, president of the American Medical Association, and Dr. Sara Goza, president-elect of the American Academy of Pediatrics, recently discussed the dangers of e-cigarettes and outlined steps that the federal government should take to more meaningfully regulate these products at a National Press Club event in Washington, D.C.

“Speaking with one voice is very important,” Fincher said. “The dramatic use of e-cigarettes by teenagers in the United States is a big focus of concern. We don't know what vaping is doing to the still-developing adolescent brain.”

ACP and a coalition of other physician groups also joined forces to create joint principles that aim to rein in the e-cigarette epidemic. These policies include banning flavored e-cigarettes and raising the minimum age to purchase these products to 21, among other measures. Currently, purchasers of e-cigarettes must be at least 18 years of age.

Taxing e-cigarettes is another part of the solution, Fincher said. “Taxing these just like we do any other tobacco product could be a boom to state economies, and these taxes can fund tobacco cessation and prevention research and help treat tobacco-related illness,” she said. Youth are particularly price-sensitive, so higher taxes may prove to be a strong deterrent. A few states already have special tax laws on e-cigarettes.

“E-cigarettes are not regulated the way other nicotine products are, and that needs to change,” Fincher said. ACP first issued a policy paper calling for such regulations in 2015. “Now five years later, there are still no regulations and we have seen tragedies and major lung injuries from vaping,” she said.

According to a study in the Journal of the American Medical Association, 27.5 percent of high schoolers and 10.5 percent of middle schoolers reported current e-cigarette use.

This use sets teens up for addiction and health issues. “One pod equals one pack of cigarettes in terms of nicotine,” Fincher said. “Young people may be vaping a lot more nicotine than they would smoking cigarettes and thereby getting addicted much quicker.” E-cigarette use is not harm reduction, but it's a gateway to use of cigarettes and other tobacco products, she added.

Many e-cigarettes and pods come in enticing flavors. The U.S. government is now taking steps to remove flavored e-cigarettes from the market. Although initially, mint and menthol were included in this ban, President Trump is now considering allowing the sale of mint and menthol.

This is a mistake, Fincher warned. “Menthol and mint are popular among teens and these flavors blunt the nicotine and give a cooling sensation, which may make it easier to smoke and harder to quit, so we want to get rid of these flavors as well,” she said.

Such steps are especially important given the rash of vaping-related lung illnesses and deaths in the United States, she said. As of press time, the U.S. Centers for Disease Control and Prevention (CDC) is reporting that 2,051 Americans have developed a severe lung illness tied to vaping and there have been 39 deaths due to this illness.

While tetrahydrocannabinol has been linked to many of the deaths, “the carcinogens and heavy metals in many of these products are harmful chemicals to the very sensitive lung, and we don't know the short-term or long-term risks,” Fincher said. The CDC recently stated that vitamin E acetate, which is sometimes used as a thickener in vaping fluid, may be responsible for vaping-related lung illnesses.

As the government moves to regulate e-cigarettes, Fincher recommends that physicians start asking patients about vaping when taking their social history. She added, “We know that vaping is becoming a quick and fast epidemic in our country and advocacy starts with the patient in front of you.”

More Information

“Electronic Nicotine Delivery Systems: Executive Summary of a Policy Position Paper From the American College of Physicians” is available on the Annals of Internal Medicine website.

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