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ACP Urges More Regulation and Oversight of E-Cigarettes

New position paper puts forth "common-sense recommendations" for products booming in popularity among youths

As the debate over e-cigarettes heats up, the American College of Physicians has a firm message for policymakers and the public: The Food and Drug Administration should regulate electronic nicotine delivery systems, which include e-cigarettes.

In addition, ACP believes, flavored e-cigarettes should be banned and governments at all levels should extend no-smoking rules to include these products. The College also supports education efforts to explain the risks of e-cigarettes and believes the products should face the same advertising restrictions as traditional cigarettes.

"We think these are common-sense recommendations for products that we don't know much about," said Ryan Crowley, a senior associate for health policy in ACP's Washington, D.C. office. Crowley wrote the organization's new position paper on electronic nicotine delivery systems, which was published April 21 in Annals of Internal Medicine.

The position paper doesn't address clinical issues regarding e-cigarettes, Crowley said, though it does call for more research into the health effects of the products. "Right now, the evidence is inconclusive," he said, noting gaps in such areas as their long-term effects on smokers and their impact on bystanders.

Electronic delivery systems, which usually deliver vaporized liquid nicotine to users through battery-powered mechanisms, have been available in the United States since 2007. E-cigarettes, the most common type of delivery system, have seen a dramatic growth in popularity in the past few years, with sales estimated to be nearly $2 billion in 2014.

Some users believe that e-cigarettes are a healthier alternative to traditional tobacco products, but critics contend that their level of safety is unknown and warn that use of e-cigarettes can lead to use of traditional tobacco products.

ACP last issued a position on electronic nicotine delivery systems in 2010. Crowley said that the College issued its new recommendations because more products have come on the market, more research has been done and additional attention has been put on the issue because of the FDA's bid to regulate the products.

E-cigarettes have also become more popular than ever, especially among young people, according to a report issued April 16 by the FDA and the Centers for Disease Control and Prevention. The number of middle- and high-school students using the products tripled from 2013 to 2014, the CDC reported -- from about 4 percent to more than 13 percent of high school students and from 1 percent to nearly 4 percent of middle school students.

That makes e-cigarettes more popular among these students than traditional tobacco products, the agencies reported.

In its position paper, ACP recommends that:

  • The FDA should regulate all electronic nicotine delivery system products. "We reaffirm our 2010 recommendation," Crowley said.
  • Flavors that distinguish one type of e-cigarette from another should be banned. An estimated 7,000 e-cigarette flavors are available, Crowley said, and there's evidence that they attract young people to the products. The flavorings may also harbor dangerous chemicals, he said.
  • Taxing of tobacco products should continue as a way to discourage use by young people.
  • Restrictions on tobacco promotion and advertising, such as the ban on TV ads, should be extended to e-cigarettes. Anti-smoking campaigns, such as those that target schools, should mention the potential risks of e-cigarettes.
  • Federal, state and local governments should extend no-smoking bans to e-cigarettes. "If a state or a local government has a law on the books that says you can't smoke combustible cigarettes in a restaurant or a bar or office, whatever the case may be, we recommend that it be extended to electronic cigarettes and other devices," Crowley said.
  • The federal government should support rigorous research into the safety and effects of these products.
More Information

A copy of 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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