The FDA is tied in knots over e-cigarette use. On the one hand, the FDA does not want people to smoke. But, on the other hand, the FDA does not want people to use smoking alternatives that could help them quit, such as e-cigarettes. To that end, the FDA recently signaled its interest in increasing regulation of e-cigarettes including Altria’s MarkTen and British American Tobacco’s Vuse, with an eye towards protecting teens from potential health effects.

As FDA Commissioner Scott Gottlieb put it:

[Some say] in order to protect kids, [the FDA] is going to encumber adult smokers by putting in place restrictions that make these products less attractive, or harder to purchase by adults. These things may all be true.

But although the commissioner recognizes new regulation could negatively impact adult e-cigarette consumers, he does not consider that new restrictions may disproportionately affect the poor.

This is likely for three reasons. First, low-income and low-skill Americans are more likely to smoke traditional cigarettes, and more likely to smoke traditional cigarettes heavily. For example, the CDC finds the prevalence of smoking is around two times as high for smokers below the U.S. poverty line as for smokers at twice the poverty level. Likewise, adults with less than a high school education are more than 2.5 times as likely to smoke as adults with a college degree.

Second, when it comes to quitting smoking, poor and less-educated Americans have the hardest time. A CDC report suggests that smokers with less than a high school degree are less than half as likely to report recently quitting smoking as smokers with graduate degrees. And adults at or above the poverty level are more likely to report recently quitting than those below the poverty level.

Evidence suggests e-cigarettes are an easy way for poor American smokers to improve their health. Unfortunately, future restrictions may change that.

Third, poor and less-educated Americans are more likely to use e-cigarettes. According to a recent study, 10.2 percent of individuals in households with between $0-$20,000 of income have used e-cigarettes, whereas about half as many individuals in households with $75,000 of annual income or more have used e-cigarettes. Education levels break the same way: Around twice as many individuals with less than a high school degree have ever used an e-cigarette, compared to individuals with a college degree or more.

Why does this matter? Low income and less-educated Americans report lower levels of access to health care and poorer health outcomes along a variety of metrics. E-cigarettes ostensibly provide an affordable avenue to improve health for smokers that can’t afford professional help quitting or reducing cigarette use.

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By: Erin Keely O’Brien, Anh B. Nguyen, Alexander Persoskie, and Allison C. Hoffman

This research described U.S. adults’ beliefs about nicotine and low nicotine cigarettes (LNCs) using the nationally-representative Health Information National Trends Survey (HINTS-FDA 2015; N = 3738). About three quarters of people either were unsure of the relationship between nicotine and cancer or incorrectly believed that nicotine causes cancer. People who were non-White, less educated, age 65+, and never established smokers were most likely to be unaware that nicotine is not a cause of cancer. More than a quarter of people held the potentially inaccurate beliefs that LNCs would be less harmful and addictive than typical cigarettes. Whites were more likely than Blacks to believe LNCs were less harmful than typical cigarettes, and never smokers were more likely to believe this than established quitters. Whites and people with at least a college degree were more likely to believe that LNCs would be less addictive than typical cigarettes. Overall, we found that many people, particularly the demographic subgroups identified here, held incorrect beliefs about nicotine and potentially inaccurate beliefs about LNCs. Findings should be considered in assessing the public health impact of marketing low nicotine products. Incorrectly believing that nicotine causes cancer could discourage smokers from switching to safer nicotine-containing alternatives, and could lead nonsmokers to experiment with low nicotine tobacco products, believing that cancer risk would be reduced. Findings underscore the need to educate the public on the health effects of nicotine and LNCs, and can help public health practitioners determine which subgroups should be prioritized in targeted educational efforts.

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– Thomas Ashworth 

A cardiology study has found that e-cigarettes can lower heart rates and blood pressures of people who smoke.

It is well known that smoking traditional cigarettes can increase blood pressure and heart rates, but it has been found that if smokers change to an e-cigarette, their health will increase tremendously.

A Cardiologist, Dr K Farsalinos, provided this study and spoke out against those who want to ban e-cigarettes, he said: “You should fight for your lives and your health. It is absolutely irresponsible and dangerous behaviour to ban e-cigarettes.”

Dr Farsalinos is a long-term e-cigarette researcher, conducting numerous studies that have been widely reported by mainstream media outlets. The Greek is a researcher at the Onassis Cardiac Surgery Center in Athens and at the Department of Pharmacy, University of Patras, Greece.

“All of these studies until now, without exception, were done without considering realistic e-cigarette use, that was the major problem.”

There have been wayward reports indicating e-cigarettes produce harmful chemicals that are carcinogenic, Dr Farsalinos says there is “absolutely no evidence hamiacetals are toxic”.

Dr Farsalinos’ findings were summarised:

• “Smokers who reduce or quit smoking by using EC (E-cigarettes) may lower their systolic BP (blood pressure) in the long term, and this reduction is particularly apparent in smokers with an elevated BP.”
• “The use of low risk nicotine-containing products (including e-cigarettes) should be investigated as a safer alternative approach to harm reversal“
• “The evidence-based notion that substitution of conventional cigarettes with ECs is unlikely to raise significant health concerns can improve counciling between physicians and their cardiovascular patients using or intending to use ECs.”

E-cigarettes are widely considered 95% safer than regular cigarettes and the NHS is looking to prescribe e-cigs to smokers.

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– ROBERT SKLAROFF, BILL GODSHALL, AND STEPHEN F. GAMBESCIA, 3/7/17

The Surgeon General recently joined tobacco control groups to condemn vaping, claiming this was another attack on public enemy number one.

This time, however, public health advocates need to assess and reject the mission-creep by these federal and nonprofit agencies.

And, as the new Administration pledges to slash many harmful regulations, it should include the Food and Drug Administration’s (FDA) recent vapor product regulation, which was touted as another important measure to protect children from Big Tobacco and nicotine.

Over the years, clinicians, behavioral scientists, and researchers have offered a sundry of ways to help addicted smokers to cut down on or, ideally, to quit smoking. Other than promoting price hikes and indoor smoking bans, those approaches have had humbling levels of success.

While not an elixir, a smoking reduction and abatement kit has come along — in the form of vaping — that satisfies the addiction by delivering nicotine, but sharply reduces the harm caused by inhaling cigarette smoke dozens or hundreds of times every day.

Because smoking is physically and psychologically addictive, some researchers think e-cigarettes satisfy both needs by mirroring the ritual of handling a nicotine-delivery device. Studies have found vaping to be more effective than other cessation techniques (drugs, counseling, psychotherapy, hypnosis, etc.) because of its capacity to yield sustained remissions.

Since 2009, adult cigarette smoking has declined by 25 percent and, since 2011, youth smoking has plummeted by 50 percent, due in part to vaping. But 27.6 million daily adult-smokers remain addicted to cigarettes.

Meanwhile there is no evidence that all other tobacco products combined cause more than minuscule levels of morbidity, disability, mortality and healthcare costs relaed to tobacco-related illnesses.

This is pivotal, for these other tobacco products are used by a total of 51 million adults in America (as of 2013-2014): E-Cigarettes (16.7 million), Cigars (13.2 million), Hookah (10.5 million), Smokeless Tobacco (8.6 million) and Pipes (2.0 million).

The 2015 National Health Information Survey found that 2.5 million adult vapers had quit smoking, and 5 million vapers were still smoking. In addition to helping many smokers quit, vaping has also emerged as the best strategy for sharply reducing cigarette consumption by smokers who continue to smoke.

Concomitantly, the risk associated with vaping e-cigs is negligible, save for a few reports of battery fires, largely due to consumer ignorance or negligence that can be reduced by better consumer education and repeal of the FDA’s regulation that has banned sales of all new safer vapor products in the U.S. since August.

Since cigarette smoking causes virtually all tobacco-linked diseases and deaths, it was counterintuitive that health groups lobbied President Obama’s FDA to extend cigarette regulations to vapor products. Vaping advocates rightly suspect that these nonprofits have exhibited mission-creep, as they abandoned their public health goals by lobbying to ban vaping and vapor products.

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