Caution advised in over-regulating e-cigarettes as alternative to smoking tobacco

April 26, 2016

Seven international tobacco control experts urged government regulators to avoid heavy-handed condemnation of e-cigarette use, in a study published online today in the journal Addiction.

The researchers noted that regulations of e-cigarettes are clearly needed, but that governments need to weigh growing evidence of the benefits e-cigarettes provide in helping some addicted cigarette smokers quit against the potential for harm if non-smokers take up vaping, the term commonly used to describe use of e-cigarettes.

"Considerable controversy has accompanied the marketing and use of e-cigarettes," said Dr. K. Michael Cummings, a professor of Psychiatry and Behavioral Health Sciences at the Medical University of South Carolina and one of the co-authors of the paper. Cummings explained that the paper describes a framework that incorporates patterns of using e-cigarettes and combustible cigarette use in a way that attempts to maximizes population health.

"While we favor common-sense regulations that will protect non-smokers, especially children from using any tobacco product, we also don't want to make it so costly and difficult for addicted smokers to get safer nicotine products that have the potential help smokers to quit," said Cummings.

There's widespread agreement among researchers that vaping is less harmful than smoking. However, e-cigarette use carries some risk, according to a number of studies performed in cell cultures that find the vapor is toxic. It's unknown if this toxicity will appear in actual people, because controlled studies haven't been conducted yet.

Regulators and public health agencies have warned that the rise of e-cigarette use could normalize smoking.

"This issue can be addressed by the media and public health campaigns that encourage norms that are hostile to cigarette smoking and at the same time distinguishing clearly between VNP (vaporized nicotine products) and cigarette risks, discouraging dual use and encouraging exclusive VNP use," the researchers write in the study.

The seven authors are lead author David T. Levy, of Georgetown University; Cummings; Andrea C. Villanti, Ray Niaura, and David B. Abrams, from Truth Initiative; Geoffrey T. Fong, of the University of Waterloo in Canada; and Ron Borland, of Cancer Control Victoria, in Australia.

An early view of the study can be found at

The study differentiated between the interests of e-cigarette makers, dividing them between traditional cigarette companies that also sell e-cigarettes and companies that don't sell combustible cigarettes.

"Cigarette companies that have entered the smokeless tobacco market have encouraged dual rather than exclusive use, and are likely to do the same with VNPs," the study stated. "By contrast, VNP companies that are unaffiliated with cigarette manufacturers want smokers to switch completely from cigarettes to VNPs."

Treating all alike with onerous restrictions could have undesirable effects, the study said.

"Product content regulations that create regulatory hurdles that only large firms can surmount are likely to favor the cigarette industry and discourage innovation by firms outside the cigarette industry," it stated. "For example, a regulation restricting VNP tank devices will favor firms selling the 'cigalike' VNPs sold by cigarette companies that are less attractive to smokers."

The researchers also said regulators should look upon the vaping industry as one that can respond to demand for products that are more helpful for smoking cessation, and encourage innovation toward that end.
The study was funded by the Food and Drug Administration and the National Institute on Drug Abuse.

Medical University of South Carolina

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