Georgia State explores health risks of electronic cigarettes

As electronic cigarettes surge in popularity, these battery-operated gadgets are also facing a growing chorus of concern.

While industry critics agree e-cigarettes are not as dangerous as regular tobacco cigarettes, they are calling for research to determine the safety and effectiveness of what’s quickly becoming the next big thing in the smoking world.

A major hub of research is underway at Georgia State University, which was recently awarded a $19 million federal grant over five years from the Food and Drug Administration and the National Institutes of Health to establish one of 14 Tobacco Centers of Regulatory Science. Michael Eriksen, dean of Georgia State’s School of Public Health, will lead the research at the Atlanta school, which will explore the marketing of tobacco and smoking alternatives, including e-cigarettes, dissolvable oral nicotine products and hookahs.

E-cigarettes have replaceable cartridges of liquid containing nicotine which heat up, creating a vapor which users inhale. Unlike a patch on your arm or chewing gum, e-cigs look more like the real thing. And they come in flavors like chocolate, apple, even tobacco.

The Atlanta Journal-Constitution recently interviewed Eriksen, who has spent a career researching tobacco prevention and control efforts, including a stint as the director of the Centers for Disease Control and Prevention’s Office on Smoking and Health. He addressed the rising popularity of e-cigarettes and hopes to better understand the long-term consequences and concerns swirling around this product.

Q: How do e-cigarettes work?

A: Like nicotine patches and gum, e-cigarettes provide the nicotine without the smoke. In some ways, it’s exactly what you want and if you are addicted to cigarettes, you want the cleanest way possible to get nicotine without the carcinogens and carbon monoxide. And e-cigarettes have the potential to do that. The safety and harm of e-cigarettes and what they contain is far and away better than traditional cigarettes because they don’t contain smoke. But that doesn’t necessarily make them safe, just better than combusted cigarettes. Everyone agrees on this. The controversy is over this issue: Can you have someone benefit individually from using e-cigarettes but harm the overall public health because of unintended consequences?

Q: What are the biggest concerns?

A: We have some concerns and some of them are already being seen. Some people will use e-cigarettes in addition to traditional cigarettes. We call them dual-users. They will keep smoking and use e-cigarettes at work and other places where they can’t smoke. For these people, they will just be getting more nicotine. And more nicotine is not safe.

The second concern is about kids starting to use e-cigarettes because they are cool and technological. The use among kids has doubled in the last year and the implications are unknown. What happens to these kids when introduced to nicotine? Will they convert to regular cigarettes?

And the third concern is one of the areas of most concern for me. There are 53 million Americans who once smoked and quit. What proportion of these ex-smokers will go back to e-cigarettes to get the buzz and fond memory of nicotine and what proportion will go back to smoking traditional cigarettes? The fourth concern is all of the confusion over where e-cigarettes can be used. If people can use e-cigarettes in restaurants and hotels and rental cars, will it undermine clean indoor air laws?

Q: You must hear from ex-smokers who smoked for years, even decades, and swear e-cigarettes helped them wean off smoking and finally kick the habit.

A: We know that’s happening, but we just don’t know how prevalent this is. That’s why we need more research. Obviously, it’s important for an individual smoker. If e-cigarettes help them quit smoking completely, they will benefit. However, there are 43 million smokers in the United States today and let’s say 10,000 smokers quit because of e-cigarettes. Those individuals will likely benefit their health. But what happens if there is another 100,000 smokers who are using e-cigarettes in addition to regular smoking? Or if a million ex-smokers go back to smoking because of e-cigarettes? What’s the overall public health impact?

Q: How big of an industry is it?

A: The market in the U.S. is about $500 million and about $2 billion globally. In trying to understand why e-cigarettes are so popular, there are two things you need to remember. First, 70 percent of smokers want to quit and wished they never started to smoke. They are looking for things to do to help them quit, or at least make smoking less harmful. Secondly, there is money to be made and a variety of entrepreneurs have entered the market hoping to profit. Given there are 43 million current smokers and 53 million former smokers alive today in the United States, the potential market is immense.

Q: What kind of regulations are there?

A: There are no rules. Because these e-cigarettes don’t fall under existing regulation, advertising is even allowed on TV. And some of the ads are not subtle. They say things like, ‘Welcome back to smoking.’ Jenny McCarthy is the spokeswoman for Blu e-cigarettes and the commercials are outrageous, but legal. Some states are just beginning to pass laws for a minimum age for purchase. E-cigarettes can have flavors like vanilla, strawberry, even cotton candy.

The FDA is considering exerting their authority and that may happen momentarily or in the next few months. And if they do, I think you can expect a minimum age of sale, a ban on flavoring and prohibition on advertising on television. However, the issue of regulating e-cigarettes is very controversial because some advocates feel that because e-cigs are certainly less harmful than traditional cigarettes, they should be encouraged and freely available. Others feel that until we know more about health effects, usage by children, dual use and use by ex-smokers, we need to proceed cautiously and that in any regard, e-cigarettes should be regulated the same as traditional tobacco products. The one thing everyone agrees upon is the need for more research and better data. Hence, the importance of our study.

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