Jan. 26 2018

Experts Clear the Air on E-Cigarettes

Mailman School environmental health scientist Ana Navas-Acien serves on expert committee assessing the risks and benefits of using the devices

As increasing numbers of Americans take up vaping, a public health debate has raged over the relative risks and merits of e-cigarettes. Do they help people quit tobacco or rather serve as a gateway to other addictions, and are there other dangers to using the devices?

Arriving with a “breaking news” alert on the New York Times, a new report by from the National Academies of Sciences, Engineering, and Medicine aims to clear the air on e-cigarettes, offering the most comprehensive health assessment of the devices to date.

Mailman School environmental health scientist Ana Navas-Acien, one of the report’s expert authors, says producing it was a challenge, as the devices are still relatively new—both as an emerging technology and area of research. 

“These products are evolving very rapidly,” she says. “Over the last few years, there has been a proliferation of different kinds of e-cigarettes, as well as differences in how they are being used.”

Over the course of several months in 2017, the expert committee met in Washington, DC, and Woods Hole, Massachusetts, weighing evidence from more than 800 research papers and hearing from representatives from industry, and with retailers and users—a perspective which helped them appreciate the diversity of device designs and how some can be customized. 

The Food and Drug Administration, which commissioned the report, has regulated e-cigarettes since 2016 under the broad category of “tobacco products” and calls them “electronic nicotine delivery systems.” The committee, instead, chose the term “e-cigarettes,” reflecting the fact that some use the devices for flavored “e-juices” free of nicotine.

A valued committee member, Navas-Acien contributed expertise in two areas newly relevant to e-cigarettes. She is an authority on the link between exposure to metals—a potential risk with the heated coils used in the devices—and risk for diabetes and heart disease as well as in measuring exposure to secondhand smoke.

In the report, the committee concluded there is strong evidence that e-cigarette aerosol contains metals. Depending on the device, these might include nickel, a carcinogen; lead, a neurotoxicant; and others. (An upcoming paper by the Mailman researcher explores the topic in greater detail.) On the whole, however, the report states that e-cigarette users and those breathing secondhand vapors are exposed to fewer toxic chemicals than with regular cigarettes.

On the big question of the connection between e-cigarettes and tobacco use, the report details evidence that teenagers and young adults who use e-cigarettes are at increased risk for trying cigarettes. Overall, though, fewer young people are smoking. As for adults, the report finds e-cigarettes can help them break a tobacco habit.

“You need a device that is sufficiently satisfying for those who want to quit,” says Navas-Acien, “but at the same time, one that doesn’t increase the risk of long-term addiction.”

Today, federal law bans minors from purchasing e-cigarettes. Many states and localities also ban the use of e-cigarettes wherever smoking is banned. Armed with the new report, the FDA will consider whether further regulation is needed. For instance, they might look at ways to reduce the chance of devices exploding and causing burns—another risk highlighted by the committee. 

Of course, the report is far from the final word on e-cigarettes. Since the devices are so new, their long-term risks are unknown. Says Navas-Acien, “There is a lot of high-quality science we still have to do.”