Book Review: Study of Public Health Consequences of E-Cigarettes

Study of Public Health Consequences of E-Cigarettes, by National Academies Press. 

What are the short- and long-term health risks of regular use of e-cigarettes? What variables of the numerous types of devices and use patterns are important determinants of risk? Are e-cigarettes an effective means to quit smoking combustible tobacco cigarettes? 

Are e-cigarettes an “initiation pathway” of youth to smoking combustible tobacco cigarettes? 

The book gives a summary of the current state of knowledge about the health risks and benefits of e-cigarette use, and provides a series of research recommendations. 

It is not easy to categorize these, either as beneficial or as harmful to health, the book says. The net public health outcome depends on the balance between adverse outcomes (increased youth initiation of combustible tobacco cigarettes, low or even decreased 

cessation rates in adults, and a high-risk profile) and positive outcomes (very low youth initiation, high cessation rates in adults, and a low-risk profile). In some circumstances, adverse effects of e-cigarettes clearly warrant concern, such as the use of e-cigarettes among non-smoking adolescents and young adults, devices that are prone to explosion, and the presence of constituents in e-cigarette liquids that are of major health concern 

(e.g., diacetyl and some other flavorings). In other circumstances, namely regular combustible tobacco cigarette smokers who use e-cigarettes to successfully quit smoking, e-cigarettes may represent an opportunity to reduce smoking-related illness. For these reasons, e-cigarette regulation that merely considers whether to be restrictive or permissive to the marketing, manufacture, and sales of all e-cigarettes for all populations is unlikely to maximize benefits and minimize the risks.

A number of federal regulatory tools exist to maximize the benefits and minimize the harms of e-cigarettes. To provide data to inform regulatory strategies that maximize benefits 

and minimize the risks of e-cigarettes, research is needed to identify product characteristics with an unfavorable health profile across key outcomes. 

For example, if evidence were to identify certain flavor additives that increased toxicity and appeal to youth, but did not enhance appeal or efficacy as a smoking cessation aid, the development of product standards to prohibit the use of such additives would likely have net improvement on the health of the population. Like the effects of e-cigarette use on smoking cessation, which may carry considerable influence on the overall population health burden over the next 30 years.

We therefore need a nuanced and balanced consideration that should be taken with regard to scientific priorities for and policy implications from evidence on the health effects of e-cigarettes. Given how rapidly the e-cigarette product marketplace and user population are changing, there will undoubtedly be many new issues that are currently unknown and will require careful surveillance and scientific scrutiny, with future evaluations to follow.