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Polosa and Caponnetto have exposed CDC's manipulation and misrepresentation of 2011/2012 NYTS data on e-cig use by youth in a peer reviewed medical journal.
In response to Lancet Oncologys editorial at
http://www.sciencedirect.com/science/article/pii/S1470204513704686
Correspondence
Time for evidence-based e-cigarette regulation
Lancet Oncology
Volume 14, Issue 13, December 2013, Pages e582e583
Riccardo Polosa, Pasquale Caponnetto
http://www.sciencedirect.com/science/article/pii/S1470204513704959
The alarm bells being rung in your recent Editorial1 on e-cigarettes are unsupported by present data. The Editorial points to a recent US Centers for Disease Control and Prevention (CDC) report,2 which claims that e-cigarettes usage in teenagers has doubled from 1·1% in 2011 to 2·1% in 2012, to support the statement that e-cigarettes are becoming a gateway product, attracting more young people to begin smoking.
However, careful reading of the CDC report shows that there are no real data to support the notion that young people are using e-cigarettes and then transitioning to smoking conventional cigarettes. The report did not suggest that regular daily use had spiked in teens, but rather that the number who had ever tried one puff in the past monthwhich is essentially a measure of experimentationhad increased. Experimentation with a novel product like e-cigarettes is not unusual, particularly in children. The CDC report provided no evidence that young people are actually taking up this behaviour and becoming regular users of e-cigarettes. Of note, of those who experimented with e-cigarettes in 2012, 90.6% were already tobacco smokers.3 The fact that experimentation was mainly occurring in young people who already smoke cigarettes is not necessarily a bad thing, if it can reduce the chance of young people becoming lifelong cigarette smokers.
The proportion of non-smoking young people who experimented with e-cigarettes in the past month was small, at 0.5%, and thus does not prove transition to cigarette smoking. No cases of non-smoking young people beginning to use e-cigarettes, becoming addicted to nicotine, and then becoming a regular cigarette smoker, were documented. Furthermore, data from a new study confirms the conclusion of the CDC report that experimentation of e-cigarettes in non-smoking high schoool students is very low, at about 0.4%, and that none of the students adopted e-cigarettes as a regular behavior, and then went on to become a regular cigarette smoker.3 Overall, the data show that use of e-cigarettes is not popular among non-smoking young people.
Another unsupported statement is that e-cigarettes also pose a serious danger of renormalizing smoking. No study has supported concerns that the use of e-cigarettes in smoke-free areas might undermine smoke-free laws. Most people have no difficulty differentiating vapour from smoke. All testing of vapour so far has shown no evidence that use of e-cigarettes results in exposure to inhalable chemicals that would warrant health concerns by common safety standards.4 Therefore, there is no justification for extending existing clean air regulations to include e-cigarettes. Furthermore, use of e-cigarettes where smoking is prohibited might encourage smokers to make the switch to a product that could save their lives, thereby helping to denormalise (rather than renormalise) smoking by reducing the overall number of smokers. Use of e-cigarettes is a gateway out of smoking.
Nevertheless, we are in no way arguing here that regulation is not needed. Just the opposite. Regulation is necessary to ensure that e-cigarettes do not become popular among non-smoking young people and to consider restrictions about use of e-cigarettes in places frequented by very young children. Likewise, it is prudent to institute controls on marketing of e-cigarettes to non-smokers and to apply the same prohibition on sales to children and youth as for tobacco products.
As a final point, we see no need to apply the strict regulations in use for pharmaceutical products that will marginalise e-cigarettes by making them unattractive to smokers and less competitively priced compared with tobacco products. Reasonable regulation of these products should simply follow good manufacturing practice policies thus ensuring that the liquids used in e-cigarettes are produced in a quality manner, do not contain contaminants or impurities, are accurately labelled, and are held under conditions to prevent adulteration.5
Present scientific evidence supports the contention that regulators, along with public officials, health authorities, and anti-smoking groups, should embrace e-cigarettes as an important strategy in their efforts to reduce smoking and its related health effects.6 It is irresponsible to mislead the public into believing that e-cigarettes pose an extraordinary danger to consumers and young people when there is absolutely no evidence to support that claim.
In response to Lancet Oncologys editorial at
http://www.sciencedirect.com/science/article/pii/S1470204513704686
Correspondence
Time for evidence-based e-cigarette regulation
Lancet Oncology
Volume 14, Issue 13, December 2013, Pages e582e583
Riccardo Polosa, Pasquale Caponnetto
http://www.sciencedirect.com/science/article/pii/S1470204513704959
The alarm bells being rung in your recent Editorial1 on e-cigarettes are unsupported by present data. The Editorial points to a recent US Centers for Disease Control and Prevention (CDC) report,2 which claims that e-cigarettes usage in teenagers has doubled from 1·1% in 2011 to 2·1% in 2012, to support the statement that e-cigarettes are becoming a gateway product, attracting more young people to begin smoking.
However, careful reading of the CDC report shows that there are no real data to support the notion that young people are using e-cigarettes and then transitioning to smoking conventional cigarettes. The report did not suggest that regular daily use had spiked in teens, but rather that the number who had ever tried one puff in the past monthwhich is essentially a measure of experimentationhad increased. Experimentation with a novel product like e-cigarettes is not unusual, particularly in children. The CDC report provided no evidence that young people are actually taking up this behaviour and becoming regular users of e-cigarettes. Of note, of those who experimented with e-cigarettes in 2012, 90.6% were already tobacco smokers.3 The fact that experimentation was mainly occurring in young people who already smoke cigarettes is not necessarily a bad thing, if it can reduce the chance of young people becoming lifelong cigarette smokers.
The proportion of non-smoking young people who experimented with e-cigarettes in the past month was small, at 0.5%, and thus does not prove transition to cigarette smoking. No cases of non-smoking young people beginning to use e-cigarettes, becoming addicted to nicotine, and then becoming a regular cigarette smoker, were documented. Furthermore, data from a new study confirms the conclusion of the CDC report that experimentation of e-cigarettes in non-smoking high schoool students is very low, at about 0.4%, and that none of the students adopted e-cigarettes as a regular behavior, and then went on to become a regular cigarette smoker.3 Overall, the data show that use of e-cigarettes is not popular among non-smoking young people.
Another unsupported statement is that e-cigarettes also pose a serious danger of renormalizing smoking. No study has supported concerns that the use of e-cigarettes in smoke-free areas might undermine smoke-free laws. Most people have no difficulty differentiating vapour from smoke. All testing of vapour so far has shown no evidence that use of e-cigarettes results in exposure to inhalable chemicals that would warrant health concerns by common safety standards.4 Therefore, there is no justification for extending existing clean air regulations to include e-cigarettes. Furthermore, use of e-cigarettes where smoking is prohibited might encourage smokers to make the switch to a product that could save their lives, thereby helping to denormalise (rather than renormalise) smoking by reducing the overall number of smokers. Use of e-cigarettes is a gateway out of smoking.
Nevertheless, we are in no way arguing here that regulation is not needed. Just the opposite. Regulation is necessary to ensure that e-cigarettes do not become popular among non-smoking young people and to consider restrictions about use of e-cigarettes in places frequented by very young children. Likewise, it is prudent to institute controls on marketing of e-cigarettes to non-smokers and to apply the same prohibition on sales to children and youth as for tobacco products.
As a final point, we see no need to apply the strict regulations in use for pharmaceutical products that will marginalise e-cigarettes by making them unattractive to smokers and less competitively priced compared with tobacco products. Reasonable regulation of these products should simply follow good manufacturing practice policies thus ensuring that the liquids used in e-cigarettes are produced in a quality manner, do not contain contaminants or impurities, are accurately labelled, and are held under conditions to prevent adulteration.5
Present scientific evidence supports the contention that regulators, along with public officials, health authorities, and anti-smoking groups, should embrace e-cigarettes as an important strategy in their efforts to reduce smoking and its related health effects.6 It is irresponsible to mislead the public into believing that e-cigarettes pose an extraordinary danger to consumers and young people when there is absolutely no evidence to support that claim.
right on!!
