Rutgers Researchers Call for Balanced Approach to E-Cigarette Use

Researchers from Rutgers University are urging for a balanced approach to reviewing the latest trends in adult electronic cigarette use.

Assistant Professor Julia Chen-Sankey and Lecturer Michelle T of the Department of Health Behavior, Society, and Policy at Rutgers School of Public Health, along with Lecturer Bover-Manderski of the Department of Biostatistics and Epidemiology at Rutgers, suggest that while there are clear health concerns associated with using e-cigarettes, particularly among those who have not previously used tobacco products, there are also potential benefits that should not be overlooked.

Researchers at Rutgers University have published an invited commentary in the Journal of the American Medical Association (JAMA) Network Open, reviewing new data on the trend of electronic cigarette use among American adults. The researchers, Chen-Sankey and Bover-Manderski, are also members of the Rutgers Tobacco Studies Center. They discuss the necessity of public health approaches to achieve a balance between risks and potential of electronic cigarettes in promoting smoking cessation among adults who currently use combustible cigarettes.

This study raises important questions about the use of electronic cigarettes by adults in the United States. What did the study find and what questions does it pose for public health policy?

Chen-Sankey's research paper explores the latest trends in electronic cigarette use among adults in the United States in 2017, 2018, and 2020. One of the key findings is that while the use of e-cigarettes among young adults aged 18 to 20 has decreased from 2018 to 2020, it has increased among other age groups. Additionally, there has been an increase in the frequency of daily e-cigarette use among current users.

Perhaps the most shocking revelation is that the usage of e-cigarettes among those who have never smoked combustible cigarettes has significantly increased. While e-cigarettes may have the potential to aid in smoking cessation, there has also been a decrease in the number of traditional smokers attempting to quit.

Bover-Manderski: How can these contradictory findings be applied to health policies? It is important to strike a balance between new teenage users and older smokers who want to quit.

Question: How do we strike this balance?

Chen-Sankey suggests that certain policy developments and strategies could ensure the public health benefits of using e-cigarettes. For instance, the recent authorization of e-cigarette products in the United States. The Food and Drug Administration (FDA) through its PMTA review could help establish public trust in authorized e-cigarette products.

Bover-Manderski stated that in order to increase the acceptance of traditional smokers using e-cigarettes as a means to quit smoking, public health education and mass media dissemination strategies should focus on promoting the evidence-based results of e-cigarettes harm reduction.

Question: Why do some traditional adult smokers refuse to use e-cigarettes as a method to quit smoking?

Chen-Sankey stated that in the past five years, the appeal of e-cigarette products for traditional smokers interested in quitting has decreased, but they have become more attractive to non-smokers. Several factors can help explain this frustrating pattern.

Firstly, policies aimed at reducing youth use of electronic cigarettes may also decrease interest and use among adult smokers attempting to quit. Additionally, media coverage may be shaping smokers' understanding of e-cigarettes as the amount of reporting on the risks for youth using e-cigarettes outweighs the potential benefits for adult combustible cigarette users.

Bover-Manderski suggests that public health organizations and healthcare professionals may need to shift their focus from the potential benefits of using combustible tobacco products among adults, to the risks associated with young people using e-cigarettes.

Question: One highlight of this study was a significant decrease in the proportion of young people aged 18 to 20 who use e-cigarettes. What explains this decrease?

Chen-Sankey suggests that this discrepancy may be related to the Tobacco Act, which limits the sale of tobacco and nicotine products, including e-cigarettes, to this age group starting in January 2020. Another potential explanation is the national restrictions implemented in February 2020 on certain flavored e-cigarettes, which may have significantly reduced their appeal among young people.

Bover-Manderski stated that it is important to acknowledge the impact of COVID-19-related lockdowns and social distancing requirements, which may restrict opportunities for this demographic to use e-cigarettes in social or group settings.

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