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TRDRP and American Heart Association gather national experts to better understand the health effects of e-cigarettes

On June 13, 2018, TRDRP and the American Heart Association held a workshop to solicit expert input to advance knowledge on the health effects of e-cigarettes. 35 experts from across the US joined together to, (i) present background information on current knowledge and the types of data sought by the FDA to regulate e-cigarettes, (ii) identify important knowledge gaps, (iii) discuss the complexities of vaping devices and behaviors that impact interpretation of clinical outcomes, and (iv) propose clinical studies and the creation of resources that TRDRP, and other funders, can support to effectively address some of the urgent questions about health effects of e-cigarettes. Participants included representatives from the Food and Drug Administration (FDA), the Centers of Disease Control and Prevention (CDC) and the National Institute on Drug Abuse (NIDA), as well as the health voluntaries AHA, American Lung Association (ALA), and American Cancer Society (ACS). Four of the attendees were co-authors of a 2018 consensus study report on “Public Health Consequences of E-Cigarettes” by the National Academies of Sciences, Engineering and Medicine (NASEM), and participants included experts on health effects of smoking and e-cigarette use, on chemical constituents of e-liquids, on biomarkers of exposure and harm, on cohort creation and management, and on health disparities.

Participants acknowledged that the health effects of e-cigarettes in humans are poorly understood, and that both the potential for harm in never smokers and for harm reduction in current smokers are important areas of investigation. This aligned with conclusions from the 2018 NASEM consensus study report, mentioned above, which concluded that “… use of e-cigarettes results in dependence on the devices, though with apparently less risk and severity than that of combustible tobacco cigarettes. Yet the implications for long-term effects on morbidity and mortality are not yet clear”.

Representatives from the FDA underscored the need for specific and quantitative research to support the creation of unambiguous and measurable e-cigarette product standards. This could, for example, be achieved through controlled human studies in which specific devices are used with specified settings and frequencies of use.  At the same time, other workshop participants identified the need for studies of human populations that reflect the reality of the complex vaping landscape. This could, for example, include a multiple vaping devices, several types of e-liquids, different use behaviors, and dual / poly use of different tobacco products and other substances of abuse.  The variables discussed impact the dose of nicotine and amount of toxins delivered to the human body; research approaches to tease apart these variables are urgently needed.

Unique opportunities may exist in California to focus health research on certain vulnerable populations and to take advantage of existing resources.  TRDRP will continue to explore opportunities to advance the understanding of the health effects of e-cigarettes and to seek partnerships with other organizations to fund this impactful research.

e-cigarette device