TRDRP’s E-Cigarette Portfolio: 9 Years of Funding Research into Vaping Behavior and Health Effects
The American public has become well acquainted with electronic cigarettes (e-cigarettes or vapes) in recent months, owing to a sudden rise in reports of severe lung injury and even deaths in e-cigarette users. Prior to this public health crisis, which remains unexplained, e-cigarettes garnered notoriety as widespread use, and attendant addiction, among teenagers and young adults frequently made the news. Yet, parents, educators and physicians found themselves at a loss for how to control this epidemic.
Since its inception, following the passage of Proposition 99 in 1988, the Tobacco-Related Disease Research Program (TRDRP) has been supporting research to create the scientific evidence base needed to implement interventions, clinical recommendations, policies and regulations that help reduce the suffering associated with commercial tobacco use. Mainly, TRDRP solicits investigator-initiated studies which, in the first few decades, were focused on combustible cigarettes. E-cigarettes were first introduced into the United States in 2006, and their use has dramatically increased since then, especially among youth and young adults. The first TRDRP-supported study that focused on e-cigarettes was funded in 2011, and the number of e-cigarette grants has increased substantially since then (see Figure 1), reflecting the rising concern and interest in the scientific community to understand the effects of a new tobacco product that continues to change the tobacco landscape.
The following analysis provides an overview of TRDRP’s e-cigarette portfolio, highlighting the breadth in subject areas funded by TRDRP, addressing an important societal problem from many different angles, from social behavioral and policy research to basic and applied biomedical research.
Figure 1: To see the number of total research awards or the number of e-cigarette awards made by TRDRP in a given year, hover your mouse over the graph.
Since 2011, TRDRP has funded 92 investigator-initiated studies that are partially (24) or entirely (68) focused on e-cigarettes, totaling almost $50 million in support. 79 of those grants fund research by independent investigators and 13 grants support research training of graduate students and postdocs. The spike in overall funding and in e-cigarette funding in 2018 is based on a substantial increase in available funds due to passage of Proposition 56 - The California Healthcare, Research and Prevention Tobacco Tax Act of 2016.
Figure 2: TRDRP funds research at California not-for-profit organizations. Each triangle on this map represents an organization that is funded by TRDRP to conduct research on e-cigarettes. To see the number of TRDRP e-cigarette grants at a particular institution, hover your mouse over that institution’s location. To date, TRDRP has funded 27 institutions to conduct e-cigarette research, with 50 grants at University of California (UC) institutions and 42 grants at non-UC institutions.
Figure 3: TRDRP supports a broad range of research to help prevent and treat nicotine addiction, counter tobacco industry strategies, and better understand and find treatments for tobacco-related diseases. This range of research is reflected in TRDRP’s e-cigarette portfolio, with about 40% of e-cigarette studies in the social sciences (social behavioral and policy research, highlighted in red) and 60% in the biomedical sciences and environmental exposure & toxicology (highlighted in orange).
Figure 4: TRDRP has a strong interest in supporting research that aims to understand and reduce tobacco-related disparities across its entire portfolio of grants. Toward this goal, TRDRP even requires that social behavioral research addresses the prevention or treatment of commercial tobacco use among California’s priority groups*. TRDRP does not require that policy research grants focus on a priority population, but most of them do.
This graph breaks down TRDRP’s social science e-cigarette grants by priority populations studied, with some of the grants counted more than once if more than one priority population was included in the study. Not surprisingly, given that e-cigarettes are disproportionately used by young people, many of TRDRP’s e-cigarette studies in the social sciences focus on youth and young adults.
A more detailed look (not shown here) into TRDRP’s e-cigarette portfolio shows that all social behavioral grants that focus on studying an intervention are focused on how best to prevent individuals from initiating e-cigarette use. More research on how to help individuals, especially newly addicted youth, to quit vaping is urgently needed.
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SES = socioeconomic status
* Tobacco-related priority populations are groups that use tobacco products at a higher rate, experience greater secondhand smoke exposure at work and at home, are disproportionately targeted by the tobacco industry, and/or have higher rates of tobacco-related disease compared to the general population (California Tobacco Education and Research Oversight Committee, 2018-2020 Master Plan).
Figure 5: According to the US Surgeon General’s reports, smoking affects nearly every organ of the body. This conclusion is based on decades of research, and similar research on the health effects of vaping is needed. While there are similarities between conventional smoking and vaping, vaping is not just a simpler way of inhaling nicotine, but comes with its own, unique compounds, such as a myriad of flavors. Once inhaled, the effects of these compounds on the body are not yet well understood.
This graph shows the specific areas of study that aim to understand the effects of vaping on the body. Within TRDRP’s environmental exposure & toxicology portfolio, researchers are looking to understand the composition of e-juices and aerosols (chemistry) and how the individual components are altered when they enter the body and how they acutely harm cells and organisms (toxicology). In the biomedical e-cigarette portfolio, half of the grants address how the heart and blood vessels (cardiovascular) are harmed by vaping, while the remaining grants look at detrimental effects in the mouth (oral), the lungs (pulmonary), and other organs, such as skeletal muscle and the immune system. Three grants focus on the unique ways in which vaping leads to addiction (neuroscience of addiction). These biomedical studies employ diverse approaches that include studying cells grown in dishes, animal models and humans, all adding to a growing body of evidence that e-cigarettes are not as harmless as suggested by some. Given the dramatic vaping-associated lung injuries reported in the past months, more studies on e-cigarette effects on lungs are urgently needed.
