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Reflections on the new SGR on e-cigarette use among youth and young adults

Dear Colleagues,
One can only hope that today’s release of the Surgeon General’s Report (SGR) on e-cigarette use among youth and young adults is the first in a series of reports addressing  e-cigarettes, and that it increases rather than quells interest in exploring the potential benefits of e-cigarettes as a cessation tool for the 37 million Americans who smoke. As you know, the great majority of smokers – over 70% -- want to quit smoking and each year over 50% of them attempt to quit.  As you also know, quitlines report that there is a great interest among smokers in using e-cigarettes as part of their quit attempts. As health professionals, our mission is to make effective treatments accessible to this population.  I would suggest, that as professionals we have the added responsibility of advocating for the development of effective new cessation tools that are attractive to smokers.
What does the new SGR do?

  • The new SGR clearly states that youth should not be exposed to nicotine, an indisputable conclusion that no organization has questioned.
  • The new SGR synthesizes and draws conclusions from the nascent research literature on potential harms of the “non-nicotine” contents of e-cigarettes. Some of these conclusions remain controversial within the research community (see attached materials).
  • Perhaps most relevant to cessation, the new SGR omits any meaningful discussion on potential benefits, stating that although e-cigarettes are less harmful than combustible cigarettes, research has not shown that e-cigarettes are an effective cessation tool.

Let’s explore this last point a bit…One question you may ask is “Why hasn’t research clearly shown whether e-cigarettes are an effective or ineffective tool for cessation?”  Well, a big part of the problem is that FDA has failed to move forward with regulating the product. If the contents of e-cigarettes, especially the amount of nicotine, are not known and are not reliably stated on the label, we cannot effectively use them as a cessation tool. To use e-cigarettes as part of a quit attempt, we need to know the level of nicotine in these products. We also need to know the other contents and to understand the biological impact and risk of the contents. A second question you may ask is “What has been done to encourage and support research on e-cigarettes as a potential cessation tool?” Unfortunately, the answer is “not enough.”
So, in this holiday season, the Surgeon General has published a report that helps protect youth. This is an important action; we should all do whatever we can to protect youth and to encourage their development of positive health behaviors and other life skills.  Similarly, we should also do whatever we can to protect smokers and to encourage their development of positive health behaviors. We call on the Surgeon General, HHS, and our colleagues at CDC, NIH and especially FDA to get even more engaged and serious on the topic of e-cigarettes. We need regulation and we need an intensive research effort to explore and translate the potential benefits and harms of these emerging new products. There are 37 million smokers and a community of cessation professionals who need you to take action and who will support you in moving forward on this agenda.
Best wishes to all of you this holiday season and in the year ahead.

Linda A. Bailey, JD, MHS
President and CEO
North American Quitline Consortium
New SGR on e-cigarette use among youth and young adults
Press release from the Campaign for Tobacco Free Kids
Press release from the Truth Initiative
Materials supporting the need for continued research on e-cigarettes:
The Truth About: Electronic Nicotine Delivery Systems (fact sheet)
Overview of Electronic Nicotine Delivery Systems: A Systematic Review (article)
Commentary on WHO report on Electronic Nicotine Delivery Systems and Electronic Non-nicotine Delivery Systems (report)

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