Tobacco use continues to be the leading preventable cause of death in the United States. The harms of tobacco use have been known since 1964 when the Surgeon General's report was released; however close to 20% of Americans still smoke. Nearly 70% of smokers want to quit, although cessation is difficult to achieve. Volpp et al reported tobacco cessation nearly tripled from 5% to 14.7% with the addition of a financial incentive, highlighting opportunities for behavioral economics to support cessation. Research is beginning to show e-cigs may be effective in supporting tobacco cessation.
The American Heart Association (AHA) should be commended for its review of e-cigs. It places appropriate emphasis on the importance of rapidly carrying out research to fill key gaps in our ability to develop science-based regulations. This something that the Vitality Institute supports and is investing in directly.
The AHA stresses that e-cig use is less risky than cigarettes in relation to heart disease; is unlikely to increase nitrosamine levels (leading to cancers); and may be useful in helping smokers not seeking other cessation methods to stop using cigarettes. They are not as bold, however, as the Royal College of Physician's recent statement that supports smokers' use of e-cigs for cessation with fewer caveats.
Their major concerns focus on fears related to renormalizing tobacco use in young people, in e-cigs being a "gateway" to tobacco use and in relation to several safety issues. The evidence cited on youth uptake does not account for the fact that youth smoking rates in the US and UK have been steadily declining and that evidence about the "gateway" concerns remains merely a theory.
A careful read of their policy indicates how the AHA have tried to tread carefully between stating that smokers who switch to e-cigs lower their overall risk for premature death, heart disease and many cancers but that the long term impact on young people is unclear. The history of how this complex message will play out in the media and be understood by smokers, regulators and policy makers suggests that the fears of harm will get prominence. This will reinforce the status quo and do little to reduce tobacco use in the 42 million Americans who still smoke and the 480,000 annual deaths that occur from tobacco use.
The Vitality Institute commends the balanced view that the AHA presents on e-cigarettes, discussing the opportunities, risks and need for further research. However, the Institute calls on physicians to follow the advice of the Royal College of Physicians and advise smokers who failed to quit tobacco using traditional cessation aids to try e-cigarettes. As said by the Royal College of Physicians, "E-cigarettes will save lives, and we should support their use."