Do e-cigarettes aid in smoking cessation or cause threat to public health?

Are e-cigarettes an important smoking cessation tool or an emerging public health concern?

Much of the public's perception on the safety of these new products stems from advertising, packaging and media representation, according to ongoing research by Olivia Wackowski, an assistant professor in the Department for Social and Behavioral Health Sciences and the Center for Tobacco Studies at the Rutgers School of Public Health.

Wackowski's studies on tobacco communication, product and risk perceptions and product use trends have been critical to informing the field of regulatory science as it relates to the FDA's authority over tobacco product regulation.

Wackowski discusses how the market surge in this broad class of electronic devices – ranging from "cigalikes," which resemble the look of cigarettes, to larger "vaporizers," "tank systems" and "pod" systems used by the popular brand JUUL – presents new challenges for public health.

What are the health risks of e-cigarettes?

Since e-cigarettes don't contain or burn tobacco, they don't expose users to the same number and level of chemicals and toxins found in cigarette smoke. However, they can contain nicotine, which is an addictive substance, and can harm development of the adolescent brain. The aerosol produced by e-cigarettes can contain chemicals and toxins, albeit in lower levels than that found in cigarette smoke.

Since e-cigarettes are a new product, we don't know much about their long-term risks or the safety of inhaling their flavoring chemicals and additives. While they shouldn't be considered safe, some public health experts believe e-cigarettes can play a meaningful role in reducing harm for smokers who switch to them instead of continuing to smoke traditional tobacco products. A concern, however, is that non-smokers and youth might start using these products for fun, enticed by the flavors or by a cool product design.

What is the public perception of e-cigarettes?

There seems to have been a shift in harm perceptions about e-cigarettes over the last several years, with the public increasingly moving toward the perception that they are just as harmful as regular cigarettes. However, studies show that younger people, e-cigarette users and smokers are more likely than the general public to think that e-cigarettes are less harmful to health than cigarettes. In fact, this is one of the reasons people give for why they use e-cigarettes.

How do packaging, advertising and media representation alter public perception of e-cigarettes?

Product advertising can increase favorable attitudes toward e-cigarettes, brand awareness and product trials. Studies have shown associations between exposure to e-cigarette ads and interest in e-cigarette use. For example, the current popularity of the brand JUUL is likely related to its bright, modern advertising style as well as the product design itself, which is small, sleek and resembles a USB flash drive.

Conversely, the increasing news coverage of e-cigarettes may be contributing to more negative perceptions about e-cigarettes. Our research at the Center for Tobacco Studies has shown that e-cigarette news stories are considerably more likely to discuss the potential risks of e-cigarettes than the potential harm-reduction benefits for smokers.

How do the regulations on sales, marketing and production of e-cigarettes differ from those of tobacco products?

The minimum legal age of sale for e-cigarettes and tobacco products' can vary by state from 18 to 21. The FDA has not yet imposed any restrictions on e-cigarette marketing channels – you may notice radio or TV ads – but has banned such broadcast advertising for cigarettes since the 1970s. However, e-cigarette advertising can no longer make claims that these products pose modified risk compared to traditional cigarettes without first applying to the FDA for permission. The FDA has not banned flavors in e-cigarettes despite having done so for regular cigarettes in 2009.

Are product warning labels on e-cigarette packaging required?

Until recently, e-cigarette products and ads haven't been required to carry warnings, although some companies have done so voluntarily. However, new FDA warning requirements became effective on August 10, 2018, requiring e-cigarette packaging and advertising to carry a unified conspicuous warning that they carry nicotine, which is an addictive chemical. This is important given that research continues to show that some young people do not know if the e-cigarettes they've used contains nicotine or not.

However, my research with experts in the tobacco control communications field indicates concerns that the nicotine addiction warning might not sufficiently resonate with young people – a priority audience for e-cigarette warnings. The FDA could propose additional warnings in the future if appropriate for public health. My current study explores the impact of other warning themes on young adults, such as warnings about the harm of nicotine on young peoples' brain development and about the potentially harmful chemicals in e-cigarettes. We are also exploring whether the FDA's nicotine addiction warning can be enhanced by pairing it with simple pictorial images, such as a yellow triangle with an exclamation point that is an understood symbol for a warning.

That said, warning labels on e-cigarettes pose a bit of a messaging challenge: They should inform consumers about e-cigarette risks and discourage use among non-smokers without discouraging current smokers from using these products for smoking cessation and harm-reduction.