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Public Health Consequences of E-Cigarettes PDF

613 Pages·2017·6.47 MB·English
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THE NATIONAL ACADEMIES PRESS This PDF is available at http://nap.edu/24952 SHARE Ū ſ Ŷ Þ Public Health Consequences of E-Cigarettes DETAILS 680 pages | 6 x 9 | PAPERBACK ISBN 978-0-309-46834-3 | DOI 10.17226/24952 CONTRIBUTORS GET THIS BOOK Kathleen Stratton, Leslie Y. Kwan, and David L. Eaton, Editors; Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems; Board on Population Health and Public Health Practice; Health and Medicine Division; FIND RELATED TITLES National Academies of Sciences, Engineering, and Medicine Visit the National Academies Press at NAP.edu and login or register to get: – Access to free PDF downloads of thousands of scientific reports  – 10% off the price of print titles  – Email or social media notifications of new titles related to your interests  – Special offers and discounts Distribution, posting, or copying of this PDF is strictly prohibited without written permission of the National Academies Press. (Request Permission) Unless otherwise indicated, all materials in this PDF are copyrighted by the National Academy of Sciences. Copyright © National Academy of Sciences. All rights reserved. Public Health Consequences of E-Cigarettes Public Health Consequences of E-Cigarettes Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems Kathleen Stratton, Leslie Y. Kwan, and David L. Eaton, Editors Board on Population Health and Public Health Practice Health and Medicine Division A Consensus Study Report of PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright National Academy of Sciences. All rights reserved. Public Health Consequences of E-Cigarettes THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by Contract No. HHSF223201610054C between the National Academy of Sciences and the U.S. Department of Health and Human Services: Food and Drug Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/24952 Library of Congress Control Number: Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2018 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24952. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright National Academy of Sciences. All rights reserved. Public Health Consequences of E-Cigarettes The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright National Academy of Sciences. All rights reserved. Public Health Consequences of E-Cigarettes Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright National Academy of Sciences. All rights reserved. Public Health Consequences of E-Cigarettes COMMITTEE ON THE REVIEW OF THE HEALTH EFFECTS OF ELECTRONIC NICOTINE DELIVERY SYSTEMS DAVID L. EATON (Chair), Dean and Vice Provost, Graduate School, University of Washington ANTHONY J. ALBERG, Professor and Chair, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina MACIEJ GONIEWICZ, Associate Professor of Oncology, Roswell Park Comprehensive Cancer Center ADAM LEVENTHAL, Director, USC Health, Emotion, & Addiction Laboratory, Professor of Preventive Medicine and Psychology, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California JOSÉ E. MANAUTOU, Professor of Pharmacology & Toxicology, Interim Head, Department of Pharmaceutical Sciences, University of Connecticut SHARON MCGRATH-MORROW, Professor, Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine DAVID MENDEZ, Associate Professor, Health Management and Policy, University of Michigan RICHARD MIECH, Research Professor, Department of Youth and Social Issues, University of Michigan ANA NAVAS-ACIEN, Professor, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University KENT E. PINKERTON, Professor and Director, Center for Health and the Environment, Department of Anatomy, Physiology, and Cell Biology, University of California, Davis NANCY A. RIGOTTI, Professor of Medicine, Harvard Medical School, Director, Tobacco Research and Treatment Center, Associate Chief, Division of General Internal Medicine, Massachusetts General Hospital DAVID A. SAVITZ, Vice President for Research, Professor of Epidemiology, Professor of Obstetrics and Gynecology, Brown University GIDEON ST.HELEN, Assistant Professor, Zuckerberg San Francisco General Hospital Study Staff KATHLEEN STRATTON, Study Director LESLIE Y. KWAN, Associate Program Officer AIMEE MEAD, Research Associate (from July 2017) ALEXIS WOJTOWICZ, Senior Program Assistant JORGE MENDOZA-TORRES, Senior Research Librarian REBECCA MORGAN, Senior Research Librarian DORIS ROMERO, Financial Associate (until March 2017) MISRAK DABI, Financial Associate (from April 2017) HOPE HARE, Administrative Assistant ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice Christine Mirzayan Science and Technology Policy Graduate Fellow ANDREW MERLUZZI, Ph.D. Candidate at the University of Wisconsin–Madison (until April 2017) v PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright National Academy of Sciences. All rights reserved. Public Health Consequences of E-Cigarettes Copyright National Academy of Sciences. All rights reserved. Public Health Consequences of E-Cigarettes REVIEWERS This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: R. GRAHAM BARR, Columbia University Medical Center NEAL L. BENOWITZ, University of California, San Francisco JOHN BRITTON, University of Nottingham CRISTINE D. DELNEVO, Rutgers, The State University of New Jersey JOANNA S. FOWLER, Brookhaven National Laboratory and National Institutes of Health MARIANNA D. GAउA, British American Tobacco Research and Development Centre STEPHEN S. HECHT, University of Minnesota HARLAN R. JUSTER, New York State Department of Health PAULA M. LANTZ, University of Michigan RAFAEL MEZA, University of Michigan MEIR STAMPFER, Harvard Medical School and Harvard T.H. Chan School of Public Health THOMAS A. WILLS, University of Hawaii Cancer Center JUDITH T. ZELIKOFF, New York University School of Medicine SHU-HONG ZHU, University of California, San Diego Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by ERIC B. LARSON, Kaiser Permanente Washington Health Research Institute, and HUDA AKIL, University of Michigan. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. vii PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright National Academy of Sciences. All rights reserved. Public Health Consequences of E-Cigarettes Copyright National Academy of Sciences. All rights reserved. Public Health Consequences of E-Cigarettes PREFACE On May 10, 2016, the Food and Drug Administration (FDA) issued a rule to extend regulatory authority to all tobacco products, including e-cigarettes that meet the statutory definition of a tobacco product. This so-called “Deeming Regulation” allows FDA to regulate the manufacturing, distribution, and marketing of tobacco products such as e-cigarettes and includes automatic provisions such as youth access restrictions on sales. Although various forms of battery-powered “Electronic Nicotine Delivery Systems” (ENDS devices) have existed for more than a decade, their popularity, especially among youth, has increased in the past 5 years, although most recent data show a slight decline. In contrast to combustible tobacco cigarettes, e- cigarettes do not “burn,” and do not contain most of the estimated 7,000 chemical constituents present in tobacco smoke. Thus, it is generally believed that e-cigarettes are “safer” than combustible tobacco cigarettes, yet exposures to nicotine and a variety of other potentially harmful constituents do occur. Harm might also occur if youth who begin their “tobacco” use with e-cigarettes then transition to combustible tobacco cigarettes or if adult cigarette smokers use e-cigarettes to supplement their smoking, rather than quitting combustible tobacco cigarettes completely. In order to inform the public about the consequences of e-cigarettes and in support of future FDA and congressional action, a thorough and objective analysis of the state of scientific evidence relating to e-cigarettes and public health is needed. To that end, the ENDS Committee was established in December 2016 under the National Academies of Sciences, Engineering, and Medicine, with an ambitious timeline to complete a review of the science that can inform the understanding of public health risks and benefits of e-cigarettes. What are the short- and long- term health risks of regular use of e-cigarettes? What variables of the numerous types of devices and use patterns are important determinants of risk? Are e-cigarettes an effective means to quit smoking combustible tobacco cigarettes? Are e-cigarettes an “initiation pathway” of youth to smoking combustible tobacco cigarettes? These are just some of the important questions addressed by the committee in this report. Where feasible, the committee applied the most important attributes of systematic review methodology to the scientific literature to establish the strength of evidence surrounding the health risks (e.g., direct harmful effects, initiation of smoking) and benefits (e.g., smoking cessation) associated with e-cigarette use. Although the use of these products is relatively new, the committee identified more than 800 peer-reviewed scientific studies in this report. Based on this review, the committee has provided a summary of the current state of knowledge about the health risks and benefits of e-cigarette use, and has provided a series of research recommendations. I am deeply gratified by the remarkable hard work and insights provided by my fellow committee members and indebted to the tireless and thoughtful work of the National Academies staff that so ably kept us on task throughout the duration of this task. David L. Eaton, Chair Committee on the Health Effects of Electronic Nicotine Delivery Systems ix PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright National Academy of Sciences. All rights reserved.

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