WASHINGTON -- "When repeated efforts with conventional treatment fails … clinicians should not discourage [electronic cigarette] use," the American Heart Association (AHA) said in new policy recommendations on the use of e-cigarettes and their effect on tobacco control and cessation efforts.
The association's overall position, which it said is based on the current evidence, is that e-cigarettes that contain nicotine are tobacco products and should be subject to all laws that apply to these products. The association also calls for strong new regulations to prevent access, sales and marketing of e-cigarettes to youth and for more research into the product's health impact.
"Recent studies raise concerns that e-cigarettes may be a gateway to traditional tobacco products for the nation's youth and could renormalize smoking in our society. These disturbing developments have helped convince the association that e-cigarettes need to be strongly regulated, thoroughly researched and closely monitored," said Nancy Brown, CEO of AHA.
The policy statement recommends a federal ban on e-cigarettes for minors and details concerns that these products may be another entry point for nicotine addiction among young people.
Echoing its recent comment letter on the U.S. Food & Drug Administration's proposed tobacco oversight rule, the association recommends strict laws that curb the intense marketing and advertising of e-cigarettes, and that ban flavorings in these products.
"In the years since the FDA first announced it would assert its authority over e-cigarettes the market for these products has grown dramatically," Brown said. "We fear that any additional delay of these new regulations will have real, continuing public health consequences. Hence, we urge the agency to release the tobacco deeming rule by the end of this year."
Another key recommendation examines e-cigarettes in tobacco-cessation counseling. The statement points to what it said is the lack of evidence establishing e-cigarettes as a primary smoking-cessation aid. Some studies suggest that the use of e-cigarettes to help smokers quit may be equal or be slightly better than nicotine patches. The association will continue to encourage clinicians to use proven smoking-cessation strategies as the first line of treatment for any patient. But it reiterates in the statement that when repeated efforts with conventional treatment fails, is intolerant, or rejected by a patient who wants to use e-cigarettes to help them quit, clinicians should not discourage their use by the patient.
The statement said, however, that clinicians be educated so they can inform patients that e-cigarettes are unregulated, may contain low levels of toxic chemicals, and have not been FDA-approved as cessation devices. The association also proposes that given the lack of long-term research studies on e-cigarette safety that it's appropriate for a health care professional to suggest that a patient set a quit date for their e-cigarette use.
The association calls for comprehensive and continuous research on e-cigarettes' use, their characteristics, their marketing and their long-term health effects on individual users, the environment and public health.
The association guidance also examines state smoke-free laws in relation to these products. While the toxic substances in e-cigarettes are lower than those in cigarette smoke, non-smokers could be involuntarily exposed to nicotine in any confined space where e-cigarettes are used. Unregulated e-cigarettes could potentially "turn back the clock to the days when smoking in public was normal behavior, undoing years of work on smoke-free laws and hampering current enforcement." Given these concerns, the association supports including e-cigarettes in these state laws, if the change can be made without weakening existing laws.
The group published the guidance in its journal, Circulation.
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