American Cancer Society Position Statement on Electronic Cigarettes

﻿The American Cancer Society (ACS) first released a position statement on e-cigarettes in February 2018. At that time, the ACS emphasized that no young person should start using any tobacco product, including e-cigarettes. However, the use of e-cigarettes in young people has since skyrocketed to epidemic proportion with nearly 30% of high school students reporting using an e-cigarette in the past 30 days and 12% reporting using an e-cigarette daily. This updated position statement replaces all previous ACS statements on e-cigarettes and guides the organization’s tobacco control and cessation efforts regarding these products. The ACS position statement will continue to be updated based upon emerging public health trends and evolving science.

No youth or young adult should begin using any tobacco product, including e-cigarettes.

The ACS encourages young people currently using any of these products to ask for help in quitting and to quit as soon as possible.

E-cigarettes should not be used to quit smoking.

The ACS does not recommend the use of e-cigarettes as a cessation method. No e-cigarette has been approved by the Food and Drug Administration (FDA) as a safe and effective cessation product.

Current e-cigarette users should not also smoke cigarettes or switch to smoking cigarettes, and former smokers now using e-cigarettes should not revert to smoking.

All tobacco products, including e-cigarettes, pose a risk to the health of the user. Beginning smoking, switching to smoking, or reverting to smoking exposes the user to potentially devastating health effects.

E-cigarettes

Using e-cigarettes, or “vaping,” are terms used synonymously to refer to the use of a wide variety of electronic, battery-operated devices that aerosolize, but do not burn, liquids to release nicotine and other substances. Nicotine-containing e-cigarettes are regulated as “tobacco products” by the FDA because the nicotine is derived from the tobacco plant. E-cigarettes pose a threat to the health of users and the harms are becoming increasingly apparent. In the past few years, the use of these products has increased at an alarming rate among young people in significant part because the newest, re-engineered generation of e-cigarettes more effectively delivers large amounts of nicotine to the brain. Many e-cigarettes sold in the U.S. contain far more nicotine than e-cigarettes sold elsewhere, which increases the risk of addiction and harm to the developing brains of youth and young adults. Marketing tactics targeting young people have contributed to the rapid increase in use. The long-term risks of exclusive use of e-cigarettes are not fully known but evidence is accumulating that e-cigarette use has negative effects on the cardiovascular system and lungs. Without immediate measures to stop epidemic use of these products, the long-term adverse health effects will increase.

Guidance for Youth Who Currently Use E-cigarettes

The harms of e-cigarette use in young people include not only the deleterious effects of nicotine, but also exposure of the lungs and airways to potentially toxic solvents and flavoring chemicals. The rapidly rising rates of use in young people and the high rates of daily use strongly suggest that many are addicted to nicotine and will have difficulty in stopping use of all tobacco products.

While some young people may be able to quit e-cigarette use on their own, others, particularly daily users, are likely to find this to be very difficult. The ACS encourages adolescent users who find it difficult to quit to ask for help from health care professionals. Parents should learn all they can about e-cigarette use and be prepared to help their children get the assistance they need. For more information go to cancer.org/e-cigarettes.

The future pattern of tobacco product use by currently-addicted youth e-cigarette users is unknown, but the only pathway to eliminating the harms of e-cigarettes is to quit using them as soon as possible and to not start using any other tobacco products, such as cigarettes. Without urgent and effective public health action, e-cigarettes will lead to a new generation of nicotine-addicted individuals.

Guidance for Adults Who Currently Use E-cigarettes

Some individuals who smoke choose to try e-cigarettes to help them stop smoking. Since smoking kills fully half of all long-time users, successfully stopping smoking leads to well-documented health benefits. Nonetheless, adult smokers who switch to e-cigarette use expose themselves to potentially serious ongoing health risks. Thus, former smokers who are currently using e-cigarettes, whether alone or in combination with combustible tobacco products, should be encouraged and assisted to stop using all tobacco products, including e-cigarettes, as soon as possible both to eliminate their exposure to ongoing health risks and avoid perpetuating addiction. If they are unable to quit e-cigarettes on their own, they should seek help from a health care professional or quitline. Individuals who are not yet able to stop using e-cigarettes should be strongly discouraged from simultaneous, or “dual,” use of any combustible tobacco products, including cigarettes. Continuing to smoke exposes the individual to enormous harms, irrespective of whether the individual is using e-cigarettes part of the time. All individuals should also be strongly counseled to not revert to smoking.

While some e-cigarette users quit on their own, many have difficulty quitting and should seek help from their healthcare providers or other support services such as their state quitline (1-800-QUIT-NOW) or the American Cancer Society (1-800-ACS-2345).

Guidance for Adults Who Currently Smoke

All adults who smoke conventional cigarettes or other combustible (burned) tobacco products should be advised to quit smoking at the earliest opportunity, recognizing that quitting is hard and often takes repeated, dedicated efforts. Individuals who smoke are strongly encouraged to consult with their doctor, pharmacist or other medical professional to seek cessation support and, where deemed appropriate, to use FDA-approved medications including nicotine replacement therapies (NRT) and/or recommended oral medications, preferably combined with individual or group behavioral counseling, which significantly increases the likelihood of success. Individuals can also seek cessation support by calling 1-800-QUIT-NOW or 1-800-ACS-2345.

Regulation of E-cigarettes

The ACS and the American Cancer Society Cancer Action Network (ACS CAN) support several critical policy approaches to reduce youth e-cigarette use without inadvertently incentivizing the use of the leading cause of preventable death – combustible tobacco products – as an alternative. The FDA must effectively regulate all e-cigarettes as soon as possible, including: enforcing premarket reviews; restricting advertising and marketing to protect youth; preventing the dissemination of false and misleading messages and imagery; and requiring strict product standards. The FDA has the authority to regulate all substances in tobacco products, including, but not limited to, flavoring chemicals and nicotine. The FDA must also continue to demand testing of all substances used in e-cigarettes, as well as the relative safety of the devices themselves (for example, preventing exploding batteries). The ACS and ACS CAN encourage prohibiting the use of all flavors, including mint and menthol, in all tobacco products, including e-cigarettes. Furthermore, the FDA should proceed aggressively with a proposal to reduce nicotine in all combustible tobacco products to non-addictive levels and also strictly limit the amount of nicotine permitted in e-cigarettes.