American Heart Association: E-Cigarettes Should be Subject to Tobacco Laws

The American Heart Association recommends removal of flavorings from e-cigarettes and restriction of sales and marketing aimed at minors.

If an e-cigarette contains nicotine, it should be considered a tobacco product and should be subject to the laws governing tobacco products, new policy recommendations from the American Heart Association (AHA) state.

The association published its recommendations online on August 24, 2014, in its journal Circulation. It recommends a federal ban on e-cigarette sales and marketing to minors and on flavorings in e-cigarette products, and calls for additional research into the devices’ health effects.

“E-cigarettes have caused a major shift in the tobacco-control landscape,” Aruni Bhatnagar, PhD, FAHA, lead author of the recommendations, said in a press release. “It’s critical that we rigorously examine the long-term impact of this new technology in public health, cardiovascular disease and stroke, and pay careful attention to the effect of e-cigarettes on adolescents.”

The recommendations cite a JAMA Pediatrics study showing that middle and high school students found the devices high-tech, accessible, and convenient, particularly in places where smoking cigarettes is prohibited. Flavored products and ads featuring celebrities make the products more appealing, the association stated.

In addition, a Pediatrics study found youth exposure to e-cigarette advertising increased more than 250% from 2011 to 2013—meaning the ads reached 24 million youths.

The association also recommends altering existing smoke-free laws to cover the devices, providing the changes can be made without compromising existing laws. Although toxic substance levels are lower than those found in traditional cigarettes, nonsmokers are at risk for involuntary exposure, particularly in confined spaces.

“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,” a press release from the association stated.

Patients who want to use e-cigarettes as a smoking cessation aid should not be discouraged from doing so, if they are intolerant of, failed at, or rejected other stop-smoking aids. Despite this, the association encourages proven smoking-cessation strategies as first-line treatment. It further stresses clinician education regarding the devices, particularly the lack of regulation, the presence of toxic chemicals, and the lack of FDA approval as a smoking cessation tool.

Due to the lack of long-term research on e-cigarette safety, the association recommends that clinicians suggest their patients set a quit date for using the devices.

Noting the growing market for e-cigarettes, the AHA urged FDA action regarding e-cigarette regulation.

“In the years since the FDA first announced it would assert its authority over e-cigarettes, the market for these products has grown dramatically,” American Heart Association chief executive officer Nancy Brown said in a press release. “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.”