SAFE GC Coalition: Development of E-Cigs for Smoking Cessation

According to the National Institute on Drug Abuse (NIDA) since e-cigarette technology emerged over two decades ago, nicotine vaping has presented a conundrum for public health- especially the health and development of youth who vape. Commercial vaping devices are optimized to deliver nicotine in the most rewarding possible way, and by mixing it with flavors, it is possible to tailor its appeal to targeted consumers like youth, making transition from experimentation to escalation of use much more likely. There is evidence that initiation with vape products in adolescence can be a steppingstone to taking up smoking cigarettes and use of other drugs.

On the other hand, there is growing evidence that vaping does not present the worst health risks associated with combustible tobacco, that it can facilitate smoking cessation, and that it is a safer alternative for smokers who can completely switch to these devices. While the US Preventive Services Task Force has determined that the evidence is currently insufficient to support recommending commercial e-cigarettes for smoking cessation, there is growing evidence from randomized controlled trials that electronic cigarettes are successful as smoking cessation aids, specifically when they are provided free as a therapeutic intervention. A Cochrane systematic review in 2024 suggested that nicotine e-cigarettes can help people stop smoking for at least six months and that they outperform nicotine replacement therapy (NRT). Switching from combustible cigarettes to e-cigarettes is also noted as an approach to reducing the harm associated with combusted tobacco use by the American Society of Addiction Medicine and the National Health Service of the UK recommends e-cigarettes as a quit aid.

Although the FDA has authorized 39 e-cigarette devices to be sold and marketed as tobacco products to adults in the United States, no electronic cigarette has yet been approved as a smoking cessation therapeutic, and as of last year the FDA had received no applications seeking approval of such a product. Yet advancing the development of an FDA-approved e-cigarette for smoking cessation could more effectively harness their potential for reducing the public health burden associated with combustible tobacco. Bringing an e-cigarette therapeutic to market would provide assurance that they are safe and effective interventions. Having FDA approval could also facilitate reimbursement by health insurance payors, thus expanding access. Moreover, smoking cessation is such a high priority area for the FDA that applicants may be eligible for review under its expedited programs, making it a potentially attractive drug development pathway.

Abstinence is currently the primary study endpoint accepted by the FDA in evaluating products for smoking cessation, and NIDA is funding research examining the impact of e-cigarettes on smoking cessation that could pave the way for their development and approval as therapeutics. quit with traditional methods. NIDA is also funding several randomized clinical trials on the use of electronic cigarettes as quit aids for people in treatment for opioid use disorder and for people

In addition to abstinence, reduced smoking may also be a valuable endpoint in smoking cessation trials if those reductions provide meaningful clinical benefits or increase the probability of eventual cessation. Additional research is needed to better understand how reduced smoking, including completely or partially switching to e-cigarettes, affects other health conditions, as well as how much of a reduction translates into health benefits. Such research could support the acceptance by FDA of reduced smoking or transition to e-cigarettes as an acceptable endpoint in smoking cessation clinical trials.

Since electronic cigarettes have only been commercially available since 2007, there is limited data on health impacts of their long-term use, and this is especially troubling given the lack of information to provide to young users who are school aged and still developing. This data is salient if e-cigarettes are to be developed into therapeutics that people may use over the long-term. Researchers at The Truth Initiative on teacher’s perspectives of e-cigarette use maintain “vaping is everywhere”-starting in middle school and becoming entrenched by ninth and 10th grades, and school bathrooms are hot spots.

E-cigarettes remain the most popular tobacco product. Oral nicotine pouches, like Zyn, are increasingly being observed on school grounds. Vaping takes a toll on students’ mental health. Many students are combating stress and anxiety, and their vaping behaviors indicate a dependence on nicotine during the school day. Vaping chips away at opportunities to learn. The distraction impacts academic performance, and the added responsibility of policing student vaping contributes to teacher burn-out. School tobacco policies are broad and can be difficult to enforce. Many policies require proof of possession, and students have become skillful at hiding products that are increasingly harder to detect.

Vaping is a community-wide issue that extends beyond the classroom. Many educators say that more in-school resources won’t solve a wider, community-wide problem of normalized vaping among parents and peers, and broad accessibility in stores. Research on the long-term impact of use is necessary to impart prevention education messages to youth.

SAFE, Inc. is the only alcohol and substance abuse prevention, intervention, and education agency in the City of Glen Cove. The Coalition is concerned with all combustible and electronic products with tobacco. The Agency employs environmental strategies to educate and update the community regarding the negative consequences of smoking and vaping. To learn more about the SAFE Glen Cove Coalition please follow www.facebook.com/safeglencove or to learn more about electronic products visit the Youth and Tobacco Use and Vaping Facts and Myths Pages of SAFE’s website to learn more about how vaping is detrimental to your health at www.safeglencove.org.

The Truth Initiative is the nation’s largest nonprofit public health organization dedicated to preventing youth and young adult nicotine addiction and empowering quitting. Research is conducted through the Truth Initiative Schroeder Institute that produces independent research to provide evidence for policy change and leadership in cessation research. For more information, please visit www.truthinitiative.org.