Research Finds Smokers Strongly Support Many E-Cigarette Policies

As the FDA is preparing to issue a final ruling on whether it will extend its tobacco regulatory authority to electronic cigarettes (e-cigarettes), researchers from Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health have identified strong support among smokers for a number of e-cigarette policies.

The proposal made by the FDA last April would require e-cigarette makers to register their products with the FDA, make an application to market the devices, use a nicotine addiction warning label, and create a minimum purchase age, along with other requirements.

While previous research has captured e-cigarette use and awareness, there is little data on e-cigarette policy perceptions. Olivia A. Wackowski, PhD, MPH, an assistant professor of health education and behavioral science in the Center for Tobacco Studies at the School of Public Health and member of the Cancer Institute’s Cancer Prevention and Control Program, and Cristine Delnevo, PhD, MPH, coleader of the Cancer Institute’s Cancer Prevention and Control Program and director of the Center for Tobacco Studies, further examined smokers’ attitudes on such policies.

The authors used nationally representative data from an online survey that captured 519 current smokers during a two-week period in April 2014, just prior to the announcement of the FDA’s proposed rule. Current smokers were adults who ever smoked 100 tobacco cigarettes and now smoke some days or every day.

Nearly one-half (46%) of these participants were also current e-cigarette users. Those participants were defined as smokers who had used e-cigarettes in the past 30 days. Former e-cigarette users made up 62% of the overall tobacco-smoking group and were defined as those who had ever tried the devices but had not used them in the past 30 days.

Respondents were asked if they ever heard of e-cigarettes prior to the survey and how harmful they believed them to be compared with tobacco cigarettes. They were also asked whether they agreed or disagreed with banning e-cigarette advertising where advertising for tobacco cigarettes is banned, placing a warning label on e-cigarettes for potential risks such as other tobacco products have, and FDA regulation of e-cigarettes.

Overall, researchers found that while 90% of respondents were aware of e-cigarettes, nearly two-thirds (62.5%) did not know the devices are unregulated. A majority (83.5%) of all respondents also agreed that e-cigarettes should be FDA regulated. This number included 77.9% of current e-cigarette users.

Nearly 87% of all respondents and 78% of e-cigarette users agreed that e-cigarettes should carry warning labels about potential risks, and a majority of respondents also agreed the devices should have the same legal age of sale as other tobacco products.

“One finding of note in this work is that nearly two-thirds of respondents did not realize e-cigarettes are not regulated under any government agency—possibly leading to a false sense of security about the safety of the devices. But when respondents were prompted, a vast majority of them believed they should be regulated by the FDA for both quality and safety. As the FDA prepares to issue a final rule regarding e-cigarette regulation, it is important to have such data,” notes Wackowski, lead author and principal investigator of the study.

More than one-half (55.5%) also supported advertising restrictions for the devices. “Exposure to tobacco advertising is a risk factor for youth tobacco use and while cigarette marketing is considerably restricted in the U.S., e-cigarette companies have no such restrictions and spend millions advertising their products in magazines, at promotional events and on TV. Youth e-cigarette experimentation is rising, and so it is encouraging that there is support to restrict e-cigarette advertising,” says Delnevo, study coauthor and a professor and chair of health education and behavioral science at the School of Public Health.

“It was also interesting to find in this study that even though smokers largely believe e-cigarettes are less harmful than tobacco cigarettes, almost 90% nevertheless agreed that e-cigarettes should carry warning labels, something they are not required to do at the moment,” Wackowski adds. The FDA’s regulatory proposal only suggests one nicotine addiction warning, and Wackowski aims to develop and pilot test a series of warnings that may be appropriate for e-cigarettes in a new research project funded by the FDA’s Center for Tobacco Products.

The authors also note future studies may also want to measure policy attitudes with larger samples and examine the attitudes of nonsmokers. They also recommend further exploration on other policy issues such as e-cigarette taxation and Internet sales and how policy perceptions correlate with knowledge and beliefs about e-cigarettes.

— Source: Rutgers Cancer Institute of New Jersey