5 Minutes with New York University E-Cigarette Expert, Donna Shelley, MD, MPH
As part of CASAColumbia’s Addiction Speaker Series, in which leading experts present their latest findings, Donna Shelley, MD, MPH, Associate Professor of Medicine and Population Health at the New York University School of Medicine, recently discussed her research on e-cigarettes.
We spoke with Dr. Shelley, who shared her perspective on e-cigarettes’ effects on the re-normalization of smoking, marketing of e-cigarettes to kids, the role of big tobacco in e-cigarette marketing and sales, and what’s needed when it comes to future e-cigarette research.
Do you think e-cigarettes are “re-normalizing” smoking?
Dr. Shelley: The first generation of e-cigarettes looked very much like a traditional cigarette. The early e-cigarettes released a vapor that could be mistaken for cigarette smoke. There is a concern that large numbers of people using e-cigarette products, in places where traditional cigarette use is banned, will erode the progress the public health community has made in terms of de-normalizing smoking. Laws banning smoking in indoor and public outdoor spaces have contributed to a change in social norms around tobacco use.
I remember the first time I saw someone using an e-cigarette in a restaurant in New York. I wondered if everyone was confused and thought the laws had changed. New York City quickly extended the smoke-free policies to include e-cigarettes. I think this type of regulation across the country is necessary, to continue to send a consistent message and reduce exposure to new products that may attract uptake among youth.
Marketing to kids is an issue with e-cigarettes. What would you like to see happen?
Dr. Shelley: We know that certain types of marketing work to increase cigarette consumption among youth. This is why the Master Settlement Agreement in 1998 banned the use of cartoon characters and other forms of tobacco advertising that directly targeted kids. We have a road map for how to reduce this type of marketing for cigarettes and we should adhere to the same regulations for e-cigarettes.
What are the dangers of the tobacco industry infiltrating the e-cigarette business?
Dr. Shelley: The industry is looking to maintain sales of traditional cigarettes, as well as get into the e-cigarette business, so there is concern that they will create marketing strategies that try to maintain dual use among smokers. The tobacco industry has always been in the business of creating new smokers to take the place of those who quit or die of a tobacco-related illnesses, so it is in their interest to increase uptake of e-cigarettes among youth, if they think that they can get them addicted to nicotine and ultimately use cigarettes. The gateway theory is still a theory, but a risk that the tobacco industry could exploit.
What do you think are the most important areas of research needed to better understand the impact e-cigarettes have on a user’s health?
Dr. Shelley: There are so many questions that need answers!
Such as: What is the efficacy of e-cigarettes compared to current nicotine replacement therapy in leading to long-term abstinence from cigarettes? Do e-cigarettes lead to total abstinence from nicotine? Does the use of e-cigarettes result in long-term dual use rather than abstinence?
We need studies to answer these questions. In parallel we need more studies that can clarify, in the short-term, the safety of these products. Some of these studies are being conducted by the National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA) funded by Transdisciplinary Tobacco Use Research Centers, but there is a need for a bigger investment given what is at stake. The public health goal is the elimination of combustible tobacco. E-cigarettes may be pointing the way towards a product that will help us reach this goal, but as the prevention community might argue, at what cost? It will take time to sort out whether this is going to be a net benefit or loss to public health.
With very conflicting views and research about e-cigarettes emerging, what do you recommend as next steps from a public health standpoint?
Dr. Shelley: Research, research, research! We need an investigational new drug application and funding from the FDA and the NIH to start to ask and answer the critical safety and efficacy questions.
In my opinion, we should expand certain tobacco control policies to e-cigarettes, like banning use indoors and in public spaces and regulating marketing and advertising. I think the U.S. is moving in this direction and not rushing to overregulate e-cigarettes before the evidence is in. What we don’t want to see is e-cigarettes becoming harder to get than cigarettes, which we know kill more than 400,000 people each year.
Donna Shelley, MD, MPH
Donna Shelley is an Associate Professor of Medicine and Population Health at the New York University School of Medicine